Why Many Therapists Don’t Take Insurance (and How to Use Out-of-Network Benefits)
It often surprises people just how many therapists don’t accept insurance—especially when insurance is the primary way most people access healthcare. So why do so many of us opt out? The truth is, insurance companies often create barriers that make it difficult to provide ethical, sustainable mental health care.
In this post, I’ll share why many therapists don’t take insurance, what that means for you as a client, and how you can still get reimbursed for therapy using your out-of-network benefits.
The Challenges of Working With Insurance
While insurance is meant to improve access to healthcare, it often creates significant barriers for mental health professionals. Here are just a few of the most common challenges:
Low reimbursement rates: Insurance often pays therapists far below the market rate, making it difficult to cover the real costs of providing high-quality care—including education, licensure, continuing education, liability insurance, and office overhead.
Limitations on care: Insurance companies often decide how many sessions are “allowed,” what type of therapy is covered, and whether someone qualifies for treatment at all—regardless of clinical need. Some therapists have even been pressured to reduce care, even when clients were in crisis.
Administrative burdens: Submitting claims, dealing with denials, and managing potential clawbacks (when insurance companies take back money they already paid) takes up countless unpaid hours. This administrative load contributes heavily to burnout and reduces the time therapists can spend actually supporting clients.
Privacy concerns: In order for insurance to cover services, therapists are often required to provide a mental health diagnosis and detailed clinical notes. For some clients, this feels like an invasion of privacy or creates fear about how that information might be used in the future, especially under the current administration.
Delayed and denied payments: Reimbursements can take months, and therapists often spend hours chasing down payments—only to deal with denials, clawbacks, and endless paperwork. It's an exhausting, unpaid workload that diverts energy from client care.
Systemic disincentives for mental health care: Insurance companies, according to industry insiders, are financially motivated to avoid attracting people with chronic or high-needs mental health concerns. This results in smaller networks, lower pay, and fewer providers accepting insurance.
The Realities Behind the Scenes
Beyond the issues with insurance companies, running a private therapy practice involves an enormous amount of invisible labor and financial responsibility. Personally, I’ve invested in three higher education degrees, taken on significant student loan debt, and spent over eight years in college—followed by two years paying for required clinical supervision.
Today, well over 20 hours each week go toward non-clinical work: marketing, session prep, admin tasks, continuing education, and running the business side of my practice. I also work evenings and weekends, lease office space in a high-cost-of-living city, and manage all client care independently—without employer-paid benefits like retirement, PTO, or health insurance.
All of this is part of why low reimbursement rates and delayed payments from insurance companies just aren’t sustainable. Choosing not to accept insurance allows me to continue offering ethical, high-quality care without burning out—and to build a practice that can grow and support others over the long term.
Why Some Therapists Choose to Stay Independent
For all these reasons, many therapists decide not to work directly with insurance companies. This choice allows us to provide more flexible, responsive, and confidential care—without interference from third parties. It also supports the long-term sustainability of our practices, which means we can keep showing up fully for the people we serve.
That said, affordability and access still matter deeply. Many of us offer sliding scale options and are committed to helping clients find ways to make therapy financially workable.
Using Out-of-Network Benefits
Even if your therapist doesn’t accept insurance directly, you can still work with an out-of-network therapist and use your insurance for therapy reimbursement by following a few key steps. Here’s how to get started:
1. Check your benefits
Call your insurance company or log into your online portal and ask:
Do I have out-of-network benefits for mental health?
Is there a deductible I need to meet first?
What percentage of the session fee is reimbursed?
Do I need a specific diagnosis or referral?
2. Request a Superbill
Ask your therapist for a Superbill—a detailed invoice that includes everything your insurance company needs for reimbursement.
3. Submit your claim
You can send the Superbill directly to your insurance company or use a third-party service to simplify the process.
Services like Thrizer and Mentaya can help streamline the reimbursement process by verifying your benefits, submitting claims on your behalf, and even applying your reimbursement instantly in some cases. They can save time and take the guesswork out of navigating your OON benefits.
Final Thoughts
Therapy should be accessible, transparent, and focused on your well-being—not dictated by red tape or outdated systems. While insurance can be a helpful tool for some, many therapists find that working outside of those systems allows them to offer more effective, ethical, and individualized care. If you're seeking support, know that options exist—and I’m here to help you find a path that works.
Interested in Working Together?
If you think we might be a good fit and you're unsure how to use your out-of-network benefits, I’d be happy to help. During a free consultation, I can walk you through the process and even check your OON benefits instantly using your insurance policy information. Feel free to reach out—I’d love to support you in finding care that works for you.
