Carey Counseling Center is a not for profit organization, making the nature of their business service billed. The Bureau of Tenncare is one of the most directly affected organizations as it relates to CCC’s billing services. Tenncare is a Medicaid sponsored, state run department that receives contract bids from united health care and Blue Cross Blue Shield. These contracts, once awarded give the recipient the opportunity to decide which of the insurance companies the clients want to utilize. Once they decide on a company, the rate of exchange that is accepted in a contract agreement between CCC and insurance companies. Many factors go into the relationship between those directly affected and the patients receiving the mental health services