Health Insurance and Private Practice: Love, Hate, and Lessons Learned

When I started my private practice in 2014, I knew one thing for sure: I wanted to be in-network with health insurance providers. Why? A few years before that, I had been the client desperately searching for a therapist who accepted my insurance. Therapy was already hard to access, and I didn’t want finances to be the barrier. I figured, if I could be that therapist for someone else (someone working hard like me) then I’d be giving back without compromising care.

Fast forward 11 years, and let me tell you: my relationship with insurance companies has been a full-on love/hate story. Sometimes they’ve helped me grow my caseload and reach clients who otherwise wouldn’t have found me. Other times? They’ve felt like sneaky little traps, draining my energy and threatening my financial security. Sounds dramatic?! Talk to other therapists who have had to deal with health insurances.

Here are some lessons I’ve learned along the way that I wish someone had told me earlier:

1. Don’t Settle for Low Rates

If your reimbursement rates are low, consider negotiating for an increase. And if they decline? You have the right to disenroll. I did. Because here’s the truth: you cannot compromise your financial security. If you show up to sessions resentful because you’re underpaid, nobody wins.

2. Transition with Integrity

When I left certain panels, I gave my clients ample notice and explained the change honestly. I set a fair rate for myself and my clients. I also offered sliding-scale slots, but only in a way that felt sustainable. Remember, sliding scales aren’t about being a martyr. They’re about balance, and you have to decide what works for your practice. It's about finding a fair balance that works for both you and your clients.

3. The CPT Code Debate (90834 vs. 90837)

If you’ve been around long enough, you know this one. The debate over 45-minute versus 60-minute sessions can spark audits. My take? Never compromise a client’s care. If the client clinically needs a 90837, then use it. Just ensure your documentation is thorough and accurate. It's not just a formality, it's your protection. It protects you, it protects your client, and (like it or not) it keeps insurance companies “happy.” We work too hard for our clients to be sloppy with notes.

4. Mix It Up: Insurance + Self-Pay

These days, my practice is a mix of both. Some clients use insurance I’m in-network with. Others, I’m not and for them, I’ve partnered with Mentaya, a platform that helps clients get reimbursed if they have out-of-network benefits. That way, I don’t lose the client, and they don’t feel completely stuck.

5. Assess Your Financial Needs (Not Just Your Heart)

Want to stay in-network? Amazing. Just ensure that you’ve done your research and that the payouts align with your financial goals. Want to stay out-of-network? Kudos to you, too. Tools like Mentaya make it easier than ever to private pay clients. Either way, don’t ignore your own numbers. Your financial health matters just as much as your clients’ mental health.

Ultimately, deciding whether to work with insurance is a deeply personal decision. There’s no one “right” answer. I support you, whichever path you take.

However, here’s what I want you to remember: you don’t have to compromise your worth to be an effective therapist.

If you’re struggling to figure out how insurance fits into your private practice or you’re ready to shift your model and need someone to walk you through the strategy, I’d love to help. I’ve been in the trenches, made the mistakes, learned the lessons, and built a practice I’m proud of. You're not alone in this journey. Let's make sure you do the same without the resentment, confusion, and burnout.

If you’re sitting with this decision and want someone who’s been there to help you think it through, I’d love to be that support. Reach out and I’d be honored to help you build a practice that feels sustainable and true to you.