Breaking Free: Why Therapists Don’t Have to Accept Insurance

brown graphic with white letters with the text "why therapists don't have to accept insurance" and a graphic with US dollars

Many therapists believe that they’re obligated to accept insurance as if it’s an unwritten rule etched in stone. It’s a myth that has circulated within the therapy world for years, casting a shadow of uncertainty over both therapists and potential clients. But let’s set the record straight. Therapists don’t have to take insurance.

Let’s go ahead and debunk that myth, shall we? In the following article, we’ll take a close look at the role insurance plays within therapy and reveal the choices therapists actually have while also considering the far-reaching implications of those choices. Whether you’re new to the world of therapy or an established practitioner, this article serves as your compass in navigating the landscape of therapists’ payment options.

So! Get ready to enter into your inner rebel’s mind as we change the narrative around “having to” take insurance as a private practice therapist.

Photo of Judd Nelson with the text "being bad feels pretty good, huh?"

We’ll explore the options, weigh the pros and cons, and ultimately uncover the empowering reality that therapists hold the reins when it comes to their practice and their clients’ well-being, all while delivering the essential support that’s sought after. Let the myth-busting begin.

Do Therapists Have to Take Insurance?

One of the most pervasive myths in the world of therapy is the belief that therapists are obliged to accept insurance. It’s a misconception that has persisted for years, leaving both therapists and potential clients uncertain about their options.

The culprit? This belief is rooted in guilt or a misplaced sense of obligation for many of us. But it doesn’t need to be this way.

Many therapists are deeply identified with the caregiving and nurturing roles, be that expressed in their families of origin or within the broader societal context – likely both! They may have served as the “helpers” who checked in with everyone else’s feelings, negotiated conflicts, and put others’ needs before their own. This pattern of prioritizing others’ well-being often continues in their professional lives.

When entering the field of psychology, counseling, or social work, these messages are further reinforced, with mantras like “We don’t do this work for the money” or “You MUST offer a sliding scale” prevalent in the community. The belief that financial success and helping others are somehow at odds can lead therapists to initially accept insurance or offer reduced fees, even if it doesn’t align with their long-term financial and career goals.

The truth is therapists do not have to take insurance.

In a society where health insurance often covers various medical and psychological services, the assumption that therapy should follow the same model is understandable. However, mental health services aren’t as straightforward as other medical treatments.

So, what are the reasons behind therapists choosing not to accept insurance?

  1. Autonomy and Control: Opting out of insurance allows therapists to have more control over their practice. They can set their own fees, design personalized treatment plans, and define their therapeutic approach without being bound by insurance company regulations.
  2. Specialization and Niches: Some therapists prefer not to accept insurance because they want to specialize in specific niches or work with particular populations. This enables them to focus on areas of therapy that align with their expertise and passions, attracting clients seeking their unique skills.
  3. Reduced Administrative Burden: Dealing with insurance companies can be administratively burdensome. Therapists who choose not to accept insurance often find that it streamlines their administrative processes, giving them more time to dedicate to their clients.
  4. Privacy and Confidentiality: For some clients, the idea of their therapy records being accessible to insurance companies is a concern. Therapists who offer self-pay or cash-pay services can emphasize the confidentiality and privacy of their practice.

It’s a common sentiment among therapists to say, “I didn’t come here to make money; I came here to help people.” There’s also the misconception that you can’t charge premium fees until you’ve been in the field for at least 10 years. However, therapists have the freedom – in fact, the responsibility, to make well-informed decisions about whether to accept insurance – taking into account factors like their practice goals, client demographics, and personal and professional preferences. This choice significantly influences how therapists provide their services and establish connections with their clients, and the decision should not be made from feelings of guilt, obligation, or simply that one has no other choice.

Woman acting surprised wearing a blue blazer. Text "Who woulda thought" on the graphic

Private-Pay vs. Insurance

One of the critical decisions you’ll face in your practice is how to structure your payment options. Two prevalent models in the field are private pay (also known as cash-only practice) and insurance-based therapy. Each model comes with its set of advantages and considerations, making it essential to thoroughly understand the dynamics of both before making an informed choice. Let’s break down the key considerations to help you understand the implications of these choices.

Private-Pay Therapy


  1. Enhanced Privacy and Confidentiality: Private-pay therapy offers a higher level of confidentiality, as there’s no need to involve insurance companies, which often require information about the client’s treatment.
  2. Freedom to Set Your Rates: With private-pay, you have control over your session fees, allowing you to set rates that align with the value you provide and your financial goals.
  3. Reduced Administrative Burden: Private-pay models typically involve fewer administrative tasks, such as dealing with insurance claims and billing, giving you more time to focus on your clients.
  4. Flexible Treatment Approaches: You have the flexibility to tailor your therapeutic approach without insurance restrictions, potentially resulting in more client-centered and effective therapy.


