You may have noticed that many therapists are leaving insurance networks to become private pay practices. As a mental health therapist of 12 years, I’ve seen the profound effects that therapy can have on people’s lives. Therapists have long recognized the value of the therapeutic relationship, typically having gone through their own therapy themselves prior to becoming a provider.

But there’s a stark, unsettling reality many clients never see that lies behind the scenes: insurance companies are not just failing therapists—they’re failing you, the people who need care the most by cutting corners, micro-managing care, and giving little to no care to smaller mental health practices that can’t fight back to the mistreatments of a large corporate organization.

This isn’t just a small hiccup in the system. It’s a pattern of injustice, abuse, and corporate greed that’s driving more therapists to leave insurance networks for good.

The investigative journalism newsroom, ProPublica, ran a recent series titled, “Why I Left the Network,” where they interviewed therapists from all over the country regarding their reasons for ending their contracts with insurance companies. This isn’t the first time there has been an article on this topic, though due to the volume and popularity of the audience of ProPublica, this series has caused quite a stir. Not surprisingly, this series has sparked more conversation within the therapist community as well as within circles of those who utilize therapy for their own health and well-being.

In my opinion, this series has become a catalyst for much-needed dialogue about the WHY behind the growing exodus of therapists from insurance networks, and I want to dive into some of the challenges that therapists face regularly when they choose to use insurance for their businesses so you are well-informed as the consumer of this service as well as a member of an insurance plan. These practices not only erode the livelihoods of those providing care but also limit access to quality treatment for the people who need it most.

Let’s break down the key issues at play and why this is a fight we all need to pay attention to.

1.Clawbacks: Financial Gut Punches Without Warning

One of the most egregious practices insurance companies use against therapists—and all healthcare providers, for that matter—is the concept of clawbacks. This is when an insurance company decides, often months or even years after a session has taken place, that they “overpaid” a provider and retroactively takes back the money. And here’s the kicker—there’s no set timeline for when they can do this.

In the ProPublica article, one therapist explained, “It felt like I was being punished for doing my job. I would get paid for services I provided in good faith, only to have that money snatched back months later with no warning.”

These clawbacks create immense financial instability for therapists. Imagine paying your bills, rent, and practice expenses, and then suddenly finding out that the money you thought you earned months ago is being taken back. Therapists aren’t given much recourse, and it’s a clear sign of how little power we have in the system.

Clawbacks can force therapists into a situation where they’re essentially working for free. This doesn’t just hurt us—it means that fewer therapists are willing to work within the insurance system because they literally cannot afford to, limiting access for clients who rely on their insurance to get care.

2.Denied Claims: Services Performed, but No Payment

Another major problem therapists face is the rampant denial of claims for services that have already been provided. After a session, therapists submit claims to the insurance companies expecting to be paid for the work they’ve done. But insurance companies have perfected the art of denial—claiming, for instance, that the treatment wasn’t “medically necessary,” or finding some obscure reason to avoid payment such as a typo on the claim form, incorrect birth date they have for the client in THEIR system, or any other number of unknown reasons. When there’s an error like this, it’s on the therapist to figure out why there was a denial. Often the insurance company defers them back to their claim form with a, “you figure it out” response before they will consider reconsidering the claim.

In “Why I Left the Network,” one therapist shared their frustration: “I would pour my heart and soul into a session, only to get a notice weeks later that the claim was denied. No clear explanation, no real reason—just a flat-out refusal to pay for services I’d already provided.”

This is the reality we face: doing the work, helping clients, and then being told that the system doesn’t value it enough to pay for it.

And the appeals process? It’s a nightmare. Therapists can spend hours fighting these denials, jumping through bureaucratic hoops, often to no avail. We spent precious time between appointments trying to get a hold of an actual person within the provider resource branch of the insurance company and often have to hang up before we get a resolution because we have to attend a session. Better luck tomorrow, I suppose…

This unpaid administrative work adds to the stress and burnout that are already rampant in the profession.

3.Navigating the Customer Service Maze: Automated Hell

Have you ever tried calling your insurance company to sort out a problem and found yourself trapped in a seemingly endless loop of automated responses and hold music? The provider side of insurance customer support is often 10 times worse. The automated system directs us to an online portal. The online portal directs us back to the provider phone line. Insurance intentionally makes this process difficult so therapists often give up out of either lack of time or sheer frustration and aren’t able to figure out the issue and never get paid for the claim.

