The Shaming of Therapists Who Drop Insurance Panels—And Why It Needs to Stop
If you’re a therapist who has ever dared to say the words, “I’m dropping an insurance panel,” or even “I don’t take insurance” you’ve likely been met with some variation of, “But why? What about your clients? How will people afford therapy?” "And sometimes, before the conversation even begins, the shaming starts.
Sometimes is it is direct other times it is indirect:
Well, I take insurance because I care about therapy being accessible
Don’t you want people to be able to use their insurance?
Do you really think anyone can afford your full fee?
I thought you wanted to work with marginalized groups…
This reaction is deeply ingrained in a system that relies on therapists absorbing the burden of a broken healthcare model. But let’s be clear: therapists stepping away from underpaying insurance contracts is not the problem. It is, in fact, a necessary step toward change—one that benefits not just therapists but also clients, the profession, and even those who wish to continue accepting insurance.
The Reality of Insurance-Based Therapy
To understand why therapists leave insurance networks, we have to acknowledge the harsh realities:
Dismal reimbursement rates: Many insurance companies reimburse at rates that do not cover the actual cost of running a sustainable practice. Some therapists make less per hour than a skilled tradesperson (or even a pizza delivery person), despite having advanced degrees and clinical expertise (and a LOT of student loan debt).
Delayed or denied payments: Therapists often have to chase after payments that are weeks or months late, or deal with arbitrary denials that take hours of unpaid work to resolve. Today in March of 2025, Tricare providers haven’t been paid for months for services provided.
Excessive administrative burdens: The paperwork, billing complications, and authorization requests required to stay in-network eat away at time that could be spent with clients.
Clawbacks: Why these don’t happen that often in the grand scheme of being a therapist- if you are working on a slim margin of profits- a clawback of thousands of dollars can be detrimental to a therapist in private practice. And, it is especially frustrating when it was through ZERO fault of the therapist.
Burnout and overwork: In order to make ends meet, many insurance-based therapists are forced to see an unsustainable number of clients each week, leading to stress, exhaustion, and eventual burnout. And even then, these therapists often still have no buffer, savings, retirement, or even time for vacations.
Meanwhile, the top five health insurance companies made over $40 billion in profits in both 2022 and 2023. The system is not broken due to a lack of money—it is broken because that money isn’t making its way to the providers actually delivering care.
Why Saying No to Insurance Is a Step Toward Change
Therapists opting out of low-paying insurance contracts is not an act of greed or exclusion. It is an act of advocacy.
It Creates Pressure for Insurance Companies to Raise Reimbursement Rates Every therapist who drops an insurance panel increases the likelihood that remaining in-network therapists can negotiate higher rates. If therapists collectively stop accepting unsustainable rates, insurance companies will have to adjust to retain providers in their networks.
It Promotes a Sustainable Profession When therapists stop undervaluing their work and charging what they need to thrive, they are able to show up more present and engaged for their clients. They have the bandwidth to pursue additional training, provide better care, and avoid the cycle of burnout that leads to therapists leaving the field entirely.
It Improves Access to Quality Care for Clients While dropping insurance can feel like it makes therapy less accessible, the reality is that a burned-out therapist with an overloaded caseload is not providing optimal care. The sustainability of the profession matters. Clients deserve therapists who are well-resourced, present, and able to do their best work—not ones who are barely scraping by.
Addressing the Shame and Misconceptions
The idea that therapists should stay in-network out of obligation—while corporate insurance giants rake in massive profits—relies on outdated, harmful narratives about self-sacrifice.
“Therapists who leave insurance panels are greedy.” No one says this about plumbers, mechanics, or accountants who charge market rates for their services. Therapy is a profession, not a charity. Therapists have bills, families, and financial goals like anyone else. Fair pay is not greed; it’s sustainability.
“Clients won’t be able to afford therapy.” While some clients will be impacted, many will still be able to access care through out-of-network benefits, sliding scale options, or lower-fee community clinics. The real issue isn’t that therapists are charging sustainable rates—it’s that insurance companies are not covering therapy adequately.
“Therapists leaving insurance networks hurts the profession.” The opposite is true. The more therapists demand fair pay, the more leverage the profession has to create change. This benefits all therapists—those in private pay practice and those who want to remain in-network and negotiate better contracts.
The Bigger Picture: What Needs to Change
For those wondering why therapists can’t simply unionize and collectively bargain for better pay, the answer is frustratingly simple: it is illegal.
Under the Sherman Antitrust Act of 1890, independent contractors—including most private practice therapists—cannot unionize to demand better wages. This law was designed to prevent price-fixing and monopolies, but in modern times, it has been used to prevent self-employed workers from advocating for fair pay.
While W-2 employed therapists can unionize, independent therapists are left with limited options. One of the best ways to push for change is to support other independent workers—such as rideshare drivers—who are fighting for exceptions to these outdated laws. If they succeed, it sets a precedent that could allow therapists to do the same in the future.
Another Long-Term Solution: Legislative Change
Texas has implemented Prompt Pay laws that penalize HMO and PPO insurance companies for delayed payments. However, these laws do not apply to TRICARE or many other major insurers.
We need national legislation that:
Expands Prompt Pay laws to all insurance companies, including TRICARE
Creates financial penalties for delayed payments
Increases transparency and accountability in payer transitions
But for now, can we can leave the shame behind?
A Call for Solidarity, Not Shame
Instead of shaming therapists who leave insurance panels, we should be standing together to challenge a system that exploits mental health providers. Every therapist who walks away from an unfair contract helps pave the way for better conditions for all therapists.
We need to stop guilting therapists into staying in systems that don’t serve them. Instead, let’s ask better questions:
How can we pressure insurance companies to pay therapists fairly?
How can we support each other in building sustainable practices?
How can we educate the public on why therapists are taking this stand?
Therapists deserve to be paid fairly for their work. They deserve to have sustainable careers. And most importantly, clients deserve care from therapists who are financially stable, well-resourced, and present—not exhausted professionals on the edge of burnout.
Dropping an insurance panel isn’t the problem. The problem is a system that forces therapists to make that choice in the first place.
Struggling to Decide Which Insurance Plans to Keep, Drop, or Negotiate?
If you’re navigating the chaos of insurance contracts and wondering if it’s time to drop a payer like TRICARE, we can help.
Take our free training on ditching insurance, diversifying your practice, and negotiating sustainable rates: ZynnyMe Free Training
You don’t have to stay trapped in an unreliable system. Learn how to protect your practice, your income, and your peace of mind.
