The Reason Why So Many Therapists Don’t Take Insurance
Why Some Therapists Don’t Take Insurance
If you’re searching for a therapist, you may notice that many therapists in private practice don’t accept insurance. Instead, they work as private-pay or out-of-network therapists.
If you have insurance, this can understandably be frustrating. So why would a therapist choose not to take it?
There are a few reasons—and it isn’t simply about charging more.
Private Pay Can Give You More Choice in Therapy
When you use insurance for therapy, your insurance company becomes involved in the treatment process to some degree.
Insurance generally requires a mental health diagnosis in order to reimburse therapy. For some people, a diagnosis is appropriate and helpful. But not everyone who seeks therapy necessarily has—or needs—a psychiatric diagnosis.
People also come to therapy for things like:
relationship and family problems
dating and attachment patterns
grief or major life transitions
career changes and questions of purpose
identity and belonging
marital challenges
personal growth and greater self-understanding
Working with a private-pay therapist allows the therapist and client to decide together what they want to work on without needing to structure therapy around what an insurance company considers medically necessary.
There Can Be More Privacy
Using insurance also means that certain information about your therapy is shared with your insurance company, most notably your diagnosis and information required for billing.
Some clients are completely comfortable with this.
Others prefer to keep their therapy outside of the insurance system altogether.
For those clients, paying privately can offer an additional level of privacy and autonomy around their mental health care.
Therapists Have More Flexibility in How They Work
Insurance plans may have requirements around documentation, diagnosis, medical necessity, and what kinds of treatment they will reimburse.
Private-pay therapy gives therapists more freedom to tailor treatment to the individual rather than to an insurance company's requirements.
This can be particularly useful for longer-term, relational, psychodynamic, depth-oriented, or couples therapy, where the goal may involve understanding patterns rather than simply reducing a specific symptom.
Insurance Reimbursement Is Also Part of the Picture
There is a practical reason as well.
Insurance companies determine how much they reimburse therapists and often require additional administrative work, including billing, documentation, claims, and sometimes treatment reviews. For an individual therapist or small private practice, this can make accepting certain insurance plans difficult to sustain.
Low reimbursement rates can affect how many clients a therapist needs to see in order to maintain a financially sustainable practice. In some cases, therapists may feel pressure to keep a very full caseload simply to cover their monthly expenses.
Private-pay therapists may have more flexibility to see fewer clients and keep their caseload within a range that feels clinically sustainable. That matters because therapy depends heavily on the therapist’s attention, presence, and emotional capacity.
We tend to understand this intuitively in other areas of healthcare. You probably wouldn’t want a surgeon who is routinely overextended, rushing between patients, or working beyond their capacity simply because they need to see twice as many people to make the economics of their practice work. Psychotherapy is different from surgery, of course, but the underlying principle is similar: the person providing your care needs enough capacity to actually provide good care.
That doesn’t mean therapists who accept insurance are burned out, or that private-pay therapists automatically provide better therapy. It simply means reimbursement structures can influence caseload size, and caseload size can influence a clinician’s ability to remain present and sustainable over time.
That is one big reason many therapists choose to remain out of network.
FAQs
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Yes. Some PPO plans include out-of-network mental health benefits, which may reimburse part of your therapy costs after you meet your deductible.
Typically, you pay your therapist directly and submit a superbill to your insurance company for reimbursement. Before starting, ask your insurer whether you have out-of-network benefits for outpatient mental health or psychotherapy, what your deductible is, and what percentage they reimburse.
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A superbill is an itemized statement of therapy services and payments that clients can submit to their insurance company to request out-of-network reimbursement.
If you’re looking for individual or couples therapy, including support with relationships, identity, major life transitions, or intercultural experiences, you can learn more about my approach and whether we might be a good fit.
