I Don’t Take Insurance. Here’s Why—And What It Means for You

When someone reaches out for therapy, one of the first questions they usually ask is: “Do you take my insurance?”

It’s a fair question. Therapy is a major financial commitment, and health care in general has become increasingly unaffordable, especially in a country where the cost of living keeps rising while wages fall behind. So when a therapist answers “no,” it can feel like a barrier. It might even feel like a judgment. I understand that, and want to be as transparent as possible about why I’ve made the very difficult decision to work outside the insurance system, and how we’ve designed our practice to support accessibility, integrity, and care without relying on insurance networks.

This is not about claiming that one model of therapy is better than another. Many therapists who take insurance provide exceptional, thoughtful, deeply ethical care, often while navigating frustrating and prohibitive systemic limitations. Every clinician has to decide what is most sustainable and aligned for them, what best supports the work they want to do, and how to balance that with the realities their clients are facing. For me, that decision has meant choosing to work outside the insurance system.

The Reality of the System

At some point, every therapist has to make the choice of whether to work with insurance or operate independently. That decision is rarely simple, and it often comes down to sustainability.

According to a 2024 survey conducted by the American Psychological Association, over one-third of psychotherapists in the United States said they don’t accept insurance, and nearly half of those who once did have opted out. For many, this shift reflects ongoing challenges: low and inconsistent reimbursement rates, significant administrative demands, and delayed or denied payments.

These issues can directly affect the quality of care therapists are able to provide. When hours each week are spent on the phone with insurance companies, resubmitting paperwork, writing treatment justifications, and chasing down reimbursements, that time and energy is no longer available for clinical work, training, or client support.

Insurance companies may also limit what kinds of care are covered, how often clients can be seen, how long sessions can last, or whether certain diagnoses qualify for treatment. In some cases, therapists must submit formal diagnoses in order to justify care, even when that diagnosis may not be the most accurate or helpful tool for the client’s process. These constraints are not inherently unethical, but they do create real limitations on clinical freedom, creativity, and depth.

Some therapists are able to navigate these systems skillfully and still do excellent work, and that deserves major recognition. Others choose to opt out so they can structure care in a way that feels more flexible, relational, and aligned with their values. Neither path is perfect, and both make sense in different ways.

How I Make It Work

At Every Body Therapy, we do not accept insurance. That choice allows us to maintain a practice that prioritizes consistency, depth, and nuance. It allows us to see clients as frequently as needed, for the length of time that feels appropriate, without pressure to fit sessions into a specific mold. It allows us to focus on the therapeutic relationship, rather than diagnostic codes or coverage criteria.

At the same time, I recognize that private pay therapy is a barrier for many people. That is not something I take lightly. Running a group practice that offers high-quality care, pays therapists generously, and provides full benefits requires us to charge rates that reflect those commitments.

To bridge that gap, we offer a number of sliding scale sessions per clinician. Clients with strong out-of-network benefits or greater financial resources pay our full fee, which helps subsidize lower-cost spots. We do not require proof of income or financial documentation — we trust clients to assess what they can reasonably afford and ask for the support they need.

This structure extends to our group therapy offerings as well. Our intention is to make group work accessible, inclusive, and truly reflective of the communities we serve — not limited to those with disposable income or ideal insurance coverage.

This model is not a fix for a broken system, but it is one way we try to offer flexibility and care without compromising the quality or sustainability of what we do.

What You’re Paying For

For clients who are able to access out-of-network reimbursement—or who choose to pay privately—there are certain freedoms that come with working outside the insurance system.

Your care is not limited by session caps or diagnosis requirements. You are not required to meet “medical necessity” thresholds to keep receiving support. You and your therapist get to decide what the work looks like—how often you meet, what you focus on, and how long the process continues.

When you pay privately, you are investing in a therapist’s time, training, and presence, not in the administrative overhead required to navigate insurance systems. That doesn’t mean one model is inherently better. It just means that in this model, the terms of the work are more directly between you and your therapist.

Final Thoughts

Therapy should be accessible. It should not require this much navigation. But the systems currently in place often complicate rather than ease that access for both clients and providers.

If you’ve ever felt frustrated or disappointed when a therapist said they don’t take insurance, I hope this explanation offers clarity. Not as a justification, but as an honest window into how this particular choice supports the kind of work we aim to do and the kind of care we believe in offering.

There is no perfect system (but there are certainly better ones!). Each comes with tradeoffs. What matters most is finding the kind of support that feels right for you, and working with a provider who is transparent about what they can offer. Whether that’s in-network or out-of-network, what matters is the quality of the relationship and the safety you feel inside it.