Why I’m Not Contracted With Insurance.

I recognize that by not being contracted with insurance companies, I’m making it harder for some people to access care. I try to offset that with a limited number of sliding-scale slots — but I also want to be honest about why I made this decision, because I think it deserves more than a quick line on a fees page.

Over the years in private practice, I’ve been contracted with a number of different insurance companies. Hospitals and large practices have full-time staff whose entire job is calling insurers, challenging denied claims, and untangling billing errors. That’s not something a solo practitioner can realistically sustain. Over time, I noticed what it was doing to my own well-being — the hours spent on hold, the denied claims, the endless corrections. It started to feel like being in an unhealthy relationship: exhausting, draining, and never quite resolved. When I ended those contracts, the relief was immediate.

I share this because I want you to know this wasn’t a decision made lightly, or out of indifference to cost. Much of my work with clients is about helping them recognize and hold healthy boundaries — including, sometimes, the hard work of stepping back from relationships that aren’t sustainable. I try to apply that same wisdom to myself. Ending my insurance contracts was a boundary I needed, to protect my ability to keep doing this work well.

A few more practical reasons

• “Medically necessary” doesn’t cover everyday struggles. Insurance requires a diagnosis that meets their threshold of medical necessity — but a lot of what people want help with doesn’t fit that bar, even when it’s genuinely affecting their life.
• A diagnosis becomes a permanent part of your record. Many people don’t realize that using insurance for therapy means a formal mental health diagnosis enters their permanent medical record — which can affect security clearances, certain careers, and eligibility for life insurance down the road.
• Insurance companies see what they’re paying for. When an insurer pays a claim, they’re entitled to access your records to verify it. I think mental health information deserves to be handled with more care than that.
• The math doesn’t work. Reimbursement rates for licensed clinical mental health counselors are often too low to sustain a private practice — even before accounting for the unpaid hours spent navigating claims and denials. Insurance companies, including publicly traded ones, are ultimately accountable to shareholders, not to clinicians or clients.

If you have questions about this, or want to talk through what it means for your specific situation, I’m always glad to discuss it directly.

I’m not alone in this

If this sounds like one therapist’s frustration, it isn’t. Journalists at NPR, ProPublica, the New York Times, and New Hampshire Public Radio have documented these same patterns across the country — insurers overriding clinical judgment, claims processes designed to wear providers down, and a widening exodus of mental health professionals from networks. A few worth reading:

• Insurers can restrict mental health care. What laws protect patients in your state? — NPR / ProPublica
• Finding a therapist who takes your insurance can be nearly impossible. Here’s why — NPR / ProPublica
• Insurers reap hidden fees by slashing payments. You may get the bill. — The Seattle Times (originally The New York Times)
• Can’t find a therapist? NH clinicians say insurance companies are partly to blame — New Hampshire Public Radio
• ‘Not medically necessary’: Inside the company helping America’s biggest health insurers deny coverage for care — ProPublica / The Capitol Forum