Stop Shaming Therapists: Why Therapists Who Leave Insurance Panels Are the Opposite of Greedy
Therapists who step away from insurance panels often face unfair criticism. One of the most pervasive myths? That leaving insurance is a greedy move, prioritizing profit over client care. But this assumption ignores the reality of what it means to run a sustainable private practice, provide ethical care, and resist a broken system that exploits mental health providers.
It’s time to unpack this misconception and explore why therapists moving away from insurance isn’t about greed—it’s about integrity, sustainability, and better outcomes for both therapists and clients.
The False Narrative of Greed
When a therapist decides to stop taking insurance, they’re often met with comments like:
“You should care about making therapy accessible.”
“How can you justify charging so much?”
“You’re only in this for the money.”
But let’s be real—no one says this about other professionals who set their rates according to their expertise and expenses.
Plumbers, accountants, and mechanics all charge for their services based on their skills, training, and the costs of running a business. No one accuses them of greed for expecting fair compensation and their services not being covered under someone's homeowners or renter's insurance. Yet, therapists—who spend years in education, accrue significant student debt, and take on the emotional weight of others’ struggles—are expected to undervalue their work.
Why?
Fair Pay Is Not Greed—It’s Sustainability
The reality is that therapists who leave insurance panels are often making a difficult, ethical decision. Here’s why:
1. Insurance Reimbursement Rates Are Truly Unlivable for Some
Many insurance companies pay rates that make it impossible to run a financially viable practice. A therapist with a master’s or doctoral degree may earn less per hour than a plumber or even a pizza delivery driver after factoring in business expenses, taxes, and the time spent on unpaid administrative work.
Even if a therapist sees 25-30 clients per week (an unsustainable caseload for many therapists and in many niches), low reimbursement rates often leave them struggling to cover office rent, health insurance, continuing education, and other essential business and living costs. The majority of therapists we meet do NOT have a backup plan for retirement, disability insurance, and are a few months away from some pretty serious financial consequences.
2. Therapists Who Charge Sustainable Fees Provide Better Care
A therapist who is financially stable can:
See a manageable number of clients instead of overloading their schedule just to pay the bills.
Refer out clients who aren't a good fit instead of feeling fearful of not having enough.
Invest in continuing education, specialized training, and clinical consultation.
Show up to each session fully present and engaged, rather than drained and exhausted.
Offer lower-fee slots, pro bono work, or sliding scale options without risking burnout.
Therapists who are forced to work at unsustainable rates are at a higher risk of burnout, which ultimately harms client care.
3. Diagnosing Clients for Insurance Reimbursement Is an Ethical Issue
In-network therapists often face a painful ethical dilemma: Diagnosing clients even when it may not be clinically necessary, just to secure insurance coverage.
For clients with normal life stressors, grief, or relationship challenges, a formal mental health diagnosis might not be appropriate. But insurance companies require one for reimbursement as well as documentation of medical necessity. This creates a pressure to pathologize, even when it’s not clinically warranted.
Private pay therapists can work with clients without forcing a diagnosis that follows them for life. They can also provide the treatment length and modality that’s actually needed, instead of being limited by what an insurance company deems “medically necessary.”
Who Is Really Being Greedy?
Let’s take a look at where the real financial disparity lies:
The top five health insurance companies made over $40 billion in profits in both 2022 and 2023.
In late 2024, Alma and Headway (third-party credentialing services) lowered reimbursement rates for therapists after renegotiating contracts with UnitedHealth’s Optum.
Therapists are starting to notice the online tech companies that are paying them abysmal rates are paying people NOT providing the core service better.
Tricare providers went months without payment for services already rendered.
If we’re going to talk about greed, let’s focus on the corporations making billions while therapists struggle to get paid for work they’ve already done.
Therapists saying no to insurance panels isn’t greedy—it’s a stand against a system that exploits providers while prioritizing profit over mental health care.
The Business of Therapy: A Reality Check
Therapists are business owners and humans. Just like any other professional running a business, they have expenses that go beyond their hourly rate. A $150 session fee does not mean the therapist is taking home $150 per hour. In reality, that fee covers:
Office rent and utilities
Malpractice insurance
Continuing education
Admin time (insurance paperwork, scheduling, consultations, notes)
Business taxes (self-employment tax is higher than W-2 employees pay)
Retirement savings (since no employer provides benefits)
Health insurance (which is expensive without employer coverage)
Many therapists can actually be making less than minimum wage or a barista when taking insurance or working for online tech giants once they factor in unpaid labor, delayed payments, and clawbacks (where an insurer demands repayment for past sessions, sometimes years later).
If an insurance contract means a therapist can’t pay their bills, afford healthcare, can’t take time off, and can’t afford to retire, then staying in-network isn’t noble—it’s unsustainable.
The Bigger Picture: Why This Matters for the Profession
Therapists leaving insurance networks doesn’t harm the profession—it strengthens it. Every therapist who refuses unsustainable contracts pushes insurance companies toward fairer reimbursement rates. Those who stay in-network benefit from this collective action, as insurers are forced to adapt to retain providers.
Therapists deserve to be compensated fairly for their work, just like any other highly trained professional. When they charge sustainable rates, they’re able to provide better care, take care of their own mental health, and remain in the field long-term.
So, What’s the Next Step?
If you’re a therapist wondering whether to drop an insurance panel, you’re not alone. The system is broken, and therapists stepping away from unfair contracts is part of the solution.
If you’ve already taken the Should I Drop Insurance? training and want deeper support, it may be time to join the Business School for Therapists—a proven program designed to help therapists build a sustainable, fulfilling, and profitable private practice.
Take the training or explore Business School for Therapists today.
Final Thought: Stop the Shame, Start the Change
Therapists leaving insurance networks are not greedy. They are reclaiming their worth, protecting their mental health, and demanding fair compensation for their expertise. And in doing so, they are advocating for a profession that serves both therapists and clients better in the long run.
Instead of shaming therapists for leaving insurance panels, let’s focus on the real issue: The insurance companies that created this problem in the first place.
