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Why So Many Therapists Say "No, I Don't Accept Insurance."

You decide that you are ready to speak with someone about life’s tribulations. You take the first step and attempt to find a therapist. You contact your insurance company to determine who is an “in network provider.” You reach out to those few therapists, and all their caseloads are full. Maybe some of them do not even get back to you. You finally find a therapist that feels like the “perfect fit,” but they are out of network and do not accept insurance. Their fee is not affordable!

So, you are at a roadblock. What do you do? You don’t want to continue internalizing… to continue to suffer. You deserve support. It can be an excruciating and time-consuming process to find a therapist.

You are absolutely not alone in this.

I want to explain why so many therapists, including myself, do not work with insurance. The explanation will not make this process any less frustrating, but perhaps this knowledge will assist you in understanding the process of finding a therapist that aligns with your values.

Therapy, by nature, is a confidential, safe, and private space where folks share some of their most vulnerable experiences. Insurance, by nature, has access and authority over our health information.

What many people who are not in the mental health profession do not know, is that when insurance is involved, therapy is no longer confidential between the therapist and client.

Therapists are required to send in their notes and treatment plans to insurance companies. These notes include what was discussed in session as well as the type of interventions used. Insurance companies push for certain types of therapy to be used – these types of therapies are oftentimes the “quick fix” and “solution focused” strategies (so that insurance does not have to pay for a lot of sessions). In other words, insurance companies, that are not trained in mental health counseling, determine what types of treatment are best for you… rather than the trained mental health professional.

Moreover, as therapists working with insurance are required to provide a formal mental health diagnosis in order for the client’s services to be paid for. This is the real kicker for me! Diagnosing can be both extremely helpful and extremely harmful.

For some, a diagnosis can mean an understanding of their experiences, a greater clarity in what they are going through, and a means of accessing medication or other services that can greatly benefit their livelihood.

For others, diagnosing can mean pathologizing, stigmatizing, and generalizing matchless and intricate experiences. Oftentimes, mental health diagnoses are responses to trauma that we endured throughout our lifetimes. The “symptoms” are simply ways that we have learned to protect ourselves and survive. Transforming this into a diagnosis can be a way of lumping our pain into a categorized “illness.”

Historically, black and brown folks are pathologized and diagnosed at much higher rates than white folks. This is yet another way of oppressing and “otherizing” entire groups of people. I refuse to be a part of this. I refuse to allow insurance to contribute to the mistrust of the traditional healthcare system for my clients. I refuse to diagnose vulnerable individuals after a singular 50-minute session, and then bill off that information to a multi-billion-dollar company. It feels like yet another way that capitalism benefits from and exploits our pain.

Let me leave you with this anecdote… I did work with insurance when I was a student intern and when I worked for a mental health agency. I was required to call insurance companies to essentially beg for them to pay for more sessions for clients who were still deeply struggling. One insurance provider asked me, “is this person suicidal enough to remain in therapy?”

Suicidal… enough?

Insurance companies get to decide if someone is “sick enough,” or “suicidal enough,” to access services that in my opinion, every single person should be entitled to as we all navigate this complexly traumatizing society.

As a therapist, I cannot stand by the systemically oppressive and profit seeking system that is insurance. One of my underlying goals as a mental health professional is to make therapy services accessible and equitable. There are other ways of making therapy accessible, outside of using insurance. Many therapists who do not accept insurance offer a sliding scale, or a “pay what you can” model. Many therapists even offer pro-bono services for individuals who are unable to pay for therapy.

Each and every human being deserves support, compassion, and care. This tender and vulnerable care should not be at the hands of an insurance company that has the capacity to exploit and breach confidentiality.

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