Why I Don’t Take Insurance as a Therapist — And Why That’s Good for You

Let’s be honest — no one becomes a therapist because they love fax machines (who is still using those?!), diagnostic codes, or chasing down unpaid claims. After a lot of reflection — and more than a few frustrating experiences — I’ve decided to no longer accept insurance. Here's why.

Why Insurance Limits the Kind of Therapy I Offer

Insurance companies often operate under a short-term, symptom-focused model: approve a limited number of sessions and expect measurable improvement within that timeframe. But therapy doesn’t always work like that — especially when we’re exploring the deeper layers of trauma, identity, grief, or long-standing patterns. This also means the length of each session is determined by insurance - and often they only approve up to 45 minutes. No insurance reimburses for more than one hour — even if your therapist sits with you longer. So yes, we technically can, but we don’t get paid for it.

Real healing often takes time. And when the process is rushed or forced into a narrow framework, it can actually disrupt the depth and trust needed for meaningful change.

This is what it looks like when your therapist isn’t on hold with an insurance company.

Why Mental Health Diagnoses Are Required by Insurance (Even When They’re Not Always Helpful)

To get sessions covered, insurance usually requires a formal mental health diagnosis. Sometimes that’s appropriate, but not always. Your pain is deeply valid and deserving of care — even if it doesn’t fit neatly into a diagnostic label.

While that diagnosis doesn’t follow you around in some public database, it does become part of your medical record. Depending on the situation, it may be accessible to future insurers or providers — for example, during applications for life insurance or long-term care coverage.

How Insurance Affects Your Privacy in Therapy

Whether you're in-network or using an out-of-network therapist, using insurance often means certain clinical details — like your diagnosis and session dates — are shared with the insurance company. In some cases, they may request additional information to authorize more sessions.

As a private-pay provider, I don’t have to submit treatment notes, justify medical necessity, or seek approval to continue our work. If you’re not seeking reimbursement, what we do in therapy stays fully between us. Therapy without insurance offers real privacy and freedom.

Therapists Spend Hours on Insurance Admin — Here’s What That Costs You

Faxing forms. Chasing down claims. Spending hours on hold just to clarify a billing code. I’ve done it all — and I realized that every hour spent on insurance admin is an hour I’m not preparing for sessions, deepening my clinical skills, or fully showing up for my clients.

Letting go of insurance has allowed me to work with a smaller, more focused caseload and offer more presence, care, and flexibility in how I show up.

Why Therapists Are Leaving Insurance: Clawbacks, Denials, and Other Hidden Risks

While I haven’t personally experienced this, I know several colleagues who’ve faced something called clawbacks — when insurance companies retroactively deny claims and demand repayment, even after sessions have already taken place. It’s not due to any mistake on the therapist’s part, but often the result of shifting policies, vague documentation standards, or internal audits conducted months later. Imagine doing all the work — showing up, supporting someone, documenting everything — and then being told you won’t be paid. Or worse, that you now owe money back. It’s destabilizing, and it’s one of the many hidden risks that are causing skilled therapists to leave insurance networks altogether.

What I have personally experienced are other insurance issues that leave both therapists and clients in difficult, sometimes unethical, positions. I’ve had situations where I was confirmed as “in-network,” only to be told after sessions were completed that I wasn’t — leaving me with an unpaid balance and a heart-wrenching choice: do I eat the cost, or does the client get stuck with a bill they thought insurance would cover?

These kinds of administrative traps don’t just create stress — they damage trust, disrupt care, and put financial strain on both sides. And most importantly, they have nothing to do with actual therapy.

Why Insurance Reimbursement Rates Don’t Reflect the Value of Therapy

Let’s be real — the reimbursement rates for therapy are insulting. They often don’t reflect the years of training, licensure, continuing education, and emotional labor this work takes. That gap puts pressure on therapists to overextend themselves, which ultimately impacts care.

And you deserve better than that.

Insurance may not see the full value of this work — but I do. I’ve spent years training, studying, and working closely with clients who want more than symptom relief. I don’t take on more clients than I can be present for, and I don’t cut corners. I price my services accordingly — because I believe good therapy is worth it.

What Private Pay Therapy Looks Like in My Practice

Is therapy covered by insurance? It depends. I don’t accept insurance directly, but I can provide a therapy superbill for clients who want to request out-of-network reimbursement. Some people get partially reimbursed through their insurance plans; others use HSA or FSA accounts to cover therapy. I’ll guide you through what I can — and be honest about what I can’t guarantee.

My practice is intentionally designed to support fewer clients with deeper care — which means I’m not stretched thin or overbooked. My focus is on depth, not volume — and I don’t believe anyone’s healing should be dictated by what an algorithm thinks it should look like.

I know therapy is an investment — and if you’re paying out of pocket, you deserve to know it’s worth it. Here’s my promise: I won’t waste your time, I won’t overbook myself, and I won’t phone it in. You get a therapist who’s fully present, clinically sharp, and genuinely invested in your growth. (And yes, I'd pay my rate to see me.)

In Short: Why I Don’t Accept Insurance as a Therapist

Now you know in general why therapists don't take insurance. I’ve thought a lot about why I don’t take insurance as a therapist — and it ultimately comes down to protecting the integrity of my work and serving my clients more fully. If you're curious about what private pay therapy looks like or how it could work for you, I'm happy to talk more.

Let’s do therapy in a way that honors your needs, your privacy, and your healing process.

Curious about how private pay therapy works, what a superbill is, or whether your out-of-network benefits apply? [Reach out here] to book a free consult and get your questions answered or click here to see my rates and learn more about private pay options.