Why It’s Hard to Find a Therapist Who Takes Your Insurance (and How Out-of-Network Coverage Can Help)
- Pauline Walfisch, LCSW-R, PMH-C
- Oct 23
- 7 min read
Why Finding an In-Network (INN) Therapist Can Be So Difficult
If you’ve searched for a therapist who accepts your insurance, you know the process can feel frustrating. You might get a long list from your insurance company, only to find out that many providers aren’t taking new clients, are no longer accepting your plan, or worse - they don't even call you back.
We get it, it can be maddening when you are desperate for help and finding help becomes just one more burden. We hope that understanding what's happening will help, and even better we’ll give you some ideas about what to do about it. (Pro-tip: Read this before your open enrollment period ends.) Here are the top reasons why finding an in-network therapist can be challenging:
1. Low Insurance Reimbursement Rates
Insurance companies often pay therapists far less than their standard rates. And I mean far less (like 25% of their standard rates in some cases). For one very big and local plan, they have not raised their rates in more than 25 years. For small private practices, these low reimbursement rates can make it financially unsustainable to stay in-network. This is especially true when the therapist is highly trained, experienced, and given a workload that is balanced and promotes therapist wellness.
2. High Administrative Burden
In-network therapists must handle paperwork, pre-authorizations, claim submissions, and follow-ups. At times, they will also wait weeks to receive payment for services. This extra workload and delay in payment, can be time-consuming and stressful, leaving less time for client care. Or additional expenses to pay a billing team to manage these administrative burdens.
3. Privacy Concerns with Insurance
Insurance typically requires a mental health diagnosis and detailed treatment plans. When you choose to use insurance you consent to releasing some personal information to the insurance company (like diagnosis and treatment plan). Some clients and therapists prefer to avoid sharing this information, choosing private-pay for greater confidentiality and privacy.
4. Limited Provider Networks
Insurance companies often have a small number of therapists in their network, especially in rural areas or for specialized services. Insurance companies also do not differentiate by specialty- to the insurance company a therapist is a therapist. But trust me, the therapist who is skilled at treating complex trauma may not be the same therapist as one who treats insomnia with CBT-I. And not all therapists are trained in every speciality. For another example, perinatal therapists with a PMH-C will be far more skilled working with new parents than someone who has never studied psychotherapy in the perinatal period. This makes it very hard to find the right fit even if you are lucky enough to find someone in your plan. While some venture capital- backed companies have gotten into the business of healthcare and expanded some networks with virtual therapists, finding an in person in-network therapist is still a struggle.
5. Demand Outpacing Supply
The demand for mental health services has skyrocketed, but the supply of therapists hasn't kept up. Therapists are all pretty full in general, and the ones who try and over-extend themselves to meet the demand and accept low in-network rates - well they often burn out pretty quickly. This mismatch results in long waitlists, tired and burnt out in-network therapists, high turnover of therapists, and lesser trained therapists who accept insurance.
6. Outdated Provider Directories
Because the turnover is so high, insurance directories aren’t always accurate. Sometimes listing providers who have retired, moved, or no longer take certain plans. Now...imagine that burnt out provider, who decided to get off the plan a year ago, is still getting daily calls from desperate clients looking for services. They have asked the insurance company to remove them from the directory but they have not yet been removed. They struggle to keep up with the calls, and they know they wont be able to help the caller, leaving them both frustrated. So, calls start to go unanswered. Both to save the therapist heartache, and because there just isn't enough time in the day to care for the clients they have, to care for themselves, and to return calls from people they can't help.
7. Therapist Autonomy
Some therapists choose to remain out-of-network so they can set their own fees, choose their therapeutic approach, and work without restrictions from insurance companies. When you are in-network you sign a contract to follow their rules even when you have a different clinical opinion. For example, insurance companies sometimes dictate the amount of time you can spend in a session depending on the diagnosis or treatment you are being provided. Or worse, they will tell you which type of therapy you can provide based on someone's diagnosis. I was once told they would only pay for a 1 hour session with EMDR to treat PTSD. PTSD can only be diagnosed 1 month after the trauma. Despite evidence that EMDR can prevent PTSD, and that the standard EMDR session is (at least) 1 hour, I could only provide (and be paid for) 45 minute sessions until the client was diagnosed with PTSD. I appealed this…And LOST.
How Out-of-Network Therapy Coverage Works
If your therapist isn’t in-network, you may still be able to use your out-of-network benefits—if your insurance plan offers them (or choose a plan that does). November is the time of year where many companies have open enrollment. That means that this is the right time to look for a plan that will increase your options with Out of Network Benefits if your current plan does not.