  1. Affordability: Private-pay therapy may not be accessible to everyone, potentially limiting your client base to individuals who can afford out-of-pocket expenses.
  2. Marketing and Client Attraction: You may need to invest in marketing efforts to attract clients willing to pay privately. Effective marketing strategies are essential for building a client base.
  3. Income Stability: Your income in private-pay therapy may fluctuate based on client demand and market conditions. Creating a financial plan to navigate these fluctuations is crucial.
  4. Diverse Client Base: Private-pay models may limit your client base to those who can afford your services, potentially reducing the diversity of your clients’ socioeconomic status.

Insurance-Based Therapy


  1. Increased Accessibility: Accepting insurance can make therapy more accessible to a broader range of individuals, as it helps cover the cost of sessions for those with insurance coverage.
  2. Steady Client Flow: Insurance-based therapy often provides a more stable and predictable client flow, as individuals with insurance may be more inclined to seek therapy.
  3. Wider Client Base: Accepting insurance can diversify your client base, allowing you to work with individuals from various backgrounds and financial situations.


  1. Reduced Privacy: Insurance-based therapy may involve sharing clinical information with insurance companies, potentially compromising client confidentiality.
  2. Limited Control Over Rates: Insurance companies typically determine reimbursement rates, limiting your ability to set session fees according to your preferences.
  3. Administrative Complexity: Dealing with insurance claims, authorizations, and billing can be administratively burdensome and time-consuming.
  4. Treatment Restrictions: Some therapists worry that they may get in trouble with their insurance companies if they don’t take on enough clients. Insurance companies also impose limitations on the number of sessions or treatment modalities, potentially impacting the quality and duration of therapy.

The advantages of private-pay therapy, including autonomy, specialization, and client privacy, often outweigh the challenges. While it may require additional marketing efforts to establish a clientele willing to pay privately, the potential for higher income and the opportunity to shape a practice that aligns with your expertise makes it a compelling choice.

Illustration of Tiffany wearing beige jacket and white scarf and green sun glasses and a word bubble saying "Who's in?"

Tailoring Payment Methods to Your Therapeutic Vision

Opting for private-pay therapy often emerges as a beacon of freedom and empowerment. When we move beyond our professional scripts, it becomes clear that private-pay therapy offers unique advantages that align with a therapist’s vision for their practice.

Private-pay therapy allows you to chart your own course, setting fees that reflect your expertise and dedication. This autonomy grants you the flexibility to tailor your caseload, ensuring you can provide the high-quality care your clients deserve without feeling overwhelmed. It fosters a deeper therapeutic connection with your clients, who are fully invested in their healing journey, having chosen to prioritize their mental well-being. If you’re considering private pay or have already gone that route, check out our “Fun with Fees Calculator” to ensure the fees you’re charging align with your financial needs AND desires.

Knowing exactly what your fee needs to be and why it can reduce confusion and guilt around setting your fee so that you can truly design a practice that works for you.

While the path of private-pay therapy may present its share of financial planning and marketing challenges, the rewards are significant. The potential for higher income per session elevates your financial stability and reflects the value you bring to your clients’ lives.

I encourage you to explore the freedom private-pay therapy can offer. It’s a path that gives you the freedom to design your practice in a way that reflects your values and vision versus falling back into a practice that reflects the haphazard Community Mental Health or professional martyrdom narratives that are so pervasive in our field.

The decision to embrace private-pay therapy isn’t just about financial considerations; it’s about creating an environment where you can profoundly impact your clients’ lives while maintaining your own well-being.

Diversity in payment models enriches the profession. As you make this pivotal choice, remember that your practice is a canvas, and private-pay therapy allows you to paint your masterpiece, one session at a time. Your unique approach, dedication, and expertise deserve to shine in the realm of private-pay therapy, where the freedom to thrive and do BETTER clinical work awaits you.


Submit a Comment

Your email address will not be published. Required fields are marked *

About the Author

Hey, I’m Tiffany McLain, LMFT, and I teach you how to charge good money for the good work you do.  I’m the founder of Lean In. MAKE BANK. Academy, a group program that empowers therapists and social workers like you to reimagine your relationship with money, offering the tools and community support to not just earn more but to fundamentally change your life and the lives of those you serve.

Get Access to Our Free Fees Calculator

& confidently set your private practice fees the right way!

Browse Related Posts

Therapist with a Garden Hoe or a Netflix Show?

After over 7 years of working with therapists in private practice around fee setting strategies, I’ve observed that there are two types of private practice therapists: Therapists with a Garden Hoe & Therapists with a Netflix Show. It’s vital that you understand...

Learn how to charge premium fees while increasing the quality of care for your clients

Because therapists with more money have more capacity to make change