Why Doesn’t My Therapist Take My Insurance?
Welcome to my new series for therapy seekers!
Over the next several weeks, we’ll be exploring the ins and outs of therapy— I’m talking license types, therapy modalities, niches/specializations, and so much more— so that you can find the right therapist for you or your teen daughter.
Missed the last post? You can check it out here.
If you’ve ever wondered why your therapist isn’t in-network with your insurance, you’re in the right place. Maybe your therapist used to be in-network but recently de-paneled. Maybe you struggled to find a therapist you clicked with who took your insurance so you decided to work with an out-of-network therapist instead.
Whatever the reason might be, you’re paying out of pocket for therapy and curious about why your insurance benefits aren’t covering your mental health treatment the way they do for your medical care.
In today’s blog post, I break down the behind-the-scenes reasons why therapists choose not to take certain insurances or insurance altogether. I also answer some common financial questions about therapy you may be asking yourself.
My hope is that, by this end of this post, you’ll have a better understanding of why your therapist doesn’t take your insurance and what you can do about it.
Let’s Talk About Insurance
When the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 was passed, and later the Affordable Care Act (ACA) of 2010, things looked promising in the mental health world. Insurance companies would no longer be able to cover mental health treatment differently than they did medical care or deny coverage for pre-existing mental health conditions. Finally, people would be able to have greater access to high quality, affordable mental health treatment, right? Right?!
Unfortunately, not…
In 2026, the insurance landscape is actively working against mental health treatment in how much it costs clients to access in-network therapy, how little therapists are reimbursed for services, and the limitations placed on therapists’ clinical care (diagnoses, medical necessity, session limits, and more).
The Cost for Clients
In the United States, we don’t have a national health insurance system like Canada or Europe; our health insurance is often tied to our work, which means that if we lose our job suddenly or decide to change careers, our health insurance is affected.
For people that are self-employed, part-time employees, or unable to work, they may have health insurance through the ACA marketplace, Medicaid or Medicare, health shares (where your money is pooled with others in the health share to cover the costs of medical expenses, but may limit what it reimburses for), or they may be uninsured.
And even if you have stable full-time employment that offers health insurance (which is not a guarantee, and that’s a topic for a whole other day), your employer chooses what health insurance carrier and plans they offer to their employees, which directly affects the cost of your insurance.
But wait, there’s more.
Not only are you responsible for the ever-increasing monthly premiums, but depending on your specific plan, you have to consider copays/coinsurance and deductibles before your health insurance will cover mental health treatment, which is often classified as a specialist visit and therefore more expensive than going to your Primary Care Physician (PCP).
After these complex math calculations are complete and you figure out what you can actually afford in your budget, you still have to find a therapist in-network with your insurance that you click with and who is accepting new clients. Assuming that you can find one, that is.
The Cost for Therapists
There are often two main reasons your therapist doesn’t take your insurance: low insurance reimbursement rates and the rules and restrictions placed on therapists’ clinical care by insurance companies.
Low Insurance Reimbursement Rates
To become an in-network therapist with health insurance panels, a therapist either has to credential through their employer, a platform (Headway, Alma, Grow, etc.), or independently—each with its own administrative burdens, costs, and timelines. Once the application is approved, the therapist is sent a contract with a reimbursement rate that they didn’t get to negotiate and which may not change meaningfully in the coming years.
And the rates are low.
Like, insultingly low given the amount of education, supervised clinical experience, and training that is required to become and remain a therapist. Sometimes 22% or lower than what a medical professional is reimbursed for (https://ensorahealth.com/blog/the-cost-of-low-pay-for-therapists/).
So even if a therapist wants to be in-network, they may not be able to afford to be and stay in business. Because seeing 30+ clients a week to earn a livable wage is a one-way ticket to burnout.
After all, therapists are only reimbursed for the time that they’re with clients, but there’s a lot that goes into running a business that isn’t compensated: documentation, collaborating with other providers caring for their client, networking, attending trainings to improve clinical skills, marketing, advertising, creating and updating a website, publishing a blog, creating social media posts…
And we haven’t even talked about the costs of being in private practice yet: rent/subleasing a physical office space, Electronic Health Records, phone service, malpractice insurance, licensure renewal fees, Continuing Education Units required for licensure renewal, and more.
Whether or not a therapist takes insurance is a numbers game.
Some therapists may be in-network with insurance panels with higher reimbursement rates and not take lower paying insurance panels. Some therapists may choose not to take insurance at all and be an out-of-network/private pay provider.
But it all comes down to whether a therapist can support themselves and their family financially on what they’re earning without burning out along the way.
