The hidden cost of insurance-based therapy: And the freedom of choosing otherwise
Why I Don’t Take Insurance (And Why You Might Not Want Your Therapist To)
Right off the bat: I’m not here to bash insurance, and I fully understand that many people need a therapist who accepts insurance—finances are real, and sometimes that’s what makes care possible. I respect that.
But I’m also frustrated by how strongly our society has pushed the message that the only “good” or “responsible” way to find a therapist is through insurance. The other day, I saw a post on LinkedIn by someone I highly respect, and even they encouraged people to only look for therapists who take insurance. I realized I can’t stay quiet about this anymore.
So here’s why I don’t take insurance—and why many therapists choose the same path.
1. Insurance Companies Reduce the Quality of Therapists’ Work Lives
Most people don’t realize how heavy the insurance burden is on therapists. Payments are often delayed or missing altogether. Getting paneled with a company can take months. And even when everything finally works, therapists might get paid far below their actual rate. If a therapist charges $150 per session, insurance may decide that session is only worth $80.
Imagine doing deeply emotional work, holding other humans’ pain, and then having to chase down payments—every month. It wears people down.
2. Therapists Work So Damn Hard to Specialize
This one hits my heart. Therapists spend years getting advanced training, certifications, supervision, continuing education. We’re healers who spend our lives understanding the human experience—and somehow we’re still treated like we should give our work away for free.
And because so many of us are soft-hearted and service-oriented, it’s easy to feel guilty charging for our time. But the truth is: we deserve to be paid just like chiropractors, orthodontists, and surgeons. Our work is no less specialized.
3. People Already Pay Out of Pocket for Tons of Other Wellness Services
Clients willingly pay for:
Massages
Chiropractic care
Orthodontics
Personal trainers
Acupuncture
Coaches
Even hair appointments
But mental health—the thing that impacts every single part of our lives—is somehow expected to be covered by insurance or it’s “too expensive.” We have to rethink that narrative.
4. Insurance Limits What Therapists Can Actually Do
Insurance often restricts:
Session length
The number of sessions allowed
Whether deeper, long-term work is “medically necessary”
What modalities are covered
And they usually require a diagnosis—sometimes even when it isn’t clinically appropriate. This pushes therapy away from healing and toward symptom management.
5. Paying Privately Protects Your Privacy
When insurance is involved, your mental health diagnosis becomes part of your permanent medical record. That can affect life insurance, certain jobs, and future medical decisions.
Paying privately keeps your healing journey confidential.
6. Good Therapy Isn’t Standardized—Insurance Wants It to Be
Real therapy requires flexibility and attunement. It requires time, presence, intuition, and relational depth.
Insurance wants checkboxes, treatment plans, and proof that you’re improving fast enough.
Humans don’t work like that.
7. Therapists Who Don’t Bill Insurance Have More Energy for Clients
Not spending hours each week fighting denials or wrestling with paperwork means therapists can show up with more presence, creativity, and groundedness.
Less burnout = better therapy.
8. Sustainable Practices = Better Care
Therapists who can charge sustainable rates can:
Stay in the field longer
Invest in advanced training
Offer specialized work
Hold fewer clients so each one gets more attention
When therapists are supported, so are clients.
9. Going Outside Insurance Often Means Better Access
Insurance panels are often overloaded. Private-pay therapists frequently have more availability and flexibility with scheduling.
10. You Still Have Options for Reimbursement
Many therapists (myself included) offer:
Superbills
Sliding scales
Out-of-network support
You can still get reimbursed—without the therapist having to deal with insurance directly.
If you want therapy that’s real—not rushed, not diagnosis-driven, not squeezed into a 45-minute box—consider stepping outside the insurance model. You’re not just paying for a session. You’re investing in expertise, presence, and a therapist who has the freedom to actually help you.
Grief isn’t always about death—it can come from change, distance, or losing a sense of who you are.
I'm Katherine Linscott, LMFT. I offer Grief Therapy for those navigating life shifts like emotional distance from family, identity loss, or transitions that leave you feeling untethered.
I also offer therapy for women 45+ and their support systems going through perimenopause.
This season of life is complex—but you don’t have to go through it alone. Learn more about me, or visit my Blog & Podcast or Homepage.