Why I Practice Outside the Insurance Model

When you’re “shopping” for a therapist, you almost definitely factor in cost to make your decision. Sometimes, potential clients are surprised to learn that I don’t accept insurance, so I am taking some time to write about why that is. Hopefully, after reading, you’ll feel confident in your choice to either reach out, or continue searching for a therapist who will accept your insurance.

“So, Kalyn,” you may be asking, “Why make it hard on us? Just take insurance!” Well, dear reader, let me explain! When I was deciding whether to participate on insurance panels, I kept rubbing up against some of the same ethical and logistical questions. Insurance companies play a large role in shaping what care looks like, and that influence doesn’t always align with what’s best for clients or the therapeutic process. Choosing not to participate is one way I maintain more autonomy in my work and keep the focus where it belongs—on my clients! So, whether I am working with couples or individuals, I accept private pay only.

As my work is primarily in the role of couples therapist, one limiting factor when accepting insurance becomes deciding who is the “identified patient”. This is in direct conflict with what most couples therapists practice; we see the couple as the client, not one person or the other. When using insurance, we must assign a diagnosis in order to be reimbursed for care. Though a diagnostic code exists for relationship problems—insurance nerds may know about this—it often is not reimbursed by insurance companies.

“So, why not just accept insurance for individuals?” I can hear this question already! My choice for not accepting insurance goes deeper than reimbursement. Though it is often true that insurance companies are more likely to reimburse a clinician for individual sessions than couples sessions, they also often limit the number of sessions they will pay for, dictate the treatment types they will allow in therapy, and require an abundance of information about the client and in-session details.

I firmly believe that my clients deserve care that isn’t shaped by those constraints. They deserve the freedom to move at a pace that supports change, not one dictated by a policy. And they deserve a space that prioritizes their privacy, autonomy, and the complexity of their experience—without needing to fit it into a system that was never designed for that kind of work. Not to mention, it seems shady to me to accept insurance for some clients but refuse that option to others. This is one area where I feel a blanket policy is the most appropriate.

It's worth mentioning that clinicians who accept insurance are held to very high standards in terms of documentation, HIPAA-compliance, and adherence to evidence-based practices. Even though I don’t work with insurance, my practice operates with the same professionalism, structure, and ethical standards you would expect in any clinical setting. You’ll still complete informed consent and intake paperwork, we’ll review policies and expectations together, and your care is documented in a secure, HIPAA-compliant system. I’m fully licensed and held to the standards of my profession, including ongoing education and ethical guidelines. The difference is not in the legitimacy or quality of care—it’s in the flexibility, privacy, and autonomy we’re able to maintain in the process.

Choosing private pay means more flexibility, more privacy, and a treatment approach tailored to you. It also means being intentional about the investment you’re making in your relationship and your wellbeing. If that aligns with what you’re looking for, we may be a good fit.