One common question individuals have when contacting therapists for services is, “Do you take insurance?”

Why don't therapists take insurance?

One common question individuals have when contacting therapists for services is, “Do you take insurance?” If the therapist answers, “No,” this might lead to feelings of confusion and frustration.  You might be left wondering why. 


Why don’t some therapists take insurance?

  • When insurance is involved, in order for a therapist to be able to bill for therapy sessions, the individual coming into therapy has to have a mental illness diagnosis, which will go on the individual’s records. The diagnosis of the individual must be covered by the insurance in order for you to use your behavioral health benefits. And yes, not all diagnoses are covered by insurances, which means that there are diagnoses that insurance companies will not pay for. This leaves it up to the therapist to keep up-to-date with what is covered and what is not covered at any given time.  
  • There are limits to the number of sessions that insurances will cover.  Once the allotted number of sessions are reached, the therapist will have to make multiple attempts to contact the insurance to ask for more sessions. In some cases, this could lead to a disruption of therapy services. 
  • The insurance company can contact the therapist at any given time to ask what the treatment goals are, how much longer therapy will last, and may potentially ask for the actual session notes of your sessions with the therapist. This back and forth communication can take time away from the actual therapy services that the therapist could be providing. 
  • Delayed payment can occur. Although you pay your co-payment on time, the therapist might not get paid by the insurance for the sessions they provide until a month or so later. And although it can vary, the payment from the insurance might also be low, which might not be enough to cover business expenses and a living wage for the therapist. 
  • The insurance decides if the treatment being provided is worth paying for. There are multiple types of interventions and treatments in the world of therapy that are helpful; however, the insurance might only be keen on a few of them. Why? Because some are more clearly measurable than others, such as the number of times you’ve had a panic attack each day this week, versus how much more comfortable you feel expressing yourself to others. This can lead to therapy sessions that are only focused on specific topics and worked on in a way that is approved by the insurance.
  • It’s tiring and can lead to therapist burnout.  On top of providing therapy services and keeping up with the expected amount of paperwork, there’s added work and time taken to meet the requirements of the insurance and keeping track of it all. 


Benefits of paying out of pocket

  •  Your diagnosis, if you have one, and/or your reason for seeking therapy will not be known to a third party and you get to decide who, if anyone, knows about it. This means that there’s full confidentiality in your services, and unless you sign a legal document (or are a danger to yourself or others), no one will know that you’re in therapy.  
  • Customization and flexibility.  In many ways, therapy is collaborative between the therapist and client, which includes the treatment interventions and goals.  The therapy and type of treatment you receive will truly fit and meet your needs. 
  • Attention and accessibility. Therapists who take out-of-pocket payment are less overburdened and tired; this means that you might experience quick response time when you contact them, full engagement in sessions, and the utmost attention and investment in your growth and process.


Don’t wait to get the help you need.  If you would like to take the next step towards finding a therapist, contact Ethera to get matched with a provider. 

About the Author:  Robyn Tamanaha is a Licensed Marriage & Family Therapist, writer, and podcaster. She has a private practice in Orange County, CA and is the host of the podcast Books Between Sessions.

*Note: the information stated can vary from therapist to therapist, and insurance to insurance. Some might be applicable more than others or not at all.