Why Many Therapists Don’t Accept Insurance and How Superbills Can Help You Save

Dear Charla,

I’ve been searching for a therapist, but I’m finding that many therapists don’t accept insurance. It’s frustrating because therapy is such a significant investment, and I’d love to use my insurance benefits to help cover the cost.

Can you explain why so many therapists don’t take insurance? I’ve also seen some therapists mention something called a "superbill." How does a superbill work, and can it help me get reimbursed by my insurance? I’m trying to figure out the best way to make therapy more affordable.

Thank you for your help!

Sincerely,
Curious About Coverage

Hi Curious About Coverage,

You’re absolutely right—therapy is a significant financial investment, and finding a therapist who accepts your insurance can feel like an uphill battle. Unfortunately, there are several systemic barriers that lead many therapists to decide not to accept insurance.

The simplest explanation is that insurance companies often don’t reimburse therapists fairly for their time and expertise. On top of that, working with insurance companies requires therapists to meet extensive administrative demands. These include maintaining detailed clinical reports, submitting claims, waiting months for payment, and dealing with potential claim denials or clawbacks. For many therapists, the time and effort required to navigate this broken system outweigh the benefits of partnering with insurance companies.

This decision, however, places a heavy financial burden on people seeking therapy. Without insurance coverage, clients must either use a Health Savings Account (HSA) or Flexible Spending Account (FSA) or pay out-of-pocket. Sadly, this often makes therapy accessible only to those who can afford it, leaving many without the support they need.

To bridge this gap, many therapists, including myself, choose to operate as out-of-network providers and offer superbills. A superbill is a detailed receipt that outlines the services provided, the session cost, and the amount paid by the client. Clients can submit these superbills to their insurance company to apply toward their out-of-network deductible or request reimbursement. This approach allows therapists to be compensated appropriately for their work while giving clients a chance to recover some of the costs.

That said, it’s important to note that we, as therapists, cannot guarantee that insurance companies will accept superbills or apply the costs to a client’s deductible. It’s frustrating to see how broken the system is, but we do our best to work within its limitations.

To increase accessibility, I maintain a limited number of sliding-scale and pro bono spots on my caseload to support those who may not otherwise be able to afford therapy. I’m also incredibly grateful to clients who can pay my full rate, as this allows me to continue offering superbills and supporting a diverse range of clients.

Thank you for asking such an important question. I hope this explanation helps you navigate the complexities of therapy and insurance.

in community,