If you have been looking for a therapist lately, you may have noticed something frustrating: the ones you want are not taking your insurance.
You call. You check the panel directory. You search your network. And the therapist who comes highly recommended, or whose website actually resonates with you, tells you they are private pay only.
It can feel like a barrier. For a lot of people, it is one.
But there is another side to this that most providers have been hesitant to share publicly. As the owner of Inside Out Therapy, I am going to share it now, because I think you deserve to understand what is actually happening and what it means for the care you receive.
The numbers do not work anymore
When I contract with an insurance company, I agree to their reimbursement rates. What most people do not realize is that those rates are set entirely by the insurance company and have not meaningfully increased in years, often decades, while everything else has.
Consider what a therapy practice actually costs to run: office rent, furnishings, an electronic health records system, phone and internet service, malpractice insurance, liability insurance, business insurance, continuing education to maintain licensure, specialized training in evidence-based approaches like EMDR and sand tray therapy, billing software, a website, and the administrative hours spent on authorizations, appeals, and paperwork that insurance requires.
None of those costs are billable. None of them are reimbursed.
And the rates themselves? One therapist in our local community recently shared that she received $46.01 for a 92-minute intake session from a commercial insurance company. That works out to roughly $245 per day if you see clients back-to-back and never take a day off. Before taxes. Before overhead. Before paying anyone else on your team.
That is not sustainable. It is not close to sustainable. And it means that therapists who stay in-network with insurance are often in a position where they cannot afford to do the work at the level it deserves.
Why therapists cannot simply see more clients
A common question when this comes up is: if the rates are low, why not just see more people?
The honest answer is that quality mental health care has a ceiling, and it is not 40 clients per week.
The clinical standard for a therapist carrying a full caseload is roughly 20 to 25 client hours per week. The rest of the time is not free. It goes toward writing session notes, treatment planning, coordination of care with schools or medical providers, billing and insurance follow-up, reviewing research, completing required continuing education, and the non-clinical work of running a practice.
Beyond the logistics, there is something harder to quantify. Therapists hold the weight of what people bring into the room. That weight does not evaporate between sessions. Processing the things our clients carry, and doing so without letting it compromise our own functioning or our presence in the next session, requires actual recovery time. Therapists who skip that step burn out. Burned-out therapists provide worse care. This is not a character issue; it is a physiological one. The same limits we help our clients understand about their own nervous systems apply to ours.
When insurance rates force therapists into caseloads they cannot sustain without compromising quality, the client pays the cost in ways that are harder to see on a bill.
What insurance actually controls (that surprises most people)
Contracting with an insurance company is not just about accepting their rates. It comes with terms that govern how care is delivered.
Insurance companies can and do require prior authorizations before certain types of treatment begin. They can limit the number of sessions covered in a given year. They can require a formal diagnosis to reimburse for services, which means a mental health diagnosis goes into your permanent health record even if you came in for something situational, like navigating a difficult life transition or processing a relationship ending.
Insurance companies also have the ability to audit records, require clinicians to justify treatment decisions, and cut reimbursement rates mid-contract with little notice. When therapists speak publicly about these realities, they risk retaliation from the panels they depend on. Most have stayed quiet because the financial risk of speaking up is too high.
The care you receive in therapy is shaped, in part, by decisions made by people who have never met you and have no clinical training. That is the piece most clients do not know until someone tells them.
What private pay actually buys
This is the part I want to be direct about, because "private pay" can sound like a premium for the same thing. It is not.
When you pay out of pocket for therapy, you get a few things that are structurally different.
Clinical freedom. Your therapist decides what you need, how often to meet, and what approaches to use, based entirely on you. There is no insurance company approving or denying those decisions. At Inside Out, that means we can draw on EMDR for trauma processing, sand tray therapy for clients who process better experientially or nonverbally, or a combination of both — based on what actually fits you, not what an insurance company has approved.
