Why We Don’t Work Directly with Insurance Companies

And Why That’s Not About You—It’s About Them.

We understand that paying out of pocket for mental health care can feel overwhelming, frustrating, or even unfair. It’s normal to wonder: Why don’t you take my insurance? Especially when you’re already feeling overwhelmed and want support without having to navigate more red tape.

We hear you. And we care deeply about making mental health care as accessible as possible. That’s why we want to explain—transparently and compassionately—why our practice has chosen not to enter into business contracts with insurance companies.

For some broader context, we are all in this boat together. Many of our providers are facing the same out-of-network costs when seeking healthcare for themselves and their families. We know what it’s like to navigate a fractured system, and we don’t take the challenges lightly. In recent years, even our primary care colleagues who do contract with insurance have reached a breaking point. Many now charge annual membership fees to make their practices financially viable.

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What Most People Don’t Know About Insurance and Mental Health Care

At first glance, accepting insurance seems like the obvious choice. But behind the scenes, the relationship between mental health providers and insurance companies is often deeply unbalanced. Here are just a few of the realities many people are surprised to learn:

• Rates rarely go up—even over decades.
  Unlike most industries, where prices rise with inflation, experience, and expertise, many insurance companies continue to pay the same low rates year after year. In fact, when adjusted for inflation, some therapists today earn less than they did 10 or 15 years ago for the same services, even when nominal “rate increases” have occurred. Meanwhile, costs for rent, healthcare, and professional education have soared.

  As a result, in-network therapists are often financially disincentivized from investing in advanced training programs that require significant coursework, supervision, and time. If you’ve ever wondered why it’s so hard to find a therapist who is both in-network and trained in Emotionally Focused Therapy (EFT), EMDR, psychological testing, animal-assisted therapy—or why it’s rare to find doctoral-level providers accepting insurance—this is why.

• Payments can be delayed or “clawed back.”
  It’s not uncommon for providers to go unpaid for months due to technical “glitches.” And even after a claim is processed and paid, insurers may later decide they made a mistake and demand the money back, even after the therapist has already done the work and paid their staff. Imagine doing your job, only to be told months later you have to return your paycheck.

• More time is spent on pre-approvals and paperwork than care.
  Insurance companies often require extensive documentation, phone calls, and approvals just to authorize basic treatment—time that could be better spent helping people. In some cases, therapists spend hours each week simply trying to get paid for sessions that have already occurred. Even as out-of-network providers, our prescribers still spend a significant amount of time advocating with insurance companies and pharmacies to ensure our clients receive the medications they need.

  “When I was in graduate school, I worked in the emergency department at Northwestern Memorial Hospital conducting psychiatric evaluations. I spent countless shifts on the phone with insurance companies, usually at least an hour per patient, trying to justify a 23-hour observation bed for individuals who were detoxing from alcohol, actively suicidal, or experiencing psychosis. Yes, you read that right—an hour on the phone per case, just to approve a single day of care that was clearly and urgently needed. That experience confirmed what I had already heard from adjunct faculty: dealing with insurance companies was something to dread. It was one of the key reasons I chose to join the Navy as an active-duty psychologist after graduation, where I could provide care in a salaried, capitated system similar to an HMO.”
  — Dr. Elizabeth Carr, Founder, Kentlands Psychotherapy

• Corporations, often with minimally trained staff, are making care decisions, not clinicians.
  Treatment plans are sometimes limited or denied by individuals who have never met the client, based not on clinical needs, but on cost-control measures and rigid formulas. This process undermines the relationship between therapist and client and compromises the quality of care.

So Why Stay Out-of-Network?

“I chose for Kentlands Psychotherapy to remain out-of-network not because I don’t care—but because I do. I’ve seen firsthand how the insurance system can erode the quality of care and exploit the very professionals working hardest to help. Staying independent means I can build a practice where clinicians are treated with respect, and where clients receive thoughtful, personalized care—not rushed, cookie-cutter solutions.”
— Dr. Elizabeth Carr, Founder

We believe our clinicians should be able to:

• Spend more time with clients and less time fighting insurance red tape.

• Tailor care to your needs and not to an algorithm.

• Earn a fair, livable wage without being at the mercy of claim errors, arbitrary denials, or profit-driven policies.

We Know It’s a Big Ask

Asking you to pay out of pocket is not an easy request. We deeply respect the sacrifice this can represent, and we’re committed to helping you navigate your options. This includes providing clear transparency in all our fees, providing our clients with “superbills” to submit for reimbursement, and helping you understand what your out-of-network benefits may cover.

It’s not lost on us that in this arrangement, you bear the burden of what’s broken in our system. But we also believe you deserve high-quality, personalized care from a provider who is empowered to show up fully for you—without burnout, interference, or underpayment getting in the way.

We appreciate your trust and investment in your mental health. We promise to honor that investment with the best care we can give.

If you have questions about navigating the system to receive the care you deserve, please call us at (240) 252-3349. We’re happy to talk you through what to ask your insurance company so you can best access your benefits.