Insurance Rules & Restrictions
Therapists entered the mental health field to help their clients. Insurance companies exist to make a profit. It’s like watching a boxing match where the underdog (the therapist) has no hopes of winning because the match is rigged.
If a therapist is in-network with insurance, they have to play by the insurance panel’s rules, which often goes against good quality clinical care:
Insurance requires a diagnosis to reimburse for services, even if the client doesn’t want a diagnosis or may not cleanly meet the criteria for one. The only way to avoid having a diagnosis on your medical record is to pay out of pocket for therapy.
Insurance requires clinical documentation to prove medical necessity for “extended sessions” that are 53 minutes or more. I’ve heard of therapists being sent threatening letters by insurance companies for “overusing” the code for 53+ sessions, which is frustrating. A typical session length is about an hour, and as long as a client wants to meet for that long and is benefiting from it, I don’t feel like insurance companies should have an issue with it.
Insurance can audit client records at any time and may decide that the client doesn’t need the services they’re receiving. They can also limit what modalities they’ll reimburse for and how many sessions a client can receive a year, and fighting that can be an uphill battle for therapists trying to support their clients.
Insurance can claw back payments they’ve sent to therapists 6 months or several years after a claim has been paid out. I know a therapist who had over $4000 that was clawed back out of his bank account without his knowledge because of a billing error (he had used the wrong time duration code and they didn’t give him a chance to fix it before taking the money back).
So some therapists choose to opt-out of the game entirely and be a private pay or out-of-network provider.
They don’t want an insurance company telling them how to provide therapy to clients and what that should look like. They want to offer high quality clinical care to their clients that honors their clients’ unique needs, concerns, and timeline for healing, and they also want to be paid a livable wage while they’re at it.
Frequently Asked Questions about Insurance with Therapy:
Why doesn’t my therapist take my insurance?
Your therapist isn’t in-network with your insurance because of low insurance reimbursement rates and rules and restrictions placed on their clinical care by insurance companies. If you want a deeper breakdown, check out the sections above.
What is an in-network therapist?
An in-network (INN) therapist is someone who is credentialed with a given insurance panel (e.g. Aetna, UnitedHealthcare) and has agreed to see clients with that insurance at the contracted rate. They can’t charge a client more than the contracted rate (separate from late or no-show fees), even if the cost of business has increased, which can make it challenging for in-network therapists to stay in business long-term.
What is an out-of-network therapist? How does that differ from private pay only?
An out-of-network (OON) therapist is not credentialed with a given insurance panel but offers a monthly superbill the client can submit to their insurance company or partners with an OON reimbursement services, like Mentaya. The client pays their therapist the full fee, but may be able to be reimbursed up to 80% for the cost of therapy after meeting their OON deductible. Sometimes this end up being a similar amount to what an in-network copay or coinsurance would be. You can see if you have OON benefits through my Mentaya benefits checker here.
Private pay only therapists are not credentialed with any insurance panels and they don’t offer superbills or OON reimbursement services.
Why would a therapist choose to be private pay only instead of out-of-network?
If a client wants to utilize their out-of-network (OON) benefits to help them afford the cost of therapy, the rules and restrictions of insurance apply, even if the therapist is being paid their full fee. OON reimbursement requires a diagnosis, which a client may not want in their medical record, and the clinical documentation may still be audited.
Some therapists choose not to have insurance involved in the therapeutic process at all by being private pay only. And some clients choose to be private pay for the diagnostic privacy and clinical flexibility, even if their therapist takes their insurance (they sign an insurance opt-out form) or offers OON reimbursement support. The client always has that choice for their care.
That’s it for today, folks! Come back next time for a continuation of the financial side to therapy, where I’ll breakdown the different ways you can pay for therapy (in-network, out-of-network, private pay, sliding scale, HSA/FSA).
And if you have any therapy-related questions that you’d like me to cover in future blog posts, you can text me at (214) 702-1785 or send me an email at hello@storiedsoulstherapy.com.
Hi, I’m so glad you’re here!
I’m Madilynn Szoboszlay, LCSW and founder/CEO of Storied Souls Therapy.
I specialize in working with high-achieving and highly sensitive (HSP) women and teen girls across Texas, Arizona, and Montana navigate anxiety, burnout, and perfectionism to feel more confident and grounded in their own skin.
Interested in working together?
Schedule a free 15-minute phone consultation with me to see if I’m the right therapist for you or your teen daughter.
Please note: This post is for educational purposes and is not a substitute for professional mental health care. Use of this site does not create a therapist-client relationship.