Why most experienced therapists don't take insurance
A straightforward guide to understanding how therapy and insurance really work
When you start looking for a therapist in Philadelphia, you'll quickly notice a split: a short list who take your insurance, and a much longer list who don't. It's natural to assume the in-network ones are the practical choice. In most of healthcare, that's true. In therapy, it's more complicated.
Most experienced therapists start their careers accepting insurance. Many eventually stop — not to be exclusive, but because the economics make it hard to do good work.
Insurance reimbursement rates are low. To stay financially viable, an in-network therapist typically needs to carry 25–35+ clients per week. At that volume:
There's less time to think carefully about each person
Treatment becomes more standardized, less tailored
Burnout is common — and turnover is high
Insurers require a formal diagnosis, which enters your permanent medical record
Insurers can limit sessions and audit treatment records
The therapists who go out-of-network do so because they'd rather work with fewer clients and do it well. That's the structural reality of how the system works.
Read a Propublicla Article explaining the problems with In-Network Care.
What about BetterHelp and similar platforms?
These platforms are easier to access and cheaper upfront. But the central issue is straightforward: you're unlikely to be matched with a seasoned, specialized clinician. Therapists on these platforms are often early-career, paid at low per-session or per-message rates, and face the same high-volume pressures as in-network providers — sometimes worse.
OUT-OF-NETWORK PRIVATE PRACTICE
Same therapist, every session
Smaller caseload — your therapist has bandwidth for your case
You control session frequency and length
No rigid protocol or session caps
No insurer access to your records
APP-BASED PLATFORMS
Hiring standards prioritize licensure over actual skill
High turnover—continuity not guaranteed
Pay structure rewards volume, not clinical quality
Higher risk of personal data sharing
Research consistently finds that the quality of the relationship between you and your therapist is one of the strongest predictors of good outcomes. Anything that undermines continuity works against that.
Learn About a Therapist’s Experience Using BetterHelp.
The good news: your insurance may still help
Many plans — especially PPOs and employer-sponsored plans — include out-of-network mental health benefits. Here's how it typically works:
You pay your therapist's fee at the time of each session.
We provide a monthly superbill — an itemized receipt with the billing codes your insurer needs.
You submit it to your insurance company and receive reimbursement directly, often by check or direct deposit.
Below is a brief primer on how to contact your insurance company and what to ask, in order to ensure you understand what you’re entitled to.
Questions to ask your insurance company
Call the member services number on the back of your card. Ask for a reference number at the start of the call.
Do I have out-of-network benefits for outpatient mental health services?
What is my out-of-network deductible, and how much has been met?
Once my deductible is met, what percentage do you reimburse for out-of-network outpatient psychotherapy?
What is your allowable rate for a standard outpatient psychotherapy session (CPT code: 90834)?
Is it worth the cost?
That genuinely depends on your situation.
If cost is a real barrier and your OON benefits are limited, consistent in-network therapy with a therapist you connect with is meaningfully better than no therapy at all.
But if you're in a position to use your OON benefits, or to pay privately, the evidence generally supports that the quality of the therapeutic relationship and the skill of the therapist matter a great deal. Choosing a therapist because they're in-network is a bit like choosing a surgeon based on who's cheapest rather than who's most qualified. The financial logic is understandable; it's just worth knowing what the trade-off is.