The Myth That Clients Won’t Be Able to Afford Therapy: What’s Really Blocking Access to Care?
One of the biggest concerns when therapists leave insurance panels is the idea that private pay rates will make therapy inaccessible. The assumption? That clients won’t be able to afford therapy without insurance.
But is that really the core issue? Or is the larger problem that insurance companies are failing to provide adequate mental health coverage, and that the mental health field is losing more therapists than it’s gaining?
It’s time to shift the focus. The real barrier to access isn’t private pay therapists—it’s a system that underpays providers, burns them out, and creates a workforce shortage that leaves clients without options.
The Real Access Issue: There Aren’t Enough Therapists
The biggest challenge in mental health care today isn’t therapists charging sustainable fees. It’s that there aren’t enough therapists to meet demand.
More therapists are leaving the field than entering it.
Many new therapists never complete licensure because the path is financially unsustainable.
Therapists in the field burn out and quit due to overwhelming caseloads, low pay, and poor work-life balance.
If the mental health field continues to lose therapists at this rate, it won’t matter whether therapy is covered by insurance—there simply won’t be enough providers to meet demand.
Why More Therapists Are Leaving the Profession
1. Low Pay and Unsustainable Caseloads
Insurance companies have set reimbursement rates so low that many therapists can’t survive without overloading their schedules. Seeing 25-30 clients a week (the norm for insurance-based therapists) isn’t just exhausting—it’s a fast track to burnout.
Therapists in private practice are expected to cover rent, malpractice insurance, continuing education, and their own health insurance.
Many in-network therapists make less than a school teacher despite years of graduate education and training.
Without the ability to charge sustainable rates, therapists are left financially insecure and unable to continue in the field.
2. Administrative Burdens from Insurance Companies
Even when therapists do stay in-network, they are often drowning in unpaid administrative work:
Delayed and denied claims leave therapists without income for months.
Clawbacks force therapists to repay money for sessions they already provided.
Excessive paperwork takes hours of unpaid time, reducing availability for actual client care.
When the system makes it so difficult to earn a living, it’s no wonder therapists are stepping away.
The Role of Coaches and Alternative Providers
As more licensed therapists leave the field, we’re seeing a rise in coaches and alternative providers stepping in to fill the gaps.
Many coaches charge higher rates than therapists without facing criticism for it.
Unlike therapists, coaches aren’t bound by insurance restrictions and can market their services freely.
Some coaches have little or no formal training in mental health but are taking on clients who would otherwise see a therapist.
This isn’t to shame coaching—it’s a needed service in many spaces. But it raises an important question: If clients are willing to pay out-of-pocket for coaching, why do we assume they wouldn’t do the same for therapy?
No one expects coaching to be covered by insurance. Yet when therapists charge sustainable rates, they’re often criticized—despite being more highly trained and regulated.
The Truth About Private Pay Therapy
For many clients, therapy is still accessible without insurance:
Out-of-network benefits allow clients to get reimbursed for private pay therapy.
Sliding scale slots make therapy more affordable for those in need.
Nonprofit organizations and training clinics provide low-cost therapy options.
Employer benefits and HSA/FSA accounts can help cover therapy costs.
The real issue isn’t that private pay therapists exist—it’s that insurance companies refuse to cover therapy at rates that make it sustainable for providers.
The Long-Term Impact of Losing Therapists
If we don’t address the workforce crisis in mental health, the future looks bleak:
Longer waitlists will leave clients waiting months (or years) for care.
Fewer therapists will mean higher caseloads for those who remain, increasing burnout.
More unlicensed or unregulated providers will fill the gap, without the oversight or ethical guidelines that licensed therapists follow.
Therapists staying in the field depends on being able to charge sustainable rates. If we want to increase access to therapy, we need to keep therapists in the profession—not shame them for setting rates that allow them to stay.
What’s the Solution?
Instead of focusing on private pay therapists as the barrier, we need to:
Hold insurance companies accountable for paying sustainable rates and reducing administrative burdens. In some cases this means asking for a raise, and sometimes it means leaving contracts that don't work for you.
Support legislation that holds health insurance companies accountable for prompt payment like they did in Texas with the Prompt Pay Act
Support legislation that increases mental health funding and expands access to therapy for those in need.
Encourage therapists to build sustainable practices so they can continue providing care long-term.
Educate clients on out-of-network benefits and other ways to access care beyond in-network coverage.
What’s Your Next Step?
If you’re a therapist struggling with insurance panels, you have options. Leaving insurance doesn’t mean abandoning your clients—it means choosing sustainability so you can continue helping people for years to come.
If you’ve already taken the Should I Drop Insurance? training and are ready to build a thriving, sustainable practice, it may be time for Business School for Therapists—a proven program that helps therapists build a profitable, fulfilling private practice while maintaining clinical integrity.
Take the training or explore Business School for Therapists today.
The Bottom Line: Keeping Therapy Accessible Means Keeping Therapists in the Field
If we truly care about making therapy accessible, we need to focus on keeping therapists in the profession.
Shaming therapists for charging sustainable rates doesn’t solve the problem—it makes it worse. The biggest barrier to care isn’t private pay therapists; it’s a broken system that underpays and overworks providers, driving them out of the field.
Instead of blaming therapists for setting fair rates, let’s demand better from insurance companies and advocate for a system that allows therapists to stay, thrive, and continue helping the people who need them most.
