Why Your Therapist Opted Out (And Why You Should Be Angry at Insurance, Not Them)
In consultation calls I am often asked if I take insurance and while in a 15-minute consultation the answer boils down to a simple “no,” it remains more complicated than that. When time allows I have found this question to be an opportunity to offer some shocking news to folks utilizing insurance for their therapy, so here is the raw, unfiltered truth about the insurance monster.
Credentialing with the Monster:
When your therapist is ‘in-network’ this means they ‘applied to be a provider,’ or paneled, with each insurance company individually. This process is extremely paperwork intensive and tedious. When you finally submit it takes an average of 3 months across all insurances, with Blue Cross Blue Shield reporting 6 months and Cigna reporting up to a year. Although you could hire someone to apply for you this doesn’t accelerate the process.
Some therapists opt to work with venture capital (VC) monsters (like Headway, Grow, or Alma). This is sometimes a necessary evil for therapists who need to make ends meet and are struggling with marketing, tedious paperwork, the nightmare of billing, or clawbacks. They can be credentialed faster because these companies are funded in part by insurance companies. The choice to go VC will be reflected in a significant pay decrease. These companies have negotiated rates with the insurance companies and then take a percent of what the therapist makes therefore exploiting them for their labor.
The Monster Doesn’t Pay:
Reimbursement rates range from $80-$130 with an average of $112, it’s important to note that reimbursement rates for ‘couples work’ are lower compared to individual rates. This means therapists are not incentivized to support couples meaning there is a lack of care. Another important note is insurance companies actually don’t have a billing code for couples so it is billed as ‘family’ showing just how much they value your relationship (sarcasm included). Sex therapy is also not technically billable because insurance companies don’t care!
When therapists are credentialed with insurance companies they have significantly less control of their session rate. Your therapist can say their couples rate for $200 but when insurance determines they are worth only $112 they can either choose to accept this rate or walk away, negotiation doesn’t exist in this space.
Insurance determines these rates based on how many other therapists are credentialed with them, what they perceive the population need to be, therapists level of education, and where your therapist lives.
Your therapist not only lacks power when setting their rate but also maintaining it. In May of 2026 therapists on Alma (one of the VC monsters) woke up to the news that Aetna would now be paying $30 less for a 60 minute session, paying the same rate as a $45 minute session. This happened with only a few weeks notice meaning therapists are put in the difficult decision to depannel and end client relationships or accept a reduced rate. I am sure this is just the beginning of other monsters following suit and further profiting off therapist labor while cutting spending.
The Billing Nightmare:
Billing insurance is not a simple task, it is extremely tedious and time consuming. If your therapist misses even 1 letter it can mean insurance doesn’t pay them. I personally know many therapists who spend hours on the phone with insurance companies advocating for their earned income.
In 2024 Blue Cross Blue Shield just simply stopped paying therapists for services rendered for months. My personal couples therapist had to shut down his own practice because he could not afford to wait months for payment. He returned to bartending, and later joined a group practice for a lower hourly rate but more payment protections. Therapists have very few protections when it comes to their income, one of the biggest risks are clawbacks (more on clawbacks later).
Billing requires documentation, documentation feeds the monster your data, which brings us to…
Private Health Information (PHI)
So you're concerned about your private health information being given to VC firms? Me too, unfortunately they aren't the only monsters on a PHI diet… Simply by using insurance to cover the cost of therapy you are agreeing to feeding the insurance monster.
Diagnosis: All insurance companies require that therapists diagnose clients to prove ‘medical necessity.’ In other words, your therapist has to prove there is something wrong with you that necessitates treatment. Although there are some benefits to receiving a diagnosis, this is often case-by-case and the blanket expectation of insurance to pathologize, and often stigmatize clients, is not in line with a strengths based approach many therapists want to offer.
Demographics: Insurance companies require extensive documentation. They require therapists to submit demographic information often in order to be paid. This information is then analyzed to determine statistical likelihood of claims and then can be used to up your insurance premiums.
Our data is the most valuable resource, it literally fuels capitalism. The vast majority of clients hold at least one marginalized identity and being required to collect demographics, write detailed progress notes and document your experience is not aligned with the autonomy and client protections therapists want to offer.
With so many populations under increased surveillance right now erring on the side of caution with documentation increases protections. Unfortunately not all therapists receive documentation training that supports them in balancing liability and clawback risk with client-centered protections.
Just an example of the horrors is that insurance companies will deny claims if gender markers are not aligned with their files. This means as the therapist, I may be put in the position of intentionally misgendering clients who are gender non-conforming in order to be reimbursed. In short, your data feeds the monster long after your session ends.
The Monster has Claw(back)s:
Clawbacks are when an insurance company pays your therapist for services rendered and then months, sometimes years later, changes their mind and requires your therapist to pay the money back. Data collected by Thrizer in 2025 shared that 27% of therapists have dealt with a claw back in the last year, so this isn’t a fringe case.
