3 Reasons I Don’t Take Insurance

3 Reasons I don’t take insurance

As a private pay therapist I often have people ask me why I don’t take insurance.  The decision not to take insurance is a conscious one. Here are 3 reasons why I don’t take insurance:

Forced Diagnosis

By being private pay, I can offer my clients safety from a forced mental health diagnosis.  Insurance companies typically only cover treatment that is deemed ‘medically necessary’.  In order to deem a treatment necessary, they require a diagnosis of mental illness. Major and minor mental illnesses continue to carry a stigma in our society.  Managed care companies force therapist to make a diagnosis whether or not they feel compelled to make one and ethically, I can not do this.

My clients – YOU- are typically diagnosed with a physical, chronic illness.  Many of these illnesses already carry with them a general misunderstanding and invalidation of symptoms.  Many conditions that are invisible, such as fibromyalgia and lupus, are widely characterized as ‘psychosomatic’ ie they think it’s all in your head!  Being forced to make a mental health diagnosis instead of focusing on quality of life, personal goals and exploration of coping strategies – does not fit within my overall vision as a practitioner.


Managed care agencies and insurance companies can require detailed information about a patient psychiatric history as a condition of paying their therapist. These requirements can compromise confidentiality.  I value the privacy and safety of each and every client’s personal experience.

Treatment Decisions

Insurance companies influence treatment decisions. In my professional opinion, treatment decisions should be influenced by the therapy goals set by the client and the therapist. Insurance companies often choose to limit the types of therapies that are offered, the length of treatment and even what is discussed in treatment.  This often leaves the therapist having to justify their treatment to insurance companies in order to move forward to receive payment which can put stress on a therapeutic relationship.


Due to the limited number of choices and treatment options available as well as the requirement to share information with insurance companies that can be considered intimate and highly confidential, I feel that I am a better therapist and better able to serve my clients by not contracting with managed care companies.


Amanda Pratt, LCSW

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