Why are Private Practice Therapists Not Accepting Insurance?
Many private practice therapists are opting out of insurance. In fact, current estimates suggest that number is 30–50%, and growing. The reasons vary. Here are a few of mine:
A non-pathologizing lens on trauma
Insurance requires a diagnosis and ongoing documentation. I view trauma through a non-pathologizing lens- as an adaptation to overwhelming experiences rather than an illness or disorder. The symptoms we often associate with trauma are, in many ways, the body’s intelligent attempts to protect us. It’s not something you are doing wrong- it’s something your system did right in the face of an experience that was too much. Because of this, it has felt a bit misaligned participating in systems that require your experiences to be framed as pathology.
The administrative burden
Working with insurance involves claims, denials, and extensive documentation- often unpaid. As a solo practitioner, that time comes at a cost.
By not accepting insurance, I’m able to:
Keep my energy focused on the work we’re doing together
Maintain a sustainable caseload where I can be fully present with each client
Continue investing in advanced training and growth
Opting out of insurance allows me to offer a high quality of specialty care and attunement that doesn’t lead to burnout.
Interference in your care
When insurance is involved, therapy is no longer just between us. Insurance companies often determine what kind of therapy is “allowed,” how long you can attend, and whether it’s “medically necessary.”
This can lead to short-term, one-size-fits-all approaches that aren’t always well-suited for deeper, trauma-informed work.
Additionally, some clients I work with do not meet criteria for a mental health diagnosis and some would prefer to have the details of their mental health treatment separate from their insurance/medical record.
Working outside of insurance allows me to offer care that isn’t confined to a specific modality or timeline. It gives us the freedom to respond to what’s actually happening for you instead of trying to fit your experience into a predefined model. Ultimately, it’s about prioritizing your needs rather than the needs of a system.
Financial realities
Insurance reimbursement rates are often low, which can require therapists to see more clients at the expense of depth and presence. Instead of using my time and energy coordinating with insurance, I am able to focus on client care, self-care, and continuing to grow in my clinical skills.
Out Of Network Options
If your plan includes out-of-network benefits, you may be eligible for partial reimbursement. Payment is collected at the time of service, and I provide a monthly Superbill that you can submit to your insurance for potential reimbursement.
Because plans vary, I recommend contacting your insurance provider directly to better understand your coverage. You may find it helpful to ask:
Do I have out-of-network mental health benefits?
What is my out-of-network deductible? Is it different for individual vs. family plans?
What is my out-of-network coinsurance rate? (This is the percentage of the fee you are responsible for after your deductible is met.)
What is my out-of-pocket maximum for out-of-network services? (Once this is met, coverage may increase to 100%.)
Understanding your benefits can take a little extra effort upfront, but it can also open up more flexibility in the kind of care you receive.
Therapy as an investment
For many therapy-seekers, deciding to step outside of insurance is less about cost and more about choosing a kind of care that feels deeper, more personal, and more in tune with their needs.
Investing in therapy is ultimately an investment in yourself. It’s about your growth, your healing, and the life you wish to create. The upfront cost of therapy pays dividends when your relationships, choices, and your sense of self begin to reflect the change happening within you.
Book a free, no-pressure consultation.
I’m Amy Williams, a Massachusetts-based Licensed Mental Health Counselor specializing in trauma and somatic therapy for women. By not accepting insurance, I prioritize personalized, trauma-informed care to help women who feel chronically anxious, overwhelmed, or on edge heal both in body and mind.
