Why Don’t You Accept Insurance?

Why don’t you accept insurance?

This is one of the first questions many people ask when reaching out for therapy, and it makes total sense.

Therapy is an investment. You want to understand what you’re paying for, why it costs what it costs, and whether using insurance would make it more accessible.

So I want to answer this directly and honestly.

I care about making therapy accessible, but I don’t accept insurance because it changes the way the work itself unfolds.

Insurance requires a diagnosis in order for therapy to be covered

This means experiences must be described in medical terms even when you’re seeking support for human struggles rather than a disorder.

That diagnosis becomes part of your medical record and can be requested by future insurers, disability carriers, and sometimes employers depending on the field.

But many people come to therapy not because they have a disorder. They come because they feel stuck, overwhelmed, disconnected, or caught in patterns they don’t understand. They are grieving a loss. They are going through a divorce. They just started college or a new job. They moved to a new city. They may function well in daily life but feel persistently anxious, dissatisfied, or unsure of themselves.

Insurance only pays for treatment of illness, so therapists have to translate human struggle into a medical category.

Sometimes that framing is helpful.

Sometimes it subtly shifts how people think about their experiences.

I want therapy to start with curiosity about your experiences rather than fitting them into a category.

How insurance affects therapy

Insurance companies determine how often we meet, what type of treatment counts as necessary, and when therapy should end. They periodically require documentation showing improvement.

But meaningful psychological change rarely follows a straight timeline.

Some weeks you talk freely.
Some weeks you feel stuck.
Some weeks you realize something important that doesn’t look like progress yet.

If therapy must constantly demonstrate improvement, it can start to feel like you need to get better rather than be honest.

I want the work to move at the pace you actually need.

Confidentiality is different with insurance

When insurance is involved, your treatment is no longer only between you and me.

I must submit diagnoses, treatment plans, and sometimes records for review by people whose role is cost management.

Many people find they speak differently when they know their inner life may exist in a file beyond the room, even if those records are rarely accessed.

I want therapy to be a private space where you don’t have to edit yourself.

Not all therapy is symptom-focused

Some therapies are designed to reduce specific symptoms quickly, and that can be very helpful.

But many difficulties repeat across relationships and stages of life. People often come in saying, “I don’t know why this keeps happening to me.”

Understanding those patterns takes time and safety. It involves thoughts and feelings that may not fit neatly into a medical model or a short timeline.

Insurance systems are built for acute care.
Depth work needs a different kind of space.

I still try to make therapy financially possible

I provide monthly superbills for clients who wish to submit for partial out-of-network reimbursement. Insurance requires that the Superbill include a diagnosis. This is a formal requirement and does not change the way we approach your work together, which remains focused on understanding your experiences rather than fitting them into a label.

It’s okay to have mixed feelings about paying privately

Deciding to pay out of pocket for therapy can bring up reactions beyond budgeting.
People often notice guilt, hesitation, pressure to “make it worth it,” or worry they are being self-indulgent.

We can talk about that openly.
Money is part of real life, and whatever it brings up belongs in the room too.

You are not expected to feel certain before starting.

What therapy here actually looks like

Sessions are not structured around checking boxes or producing weekly progress. Some days you may talk about something very present. Other days you may notice a thought you almost didn’t say, a reaction you had toward me, or a feeling that doesn’t fully make sense yet.

We pay attention to patterns that appear over time rather than rushing toward solutions. The goal is not just relief in the moment but understanding yourself in a way that changes how you relate, choose, and experience your life outside the room.

Why this matters

I want therapy to be a place where you don’t have to prove you’re sick, improve on a schedule, or fit your experience into a category before we understand it.

For many people, that makes it easier to speak honestly and to discover things they didn’t know they were holding in place.

If you’re unsure whether this kind of therapy fits you, we can talk and figure that out together. You don’t have to decide alone.

If you have questions about fees or reimbursement, you’re always welcome to ask.