Clawbacks can be due to the client not being insured at the time of services, a mistake in billing, or if the insurance companies determine the sessions weren’t needed and therefore they don’t want to pay for it. Therapists may be required to pay back thousands of dollars out of blue, causing some to file for bankruptcy. These VC backed companies offer some clawback protection but it’s not promised. If your therapist wants to receive these minimal protections they may be required to submit your therapy notes for review. This means giving these VC monsters your private health information.
The Monsters Preys on Client Care:
Lower rates, less control, and financial uncertainty with clawbacks means therapists need to see more clients…
When your therapist's rate is $200 for an hour-long couples session, but insurance only pays them $112, therapists are forced to increase their caseloads to make up for lost income. This compromises client care and leads to increased burn out.
The standard, ethical suggestion is that therapists see around 20 clients per week. This assumes your therapist sees you for 1 hour a week and then spends 1 hour outside of session on your care, adding up to a 40 hours work week.
In my experience, community health centers often require ‘productivity rates’ of 32-36 clients per week while group practices can be required slightly less and pay similarly.
The work you don’t see can be coordinating care with other providers, reading books related to your needs, seeking supervision, attending trainings, or conceptualizing and planning how they can better support you. If this external hour is spent on the phone with insurance companies, its not spent on your care. If this external hour is spent on rewriting documentation notes after “not including enough proof of medical necessity" or “not including demographic information” its not spent on your care. All this time can mean less time on you and therefore higher burnt out for therapists and impacted care.
And if that isn't enough, the monster also determines how often you're allowed to see your therapist. Having a hard week? The monster doesn’t care! Insurance companies set limits on session length, frequency, and in turn are dictating the pace of your access based on cost, not clinical need.
Now that you understand the monster, let's talk about how to find a therapist in spite of it:
Finding a therapist can be genuinely frustrating and I say that as someone who has also struggled to find the right therapist myself. Part of that is because we treat therapists as customizable Sim characters, as if the perfect one is just one cheat-code away:
"Im looking for a BIPOC therapist with at least 15 years of experience, trained in IFS and EMDR, with personal experience parenting twins. I am available at 7 pm on weekends, in-network with Wellpoint — no out-of-network."
That's not a referral request. That's a fantasy.
Insurance panels were never designed to connect you with the best therapist, they were designed to connect you with the cheapest option they're contractually obligated to cover. Due to low reimbursement rates and expensive training the most skilled, experienced therapists have left panels entirely. And it’s not because they don't care about you or accessibility, but because the system made it unsustainable to stay with the monster.
So when you filter your entire search by "in-network only," you're not protecting yourself, you're letting the monster stay in power, you're letting insurance companies dictate your access to mental healthcare.
When your needs are that specific you will probably be paying for it. These niche trainings can be hundreds of dollars. Do you want an IFS trained therapist? I get it! Level 1 training for IFS costs between $3,990 and $5,299.
“But They Are Caring Professionals”
Yes, it's true your therapist actually does deeply care, and they deserve to be compensated.
Your therapist completed an undergraduate program and a masters program, sometimes even a doctoral program! They completed at minimum 2 years of unpaid internships to accrue over 3,000 hours of clinical experience. On top of that they are self-employed meaning they receive no benefits package so need to adjust their rates to support.
Therapists’ income needs to include considerations like sick time, continuing education requirements, licensing fees, parental leave, vacation days, health insurance premiums, yearly licensing fees, and approximately a 30% self-employment tax rate.
Research suggests that being compensated for emotional labor in addition to a good work life balance prevents burn out.
Fighting the Monster
There are ways to fight back both as a therapist and as a client.
Many therapists are leaving insurance, as they should! These monster companies will only continue to get worse and take advantage of your therapist and your care until we push back. Depanneling is the first step.
Therapists understand this means their services may be less accessible, and most therapists care about accessibility. To combat this, therapists can and often do offer sliding scales. As the client asks them about it, feel empowered to use their sliding scale if you qualify.
You can also call your insurance to understand your benefits. Be an informed consumer! If you have a PPO you might have out-of-network benefits. This means your insurance company allows you to see out-of-network providers and they will reimburse you for some or all of it. Therapists can offer superbills, which are a receipt of services provided and you send the receipt to your insurance company and insurance pays you back. This is a great option for therapists who don’t want to take part in this corrupt system and for clients who can afford to pay for services up front and get reimbursed later. Many insurance companies offer higher reimbursement rates to clients seeking coverage than when paying therapists.
As a client you can also utilize FSA and HSA accounts. These accounts are tax-advantaged spending money you received for other health care services, sometimes not covered by insurance. Make sure you are an informed consumer and understand if your account is used or lose it. You may also be able to transfer additional money into these accounts in advance to take advantage of tax benefits and cover anticipated therapy costs.
The bottom line is you deserve mental health care and your therapist deserves to be compensated. These things can happen in tandem when we work together outside of the system.
Additional Resources:
State of Mental Health Insurance and Marketing Report
Project Passion Therapy Sliding Scale Policy and Self Assessment