Choosing a therapist can feel overwhelming, and one of the first questions many people ask is, “Do you take insurance?” For many therapists, myself included, the answer is no. This isn’t a decision made lightly—it’s a thoughtful choice based on clinical, ethical, and practical considerations. Let me explain why.

The Necessity of a Diagnosis

When therapists bill insurance, they must provide a diagnosis to justify treatment. This diagnosis becomes a permanent part of your medical record, which could potentially impact your future (for example, when applying for certain jobs or insurance policies).

Not every person seeking therapy meets the criteria for a mental health diagnosis. For example, if you’re working on improving boundaries, processing a breakup, or navigating career stress, you may not qualify for a formal diagnosis, even though therapy would be immensely helpful. Private-pay therapy allows us to focus on your goals without needing to label your experience as a “disorder.”

Therapists’ Ethical Considerations

Insurance companies often dictate the type and frequency of therapy they will cover. This can limit the therapeutic process and interfere with personalized care. Private-pay therapists have the freedom to provide the type of therapy best suited to you—not what’s dictated by an insurance policy.

Additionally, some therapists feel that the diagnostic requirements and restrictions imposed by insurance companies compromise their ethical commitment to client confidentiality and autonomy. Working outside the insurance system ensures that decisions about your care stay between you and your therapist.

More Time and Energy for Clients

Billing insurance involves significant administrative work, including submitting claims, following up on denials, and navigating complicated processes. Many private-pay therapists choose to redirect that time and energy into their clients.

By operating outside of insurance, I’m able to focus on providing high-quality, personalized therapy without the constraints of bureaucracy. This means more availability, less rushed sessions, and the flexibility to tailor therapy to your unique needs.

Low Reimbursement Rates and Clawbacks

Many therapists choose not to accept insurance due to the low reimbursement rates they receive from insurance companies, which often means they are paid significantly less per session than the standard cost of therapy, making it difficult to sustain their practice. To try to compensate and make an affordable wage, therapist have to schedule a lot of client sessions per week. For some therapists, they do not have the capacity to see 25-35 clients a week without it impacting their quality of work (and possibly their mental and physical health).

There is also the scary possibility of clawbacks. Insurance clawbacks occur when insurance companies retroactively demand repayment for services they’ve already reimbursed. This can happen due to audits, documentation not meeting insurer requirements, coding errors, or changes in a client’s insurance coverage. Clawbacks can happen months or even years after the service was provided, creating financial strain and administrative burdens for therapists who have already fulfilled their obligations in good faith.

For many therapists, clawbacks highlight the unpredictable nature of working with insurance companies and the potential stress it adds to their practice. Hence another reason some therapists opt to be private-pay providers, to avoid the risks and stress of above while simultaneously allowing them to have a better work/life balance.

Accessible Options for Private-Pay Clients

I understand that private-pay therapy isn’t an option for everyone, and I aim to make it as accessible as possible. At Rosebud Psychotherapy, I offer:

• Sliding Scale Spots: Reduced-rate sessions for those with financial need.

• Superbills: Detailed invoices you can submit to your insurance provider for potential reimbursement.

• Group Therapy: A highly effective form of therapy that is also a lower-cost way to access support and connection.

The Takeaway

Choosing private-pay therapy means investing in care that prioritizes your goals, privacy, and the quality of the therapeutic relationship. For many clients, it’s a worthwhile choice that allows for a more personalized and effective therapy experience.

If you have questions about how private-pay therapy works or whether it’s the right fit for you, I’d love to connect and help you explore your options. Therapy is an investment in yourself—and you deserve care that truly works for you.

Interested in learning more or scheduling an appointment? Contact me today.