If you’ve ever sought out therapy or counseling and noticed that some mental health therapists don’t accept insurance, you might reasonably wonder why.
While insurance often covers physical health care, coverage for mental health care comes with its own costs and considerations.
There are several important reasons why many providers, including online therapists, opt out of insurance panels. More often that not, these reasons have to do with providing the best quality of care for their clients.
Why Many Therapists Do Not Accept Insurance
I’m going to walk you through the most common reasons therapists do not take insurance. Plus, we’ll cover what this means for you as a client.
Protecting Confidentiality and Privacy
When insurance companies are involved, your therapy is no longer fully private. They may require treatment plans, progress notes, and session details before they approve payment.
That means your most personal information could be reviewed by multiple people in the insurance system. For clients, this can feel like an invasion of privacy in a process that should feel safe and confidential.
By not accepting insurance, therapists can prioritize client privacy and maintain confidentiality within the therapeutic relationship.
Pressure to Diagnose
This matters because not every life challenge is a disorder, and many people seek therapy before their struggles would meet that criteria. Mental health diagnoses are not always appropriate or necessary. For example, client seeking therapy for relationships or marriage counseling may not meet DSM criteria for a mental health diagnosis.
Once a diagnosis is in your file, you lose control over who sees it. Employers, schools, or future insurance providers may request access, and that information can follow you in ways you didn’t intend.
By not taking insurance, therapists are free to offer support without the pressure to label their clients. Placing diagnostic labels on clients is a practice misaligned with many therapists’ value system.
Limited Treatment
Insurance often dictates how many sessions are “allowed” and which providers you can see. Or, they may dictate the type of therapy a client can receive based on their diagnosis on record. They may cover only a set number of sessions or deny coverage after the fact, leaving you responsible for unpaid bills.
In other words, insurance can deny care based on their interpretation of your medical and mental health needs.
This creates stress and can interrupt therapy right when you’re making progress. For clients, that means losing control over your own care and timeline for healing.
By not working with insurance, therapists can offer the full range of therapeutic approaches, free from restrictions. They can tailor the treatment plan to the client’s presenting needs rather than an insurance company’s guidelines.
Couples Counseling Isn’t Seen As Necessary
Insurance companies may say they “cover couples counseling,” but what they actually mean is that they cover therapy when both people are present.
In practice, this usually requires one partner to be diagnosed with a mental health disorder, and the other is considered a support person in treatment. As opposed to them being in therapy together as a relationship focused on healing their bond.
Insurance companies do not view relationship stress as a “medically necessary” treatment. In fact, they often categorize it the way they would a cosmetic procedure—something that may be valuable, but not needed.
Yet research consistently shows that the quality of our closest relationships directly impacts mental health, physical health, work performance, and overall well-being. For clients, this means that one of the most important areas of life—your relationship—gets overlooked by insurance, even though it plays a central role in your health and happiness.
Allowing More Personalized and Flexible Care
Instead of adhering to treatment protocols determined by insurance, private pay therapists can focus on the unique needs of each individual and provide therapy that is more effective in the long run.
For each client, depending on unique circumstances and treatment goals, we may need to meet longer or more frequently than insurance allows. As such, working without insurance provides freedom to provide flexible and client-centered care. This could mean longer sessions, more frequent sessions, or modern modalities not covered by insurance.
The best care is provided when therapists can work collaboratively with clients to determine what kind of treatment is best for them without the constraints of insurance regulations.
Minimizing Administrative Burden
Working with insurance companies requires significant administrative work, from submitting claims to handling denials and appeals. This process can be time-consuming and takes away from the time therapists could spend on client care, continuing education, or necessary self-care.
Many therapists work independently and do not have staff to manage these administrative tasks. Therefore, they choose not to accept insurance to focus more on direct clinical work rather than navigating the bureaucracy of insurance systems.
Prioritizing Long-Term Healing Over Quick Fixes
The medical system in the United States, and therefore insurance companies, tends to focus on symptom reduction rather than root-cause, in-depth healing.
Many therapists believe that true transformation requires time and consistent therapeutic work, beyond what insurance typically covers. By not relying on insurance, therapists can provide the kind of therapy that focuses on sustainable, long-term growth rather than quick symptom-focused fixes.
Using Out Of Network Benefits
Even if a therapist is not in-network with your insurance, you may still be able to use your out-of-network benefits to get reimbursed for therapy. (This video walks through my best tips for finding a therapist that is the right match for you.)
This depends on your specific plan and the type of services provided.
Therapists can provide a Superbill (I.e., a detailed receipt) that you can submit to your insurance company. You’ll pay for sessions upfront, and then your insurance may reimburse you directly. I’ve had clients get up to 60% of the fee reimbursed.
Here are some questions you can ask the Member Services department of your insurance company:
- Do I have out-of-network outpatient mental health coverage? Am I able to use these benefits for telehealth?
- What is my out-of-network deductible?
- How much of my deductible has been met this year?
- Do I need a referral from an in-network provider to see someone out-of-network?
- What percentage of outpatient psychotherapy sessions are covered per session?
- How much will I be reimbursed for a 50 minute psychotherapy or relational session?
- How do I submit claim forms for reimbursement?
- How long does it take for me to receive reimbursement?
What This Means for You as a Client
While the cost of therapy without insurance may feel like a barrier, many therapists offer sliding scale fees or other solutions to make therapy accessible.
It’s important to remember that therapists who choose not to work with insurance do so with the intention of offering the best care possible, without compromising the quality of their services. They often have advanced training in the models of therapy they offer.
If you’re considering therapy and unsure about the payment options, don’t hesitate to ask your therapist about their policies. Most therapists are happy to discuss their decision and offer clarity on why this approach might ultimately be more beneficial for you as a client.
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