Additionally. when we do try to call insurance companies to resolve issues—whether it’s a denied claim, a delayed payment, or a question about coverage—we’re often met with complex, confusing customer service systems. Automated menus send us in circles, and when we finally reach a human being, they’re often not equipped to help us. We might be transferred multiple times, each person passing the buck, until we’re forced to hang up (or are hung up on “accidentally”) out of sheer exhaustion.

As one therapist explained in the ProPublica piece, “I would spend hours on the phone with insurance companies, just trying to figure out why I wasn’t getting paid for services I’d already provided. The system felt deliberately designed to wear me down, to make it so frustrating that I’d give up.” This level of inefficiency is demoralizing, and it’s clear that the insurance companies have little interest in actually resolving problems—they’re just biding time, hoping providers will quit pursuing their rightful payments.

4.Restricting Access to Care: The Injustice of Session Limits

Another injustice therapists constantly face is insurance companies’ arbitrary session limits. Regardless of how severe a client’s mental health condition might be, insurance companies often impose strict limits on the number of therapy sessions they’ll cover or the length of session time they will allow. This is yet another way they prioritize profits over people. These “rules” are often unknown and are situation dependent with no actual rhyme or reason. One therapist may get a warning to stop providing 90837 services (53+ minutes) and told to only provide 90834 services (45 minutes) while another never gets a warning.

One therapist in the ProPublica article said, “I had clients dealing with severe trauma, people who clearly needed long-term, consistent care. But I was constantly having to justify to the insurance companies why they needed more than just a few sessions. It felt dehumanizing, like I was being asked to put a price tag on my clients’ well-being.”

Additionally, add-on codes were removed from the billing schedule a couple of years ago, meaning that many new and highly effective therapies (such as intensive trauma therapies that may last 90 minutes+) are no longer reimbursed more for the additional time. Whether a session is 53 minutes or an hour and 53 minutes, the reimbursement rate stays the same.

This practice forces clients to either pay out of pocket for additional sessions or simply go without the care they need. And for therapists, this constant battle with insurance companies drains time and energy that could be better spent focusing on providing care.

5.The Emotional and Financial Cost: Why Therapists Are Leaving

Given all these injustices, it’s no surprise that therapists are leaving insurance networks in droves. We simply can’t continue to operate within a system that devalues our work, underpays us, and makes it nearly impossible to provide the kind of good quality care our clients deserve.

But make no mistake—this isn’t about therapists “wanting more money” or “not caring about accessibility.” It’s about survival. The mental, emotional, and financial toll that comes with working in this broken system is unsustainable for solo providers or small group practices. Many therapists, myself included, want to show up fully for our clients, but the constant fight with insurance companies had made it nearly impossible to do so.

What Does This Mean for You?

For clients, this shift away from insurance networks may feel overwhelming, but leaving the insurance system actually allows us to provide better care. When therapists are free from the oppressive practices of insurance companies, we can focus on what matters most—your well-being.

While this may mean higher out-of-pocket costs for some, many therapists offer sliding scales, and there are ways to use out-of-network benefits (such as with Mentaya), HSAs, or FSAs to help cover the costs. By stepping away from insurance networks, we regain the ability to treat you as an individual, not as a number on an insurance claim.

The Bigger Picture: A Call for Reform

At the heart of this issue is a healthcare system that has long prioritized corporate profits over human care. The mental health industry is just one part of this hugely broken machine. We need systemic reform that recognizes the true value of mental health care, compensates therapists fairly, and makes treatment accessible without forcing therapists and clients into a bureaucratic quagmire.

ProPublica’s article “Why I Left the Network” captures just a fraction of these issues, and I encourage you to read it in full here. The more people who understand the realities behind insurance networks, the closer we’ll get to creating the change that’s so desperately needed.

Please also know that therapists are finding ways to join together to take collective action against the injustices in the insurance system (even though anti-trust laws ‘prohibit’ us from doing so). We want mental health to be accessible to all, but we need to all join together and take a stand in order for this dream to become a reality in our future.