Your Practice, Your Rules: Why Private Pay Might Be the Future For Mental Health
For too long, mental health practice owners have been trapped in a system that undervalues their work, underpays their expertise, and overwhelms them with administrative headaches.
The culprit? Insurance panels.
If you’re a mental health provider who is taking insurance but constantly feeling exhausted, overbooked, and financially stuck, I have a hard truth for you:
Insurance is not designed to serve you—or your clients.
It’s designed to control costs, dictate care, and keep therapists underpaid while increasing profits for companies that have zero stake in your well-being.
So let’s talk about something radical: What if you left insurance behind and transitioned to private pay?
I know what you’re thinking.
💭 But my clients need me!
💭 What if I can’t fill my practice?
💭 Isn’t it unethical to turn people away who can’t afford my services?
I hear you. And I also know that staying on insurance panels is hurting more than it’s helping.
Let’s break this down, once and for all.
Insurance Controls Your Worth (and It’s Not Pretty)
Did you go to school for years, train relentlessly, and build a practice just to have an insurance company decide your value? Didn’t think so.
And yet, that’s exactly what’s happening. Insurance companies:
❌ Dictate your rates—often paying you 40-60% less than private pay clients.
❌ Create payment delays—you can wait weeks or even months to be reimbursed.
❌ Deny legitimate claims—forcing you to fight for the money you already earned.
The result?
➡️ You have to see more clients just to make ends meet.
➡️ You’re constantly chasing down payments instead of focusing on care.
➡️ You’re financially limited by rates set by companies that don’t understand the value of what you do.
Insurance Doesn’t Actually Mean Access
A lot of therapists stay on insurance panels because they believe it’s the only way to make therapy accessible. But the reality is more complicated.
✔️ In 2020, 29% of Medicaid enrollees had a mental illness, compared to 21% with private insurance and 20% uninsured—yet many still struggled to access care. (KFF Report)
✔️ In 2021, two-thirds of Americans with a diagnosed mental health condition couldn’t get treatment—even though they had insurance. (NPR Report)
Insurance networks don’t guarantee access—they just shift the burden of cost and paperwork onto providers and clients.
And when therapists burn out because of low reimbursement rates, overloaded schedules, and endless admin work, access to care actually decreases—because fewer providers can sustain their practices.
Insurance Actually Makes Pro Bono Harder
If you think staying in-network helps you provide more low-cost care, think again.
When you take insurance, you’re locked into their rules—which means:
🚫 You can’t always offer lower-cost or pro bono sessions to clients who need them.
🚫 You have to charge deductibles and copays—even if a client is struggling.
When a client has insurance, you’re often required to bill it, even if they’d prefer a sliding-scale fee.
Private pay actually gives you more flexibility to:
✔️ Offer sliding-scale or pro bono sessions without violating insurance contracts.
✔️ Control your own financial model instead of being dictated by insurance.
✔️ Create group therapy options, workshops, or other accessible services outside of insurance restrictions.
If your goal is to provide affordable mental healthcare, private pay often gives you more power to do it—on your own terms.
Insurance Limits Your Clinical Freedom
Want to try an innovative new approach? Better check with insurance first.
Want to see a client for longer than 45 minutes? Not covered.
Want to work holistically instead of chasing diagnostic labels? Good luck.
Insurance dictates treatment plans, session limits, and even whether a client “qualifies” for care.
That’s not how therapy should work.
Going private pay gives you the freedom to:
✔️ Set your own rates.
✔️ Offer longer or more frequent sessions when needed.
✔️ Treat the whole person, not just their diagnosis.
You should be the one making clinical decisions—not an insurance adjuster.
Privacy Concerns Are Real
For some clients, insurance isn’t just a hassle—it’s a risk.
People in careers like military, law enforcement, federal agencies, aviation, and healthcare often avoid therapy because they don’t want it showing up on their insurance records.
Some employers and licensing boards require mental health disclosures, which can make professionals hesitant to seek therapy through insurance.
Private pay gives clients control over their privacy and medical records—removing a huge barrier to getting the care they need.
Who Insurance Works For (and Why That’s Okay)
Here’s the truth: Insurance-based therapy works for big agencies, hospital systems, and community clinics because they have the resources to handle the billing headaches.
If you’re a solo or small group practice, it’s okay to acknowledge that insurance may not be the right model for you.
Clients who truly need insurance-based therapy still have options—but that doesn’t mean you’re obligated to be one of them.
How to Transition to Private Pay (Without Losing Your Mind)
Step 1: Evaluate Your Numbers
What’s your average reimbursement rate from insurance?
How many extra sessions do you need to work just to cover lower rates?
How much time are you losing to claim submissions and denials?
How much are you paying for insurance billing services and support?
You’ll probably realize that raising your rates and reducing your caseload is the most sustainable path forward.
Step 2: Gradually Drop Insurance Panels
Stop taking new insurance clients and focus on building your private-pay caseload.
Notify existing clients 3-6 months in advance of upcoming changes.
Provide referral options or superbill guidance for those who want to continue with insurance.
Step 3: Learn to Market Yourself Effectively
Private pay therapists aren’t just selling therapy—they’re selling transformation.
Your messaging should highlight:
✔️ Your specialized expertise
✔️ The personalization and flexibility private pay allows
✔️ The long-term impact of working with you
Final Thoughts: Build a Practice That Sustains YOU
Leaving insurance isn’t about turning away clients—it’s about turning toward a better way to practice.
A way that supports your well-being.
A way that values your time.
A way that allows you to thrive, not just survive.
The sooner you make the transition, the sooner you reclaim your time, your income, and your ability to provide high-quality care—on your terms.
Your practice. Your rules. Your future.
Thinking about dropping insurance but don’t know where to start?
Join our live webinar, Breaking Up with Insurance: A Step-by-Step Guide to Private Pay Success on March 19th at 1pm EST. Attend in person to participate in a Live Q&A Session so we can answer your most pressing questions. Can’t attend in-person? Register to receive the recording! Everyone who registers will also receive The Private Pay Transition Guide.
