The Truth About Why Caring Therapists Don’t Take Insurance
(And Why You Should Be Grateful They Don’t)
A board-certified OBGYN recently laid it out with calm frustration in a now-viral video: she tried to prescribe a medication. One her patient clearly needed. She followed protocol. The pharmacy kicked it to the insurance company. The insurance company redirected her. Then they faxed her forms. Then more verifications. Then they made her wait. All this—just to find out if a basic prescription would be allowed.
And she’s not even in mental health.
Here’s the video, in case you missed it:
🔗 https://x.com/WallStreetApes/status/1935123904831570298
That clip lit the match for this article. Because what she describes? That maze of pointless red tape? That’s daily life for therapists too—except instead of antibiotics or hormone treatments, they’re trying to secure support for people with PTSD, suicidal ideation, complex grief, or childhood abuse histories.
People whose suffering doesn’t show up on a scan, but is just as real.
Let’s stop pretending therapists avoid insurance because they want to make more money. Most of the ones who opt out are just trying to stay ethical. And keep their clients safe.
What Actually Happens When a Therapist Accepts Insurance
This isn’t something clients are usually told. But it’s the reason your therapist might pause when you ask, “Do you take my insurance?”
Here’s what they’re up against:
For every 60-minute session, there’s another 30 minutes of documentation and billing
Claims portals break
Authorizations require diagnostic inflation
Sessions get denied for being too short, too long, or too frequent
Therapists end up on the phone justifying your trauma to someone with no clinical training
It’s exhausting. And it’s unpaid.
The average therapist accepting insurance might get $60 per session. After overhead—rent, license fees, liability insurance, continuing education, taxes—they’re often pulling $10 to $20 an hour.
That’s less than a dog groomer. Except the therapist might be walking someone through grief, incest recovery, or active suicidal thoughts.
I Didn’t Take Insurance—Because I Took My Clients Seriously
When I served as clinical director of a trauma clinic, I worked directly with state auditors. No games. No shortcuts. We didn’t fake compliance, fluff client files, or push people into treatment they didn’t ask for. We did things clean and honest.
More on that later—that story deserves its own article.
Outside of that role, I also worked privately with therapy clients. I never once billed insurance. People asked why. And I told them the truth:
“Because I care more about your healing than they do.”
It had nothing to do with charging more. It had everything to do with not compromising care—your privacy, your pacing, or your goals. Because real healing doesn’t follow a stopwatch. And it sure as hell doesn’t belong in a billing code.
What Clients Don’t Realize About Using Insurance
1. You must be diagnosed.
Not “maybe.” You must be. Therapists can’t bill insurance unless they label you with a disorder—whether it fits or not. And that diagnosis stays in your file forever.
2. Your private info isn’t really private.
Insurance reps, auditors, and even outsourced contractors can legally access your clinical records. HIPAA has holes when you sign that release form. You’re letting strangers read the darkest parts of your life.
3. Insurance decides when treatment ends.
Not you. Not your therapist. If they say “you’ve had enough,” you’re cut off. Even if you’re finally making progress.
4. Therapists are expected to prove your pain.
This isn’t hyperbole. They’re often asked to send documentation, notes, and “measurable outcomes” to justify continued care. That means your trauma has to be reworded into clinical language, then reviewed by non-clinicians who determine whether it’s “valid.”
If this system sounds dehumanizing, it is. And it’s working exactly the way it was built to work—cheap, fast, and ultimately extractive.
Why Many of Us Walked Away
Because we weren’t okay with compromising care.
We didn’t want to label people unnecessarily.
We didn’t want their records picked through by strangers.
We didn’t want someone in a cubicle deciding how long someone gets to work on healing.
So we stepped out. And many of us started offering private-pay services with sliding scales, cash discounts, or flat rates that are lower than most insurance deductibles anyway. We didn’t do it to make more. We did it to lose less—less time, less integrity, and to have fewer clients stuck in a broken model.
Let’s Talk Cost, Honestly
Most people with insurance still end up paying $40 to $100 per session due to high deductibles or limited coverage. Meanwhile, many private-pay therapists charge $60 to $150 depending on location and experience.
But with private pay, there’s no diagnosis, no risk of audit exposure, and no third party controlling your progress. You’re paying for care—real care. Not corporate compliance.
So yes, it’s often smarter, safer, and actually cheaper to pay your therapist directly. And you're not just buying time—you’re protecting your own autonomy.
Final Thought
The same system that tied that OBGYN’s hands when she tried to prescribe medication is the same one that tries to dictate how we treat trauma.
The best therapists don’t take insurance—not because they think they’re better, but because they’ve seen how it works. They know who it really serves. And it’s not you.
So next time you hear a therapist say, “I don’t take insurance,” don’t see it as a barrier.
See it as a red flag—as someone who really cares about you!
Sources That Don’t Suck:
American Psychological Association. (2022). Why many therapists don’t take insurance. https://www.apa.org/monitor/2022/09/insurance-mental-health
U.S. Government Accountability Office. (2022). Behavioral Health: Available Information on Behavioral Health Treatment Use and Insurance Coverage. https://www.gao.gov/products/gao-22-104597
Kaiser Family Foundation. (2021). Mental Health and Substance Use Considerations Among Adults During the COVID-19 Pandemic. https://www.kff.org
National Institute of Mental Health. Mental Illness Statistics. https://www.nimh.nih.gov/health/statistics/mental-illness
HIPAA Journal. (2021). What are HIPAA Covered Entities? https://www.hipaajournal.com