Why Doesn't My Therapist Take Insurance?
Have you ever wondered why your therapist doesn't accept insurance? Or maybe you're looking for answers on how to use your out-of-network benefits to help cover the cost of therapy?
You're not alone, and you're not imagining things. It's becoming increasingly common for high-quality therapists, especially in larger cities like New York, to practice outside of insurance networks entirely. Before we explain why, let's start with a quick lesson in insurance basics.
Insurance 101: Key Terms to Know
Insurance language can be confusing even under the best circumstances. Here are a few terms worth understanding before you start (or continue) your therapy journey:
Premium: the amount you pay your insurance company each month for coverage, regardless of whether you use it.
Deductible: the amount you must pay out of pocket each year before your insurance starts covering costs.
In-network: a provider who has a direct contract with your insurance company and accepts their negotiated rate.
Out-of-network (OON): a provider who does not have a contract with your insurance company. You typically pay the provider’s full fee, and your insurance may reimburse you for a portion afterward.
Superbill: a detailed receipt your out-of-network therapist provides, which you submit to your insurance company to request reimbursement.
Reimbursement: the amount your insurance company pays you back after you submit a claim for out-of-network services.
What Does "Out-of-Network" Actually Mean?
When a therapist is in-network, they've agreed to accept a negotiated rate from your insurance company in exchange for being listed as a covered provider. You pay a copay, and the rest is billed directly to your insurer.
When a therapist is out-of-network, like the clinicians at SoHo Psychotherapy, there's no contract between the provider and the insurance company. Instead, here's how it typically works:
You pay the full session fee directly to your therapist at the time of service.
Your therapist provides you with a superbill, a receipt that includes the diagnostic code, session date, and fee.
You submit that superbill to your insurance company.
If your plan includes out-of-network benefits, your insurer reimburses you directly, often a percentage of the cost, after your deductible has been met.
This is an important distinction: with out-of-network benefits, you are reimbursed, not billed at a discount upfront. Many PPO plans include OON mental health benefits, though the percentage reimbursed and the deductible required vary widely by plan, so it's worth calling your insurance company to ask directly.
Why Doesn't SoHo Psychotherapy Take Insurance?
This is a fair question, and not one we take lightly. Practicing outside of insurance networks is a deliberate choice, rooted in what we believe creates the best possible care for our clients.
It allows for truly individualized treatment.
Insurance companies require a specific diagnostic code in order to pay for services, along with documentation that justifies ongoing treatment within their guidelines. That means in-network therapists are often required to fit each client's experience into a predefined box, even when that doesn't reflect what's actually happening in the room and their lives.
By working outside of insurance, we're able to treat the whole person rather than a diagnosis, and build treatment plans around what someone actually needs rather than what an insurance claim form requires.
It allows us to spend our time on clinical work, not paperwork.
In-network therapists often have to satisfy detailed documentation requirements for every session in order to get paid and avoid claims being denied. That can mean writing extensive session notes and summaries that exist primarily to justify treatment to a reviewer, not to support the client.
Working outside of insurance frees up that time and energy for the work that actually matters.
Newer clinicians often rely on insurance panels to build experience.
Many therapists join insurance networks early in their careers as a way to build a caseload while gaining experience. As clinicians become more established, they often transition away from insurance, in part because reimbursement rates are typically lower than what a seasoned specialist's time is worth, and in part because they no longer need the referral pipeline that insurance panels provide.
This is consistent with broader trends; reporting from ProPublica and NPR has found that therapists are typically paid far less by insurance companies than what they could earn from out-of-network clients, with one analysis finding therapists earn roughly $98 for a 45-minute session through insurance, compared to more than double that working independently.
It protects your privacy.
When a therapist bills your insurance directly, the insurer requires detailed clinical notes and a diagnosis to evaluate and approve continued treatment. That means a claims reviewer, sometimes a third party, sometimes overseas, and sometimes an AI bot, has access to the details of what you share in session.
As an out-of-network provider, our team is only required to provide a summary of treatment progress for reimbursement purposes, not a full account of what's discussed. We believe what happens in the therapy room should stay as private as possible.
We also want to be honest that none of this means insurance-based care is bad, or that in-network therapists provide worse care. Plenty of wonderful, skilled clinicians work within insurance systems, often because they're deeply committed to making therapy accessible. Our decision is simply about the kind of practice we've chosen to build, and the kind of care we want to be able to offer without compromise or bending to insurance requirements.
Getting the Most Out of Your Out-of-Network Benefits
If you have a plan with out-of-network benefits, there are a few things worth knowing:
Check your deductible: Many plans have a separate deductible for out-of-network services, and reimbursement often increases significantly once that deductible is met.
Pay attention to open enrollment: If your current plan doesn't offer strong out-of-network mental health benefits, open enrollment is your window to choose a plan that does.
Ask your insurer directly: Specifically ask your insurance provider: "What are my out-of-network outpatient mental health benefits and deductible?"
Keep your superbills organized: Many clients submit them monthly or quarterly, depending on their insurer's process.
A Note on Privilege and Access
We know that paying for therapy out-of-pocket, or relying on partial reimbursement through out-of-network benefits, is a privilege not everyone can access, and we don't take that lightly. At SoHo Psychotherapy, each clinician reserves a specific number of sliding scale spots in their schedule. If you are curious if you would qualify, please inquire!
Schedule a free initial consultation here.
SoHo Psychotherapy is a private-pay, out-of-network therapy practice located in SoHo, New York City. We provide superbills for all sessions to support clients in seeking out-of-network reimbursement through their insurance plans.