What exactly is “Out-Of-Network”?
Out-of-Network (OON) means that the therapist has not signed a contract with the insurance company to “participate in their plan”. This means that they have not agreed to follow the insurance company’s rules of care and accept a guaranteed payment amount in exchange for being listed in their directory. These therapists still follow ethical and clinical guidelines- but they are not “contracted” with the insurance company. Essentially, they aren't beholden to the insurance company and they don't get any perks from the insurance company (like being listed in the directory).
Here’s how using an out-of-network therapist typically works:
Check if you have OON benefits Most commercial insurance plans offer out of network benefits. Typically they will specify a deductible you have to pay out of pocket before your OON benefits “kick-in”. We have seen plans with deductibles as low as $50 and as high as $10,000. After the deductible period they will cover a percentage of your bill (or in some unfortunate cases, a percentage of whatever they think is a fair number- Yes, you read that right). For most of our out-of-network clients 80% of their bill is covered. Making the copay (or co-insurance) only slightly more than their INN copay.
Get Paid! Depending on the provider’s policies, and the insurance companies rules, there are a few ways this can go:
You Pay upfront – You pay your therapist their full session fee at the time of your appointment.
Get a superbill – Your therapist provides an itemized invoice you submit to insurance on your own for reimbursement.
Therapist submits the claim instructing the insurance company to reimburse you directly.
Therapist bills directly as an OON provider- If the therapist agrees to “accept assignment” they can bill the insurance company directly. This means that you pay your deductible and your portion of the co-insurance and the insurance company pays the provider directly for the portion they cover.
Pro Tip: Call your insurance provider and ask:
Do I have out-of-network mental health benefits?
What’s my deductible?
What percentage of the provider's fee will be reimbursed? What percentage will I be responsible for?
How do I submit claims?
Benefits of Choosing an Out-of-Network Therapist
Using an OON provider can offer many benefits:
More Provider Options – You’re not limited to the in-network list. You have a much larger pool of therapists to choose from.
Access to Specialists – Find therapists with niche expertise and training (e.g., trauma, EMDR, perinatal mental health).
Access to Good Therapists with Good Self-Care – Find therapists who are not burnt out, who have flexible schedules, who are able to take care of themselves so they can take care of you.
Shorter Wait Times – OON therapists may have more openings, because they are paid more fairly they don't have to “pack their schedules” (or in some cases double book).
Flexibility in Care – Session length, frequency, and approach aren’t dictated by insurance rules.
Feel Better Faster – Get started in treatment faster, get the right treatment, see specialized and highly trained providers. This combination can cut down the duration of time you spend in therapy before you see real results.
Next Steps:
Search for therapists by specialty and location.
Call your insurance company to confirm OON coverage.
Compare the cost difference between in-network and out-of-network options.
Your mental health is worth the investment—whether you choose in-network or out-of-network care.
In-Network vs. Out-of-Network Therapy: A Quick Comparison
Feature | In-Network Therapy | Out-of-Network Therapy |
Cost per Session | Usually lower upfront; you pay a copay or coinsurance. | Higher upfront cost; you may have a deductible to meet before your coverage kicks in. Your co-insurance may be higher than your INN copay |
Insurance Coverage | Your insurance pays a set portion directly to the provider | Your insurance covers a portion which may be sent to the provider or sent to you as reimbursement |
Provider Choice | Limited to therapists in your insurance network- regardless of specialization. | Greater pool of licensed therapists allowing you to look for specialization |
Specialty Options | Fewer therapists with niche expertise. Specialties often not listed in directory information | Easier to find specialists (e.g., trauma, EMDR, perinatal mental health). |
Wait Time | Can be longer due to high demand for in-network providers. | Often shorter; more flexibility in scheduling. |
Therapy Approach | Must follow insurance guidelines for session length/frequency. | Therapists have autonomy over treatment plans and methods. |
Administrative Work | Minimal for the client; handled by the provider. | You may have to submit claims yourself for reimbursement. (In some cases when insurance allows the provider can send the claim- this is what we do at HHP) |
The Bottom Line: In-Network vs. Out-of-Network Therapy
Finding an in-network therapist can be difficult due to low reimbursement rates, administrative challenges, and limited provider availability. But out-of-network therapy coverage can open up more choices, faster access, and specialized care, making it easier to find the right therapist for your needs.
If you can’t find a good match in-network, check your OON benefits—you might be able to work with the therapist you want and still get reimbursed.
Ready to get started with therapy and have questions? We will help you find out what your benefits will cover. Book an appointment or contact us.
Want to learn more about Helping Hands Psychotherapy's services and fees? Click here.
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