Why It’s So Hard to Find a Therapist Who Takes Insurance

By Albert Stumm

You finally decide it’s time to start therapy, open the insurance directory, start calling, and quickly hit the same problems. No one seems to have openings. Listings are outdated. Maybe the providers who are available don’t seem like the right fit.

It’s frustrating to have insurance and not be able to use it. But the problem isn’t that therapists are being difficult, or that you’re doing something wrong. It’s a bigger flaw in the way mental health care and health insurance fit together.

Here’s why finding an in-network therapist who takes insurance can still be so hard, and what you can do if the search starts to feel overwhelming.

Insurance Can Help, But It Comes With Tradeoffs

The biggest benefit of choosing a therapist who takes insurance is obviously to defray the cost, and federal mental health parity laws were designed to make mental health coverage more comparable to medical coverage. But using insurance also means therapy has to fit into a system built around medical necessity.

“For insurance, it’s working off a medical model,” said Teri Schroeder, co-owner of Just Mind Counseling. “When you go to see a doctor, it’s like, ‘What’s the problem, then we need to resolve that problem.’”

That model makes sense with an illness or a broken bone. Therapy is often more complicated. Relationship issues, grief, communication problems, life transitions, parenting stress, trauma, or a desire to understand yourself better aren’t something that needs to be cured.

To use insurance, however, a therapist generally needs to give a diagnosis and document treatment around that diagnosis.

“You have to be molded into being given a medical mental health diagnosis,” Teri said. “Sometimes that could be a good fit, but sometimes people want to come to therapy because they want to improve their relationship or they want better communication skills or they want to work through difficult experiences from their past.”

Why Many Therapists Don’t Take Insurance

Most therapists would like to be a therapist who takes insurance and make care more accessible. But accepting insurance can be difficult to sustain.

Insurance companies set reimbursement rates that are often significantly lower than what therapists charge for private-pay sessions, as much as half. Most sessions last close to an hour, and therapists also spend time outside of sessions writing notes, coordinating care, handling billing issues, and responding to insurance requests.

Some therapists leave insurance panels after years of experience because the reimbursement no longer matches their training, expertise, or administrative burden. Some practices that rely heavily on insurance may need clinicians to see more clients each week to stay financially viable, which can contribute to burnout.

None of this means you cannot find an excellent therapist who takes insurance. Many skilled, compassionate therapists do. But it helps explain why the search can be harder than many people expect, especially if you need a specialist, want couples therapy, or are looking for someone with immediate availability.

Insurance Can Shape the Kind of Therapy You Receive

Insurance isn’t supposed to decide your care. In practice, though, insurance rules can influence what gets covered, how long sessions last, and what kind of treatment is easiest to provide.

Couples therapy is a common example. Insurance is usually built around treating an individual with a diagnosis. But couples therapy often focuses on the entire relationship, including communication patterns, emotional disconnection, betrayal, parenting stress, intimacy issues, or recurring conflict.

Evonne Noble, owner of Puget Sound Psychotherapy in Seattle, said that can put therapists in a difficult position.

“A lot of couples counselors will not take insurance on principle,” Noble said. “They don’t want to have to focus on diagnosing Mark’s depression, and then all my couples therapy is supposed to be focused on helping Mark’s depression.”

Session length can also matter. Some therapy fits well into a standard 50-minute appointment. But for complex trauma, high-conflict couples work, or deep emotional processing, that format may not always be ideal.

Noble compared it to an incomplete medical dose.

“It’d be like telling a diabetes patient, take half your insulin,” she said. “The dosing sometimes is insufficient.”

What Clients Often Don’t See Behind the Scenes

When people think about the cost of therapy, they often think only about the time in the room.

But insurance-based therapy often includes a lot of unpaid or underpaid work: verifying benefits, submitting claims, correcting denied claims, responding to audits, documenting medical necessity, justifying continued care, or clarifying why a certain session length or treatment approach is needed.

William Schroeder, co-owner of Just Mind Counseling, said even practices that are good at billing still have claims that don’t pay smoothly.

“There’s a lot of time that also goes into taking insurance, which I think clients aren’t aware of,” he said. “The clinician is often having to call the insurance company spending hours to justify care, and all of that is unreimbursed.”

What to Do If You Can’t Find the Right In-Network Therapist

If you want to find a therapist who takes insurance, start by calling the member services number on the back of your insurance card. Ask specific questions and take notes during the call.

Ask whether you have mental health benefits, what your copay or coinsurance is, whether you need to meet a deductible first, and whether telehealth is covered.

Also ask about out-of-network benefits. If you find a therapist you like who doesn’t take your insurance, they may be able to provide a superbill — a receipt you can submit to your insurance company for partial reimbursement.

You can also ask about a single-case agreement. That’s when an insurance company agrees to cover an out-of-network therapist for a specific client, often because the client can’t find appropriate in-network care. It’s not guaranteed, and the therapist has to agree to it, but it can sometimes expand your options.

If you call several providers listed in your insurance directory and none are available, tell your insurance company that. Ask them to help you find someone who is actually taking new clients and fits your needs.

Noble said consumers often have more agency than they realize.

“They need to treat their insurance like, I am your customer and you owe me services,” she said.

The Bottom Line

Insurance can make therapy more affordable. It can also make therapy more complicated.

That doesn’t mean you should give up on finding a therapist who takes insurance. But you may need to ask more questions, understand your benefits, and consider more than one path to care.

If you are struggling to find a therapist who takes insurance, reach out to us. We’ll work with you to help find ways to get support.

FAQs: Why Is It So Hard to Find a Therapist Who Takes Insurance?