No mandatory diagnosis. If you do not meet criteria for a diagnosable condition, that does not disqualify you from getting support. Life transitions, relationship strain, burnout, grief, anxiety that does not rise to a disorder level: these are all valid reasons to seek therapy, and private pay allows us to work with all of them.
Confidentiality that is more complete. Insurance companies have access to your clinical records as a condition of payment. Out of pocket, your records stay in our practice and are not shared with a third party unless you choose to involve one.
A therapist who can sustain the work. This matters more than it sounds. A clinician who is not overloaded, not fighting insurance companies for every session, and not financially underwater shows up differently. That is the practitioner you want holding the hard things you bring to the room.
What about people who genuinely cannot afford it?
This is the real tension, and I do not want to gloss over it.
There are people in our community who have insurance specifically because private pay is not accessible.
The frustration those families feel when providers leave panels is legitimate. A parent trying to get mental health care for a child, a first responder who finally decided to ask for help, a mom who is barely holding it together: they should not have to choose between their insurance benefits and quality care. The system that puts them in that position is the problem, not them.
What I can say honestly is this: the answer to that systemic problem is not for therapists to absorb an untenable financial model indefinitely. The answer is better reimbursement rates, meaningful insurance reform, and expanded access to community mental health resources. Those are worth fighting for, and many providers in this area are doing exactly that.
In the meantime, if cost is a barrier, it is worth asking about. Some private pay practices offer reduced fees for a limited number of clients. Some work on a sliding scale tied to income. Some may be able to provide a superbill, which you can submit to your insurance for potential out-of-network reimbursement. None of those are guaranteed, but they are worth a direct conversation.
Why I am sharing this
Inside Out serves adults, adolescents, and children in the Peoria and Phoenix area. We do work I believe in, using approaches like EMDR and sand tray therapy that do not just manage symptoms but work at the level of the nervous system — changing how the body holds and responds to what it has experienced. That work takes time, clinical skill, a clinician who is not burned out, and the freedom to choose the right tool for the right person.
I started this practice because I wanted to do this work well. Staying in a system that makes doing it well nearly impossible is not a sustainable answer for our clients or for us.
If you have been hesitant about private pay therapy, I understand. I hope this gives you a clearer picture of what is behind the change you are seeing, and what you are actually getting when you invest in care outside of insurance.
If you want to talk about what working together could look like, we are here for that conversation.
Questions people ask about private pay therapy
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Your insurance covers sessions, but it also shapes how those sessions can be delivered. Out-of-network therapy gives your clinician more clinical freedom, removes the mandatory diagnosis requirement, and keeps your records more private. For people dealing with things that do not fit neatly into a diagnostic category, or who want care that is not subject to insurance approval processes, private pay changes the actual experience of therapy, not just the billing.
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Rates vary by provider, experience level, and specialty. At Inside Out, session fees reflect the clinical training, specialized certifications, and years of experience our team brings. We are happy to talk through fees directly during a free consultation call.
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Depending on your plan, you may have out-of-network benefits. We can provide a superbill, which is an itemized receipt you can submit to your insurance company for potential reimbursement. How much you receive back depends entirely on your specific plan. It is worth calling your insurance company before your first session to ask what your out-of-network mental health benefits look like.
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Rates reflect the actual cost of providing care, not what an insurance company has decided to reimburse. When therapists leave panels, they are typically setting rates that allow them to maintain quality caseloads, continue specialized training, and run a practice that is sustainable long-term. The rate you pay privately is closer to the real cost of the service than what insurance has conditioned us to expect.
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This is worth asking about directly rather than assuming the answer is no. Some practices, including ours at certain times, carry reduced-fee slots. Community mental health centers and training clinic programs may also be options depending on your situation and location. We would rather have that honest conversation with you than have cost be a barrier that goes unaddressed.
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Yes, in a meaningful way. When insurance pays for mental health services, a billable diagnosis is typically required and goes into your insurance records. Seeing a private pay therapist means your session information stays within our practice and is not shared with your insurance company. If diagnostic history, privacy, or employment considerations matter to you, this is worth factoring into your decision.