Why Many Therapists Don't Accept Insurance

It was a hard decision whether to accept health insurance or not, as a new private practice therapist. With my commitment to social justice, I wanted to find a way to serve low-income folks in my private practice. Having too many low-fee spots is hard (see my other blog post on Why Does Therapy Cost So Much?!). But, in my own personal experience as a therapy client navigating the health insurance system, and my five years working in community mental health (under the umbrella of Medi-cal), I experienced the limitations and harm of the health insurance system (or mental health industrial complex). It makes sense why so many therapists don't accept insurance. I did not accept insurance but ended up signing up for Alma, an insurance platform. So many folks are unable to pay out of pocket.

Requirements of insurance to assess and diagnose people, especially people with trauma (who need time to build trust) within 30 days (or less) is not ideal. Many questions are not meant to be asked so soon without building trust and an alliance with clients. Diagnoses should NOT be given so soon, and sometimes not at all. For many folks, diagnoses can cause stigma, labeling, confinement, and shame. For many people, diagnoses ARE helpful, but still, time and collaboration with clients are essential. The decision of whether to give a diagnosis should be made by the clinician and client, not insurance companies.

Another reason many do not to accept insurance is for client care and for my own wellbeing. Insurance companies require therapists to onboard multiple clients with strict timelines, resulting in burnt-out therapists. Plus, the reimbursement rates that insurance companies pay therapists are SO low. Therapists often have to have more clients on their caseload in order to make a living. A higher case load of clients is not good for clients because therapists cannot give proper care and attention to clients. Also, Insurance companies don’t consider our specialties, including all of the money and time spent on trainings and continuing education we’ve attended since school.

Burnout is exacerbated by the hours of paperwork and fighting with insurance companies to get claims approved. I have colleagues who complain about this and who put so much time and energy into it. They become consumed by paperwork rather than client care, continuing education, or self-care. When taking insurance, therapists are confined by insurance, and insurance companies have power over treatment. This is wrong. The client and therapist should have power over treatment, not insurance companies.

Shawna Murray Brown has a webinar on Decolonizing Your Therapy Practice and she says when we accept insurance from our clients, we are perpetuating a system of capitalism with oppressive foundations, and normalizing Western Colonialism. She establishes grassroots efforts in her practice rather than accepting insurance. I appreciate what Shawna Murray Brown says, because I am an anti-capitalist and Western medicine has become all about making profits for insurance companies, turning patients into products in a factory. This is wrong and I don't want anything to do with it. I also refuse to participate in and enable the corrupt system of health insurance.

You might ask “If you aren’t accepting insurance how will you serve low-income people?” I am continuing to explore how to do this-join me! I am in a private practice-building peer consultation group where we frequently discuss this. I continue to work with my budget so that I can have a sliding scale, including a number of very low-fee spots. I am planning free workshops for the community. I am networking with colleagues to explore creation of non-profits. I am reaching out to non-profits and proposing collaborations. I am taking Shawna’s advice to create a village (through consultation groups, mentorship, trainings, networking) because she says that individualism upholds colonial interests and capitalism. In addition, I continue to educate, discuss, and take political action to fight for universal healthcare and to fight capitalism.

I am a psychotherapist in private practice in Berkeley, California.

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