Why Your Therapist Doesn't Take Insurance

And why that's not about you (or them)

I see you. Scrolling through Psychology Today, filtering by your insurance, watching the results shrink to almost nothing. Finally finding someone who looks like they might get it, might understand your family dynamics, your cultural background, the weight you carry…only to see "private/self-pay only."

And then comes the frustration. Maybe the anger. "Why is mental health care only for people with money? Why don't therapists want to help regular people? Do they even care?"

I've seen these conversations everywhere: Threads, Twitter, Reddit, TikTok. The posts calling therapists greedy. The comments saying we only want rich clients, and I get why people feel that way. When you're struggling and the system keeps telling you no, it's easy to blame whoever's standing at the gate.

But I need you to know: the gate isn't us. We're trapped behind it too.

The System Was Never Built for Us

Let me be real about what happens when therapists work with insurance companies.

Insurance reimburses therapists approximately $40-80 per session, and sometimes even less. For context: I have a graduate degree, thousands of supervised clinical hours, a license to maintain, liability insurance, continuing education requirements, and all the costs of trainings that help me be a better clinician, and insurance wants to pay me less than what you'd spend on a haircut.

A 2023 Government Accountability Office report confirmed what we already knew, low reimbursement rates are one of the main reasons mental health care is so hard to access. These rates haven't meaningfully increased in decades while rent, student loans, and the cost of everything else keeps climbing.

But here's what really matters for our community:

Insurance requires a diagnosis on day one. Before a therapist even knows you, they have to label you with a mental health condition to get your sessions covered. That diagnosis goes on your permanent medical record. For Black and brown folks already navigating systems that pathologize us, that's not a small thing. And what if you just need support processing generational patterns, family dynamics, or cultural identity? Insurance doesn't cover "I'm trying to break cycles."

Insurance dictates your care. They decide how many sessions you "need," what conditions they'll cover, and what treatment approaches your therapist can use. Your healing has to fit their budget. If you need more time…(and trauma work, especially generational trauma, takes time)…too bad.

Finding culturally competent care is already hard enough. Now add the insurance filter. The therapists who specialize in serving BIPOC communities, who understand code-switching and colorism and the particular exhaustion of navigating white spaces, a LOT of them aren't on insurance panels. Because they can't afford to be.

The experienced therapists who've been doing this work for decades? Most have left insurance entirely. Studies show less than 20% of therapists in some areas accept insurance. The ones who do are often newer clinicians still building their practices. Which isn't inherently bad, but it limits your options for specialized, culturally informed care.

Let's address what you're really thinking

"Therapists are just greedy."

Nobody becomes a therapist to get rich. We sit with people's deepest pain. We hold space for trauma passed down through generations, for grief that has no name in English, for the exhaustion of being everything to everyone in families that never learned another way. Believe me when I say, we're not choosing between a yacht and your copay. We're choosing between sustainable practice and burnout that forces us out of the field entirely.

When therapists take insurance at those rates, they have to see waaaay more clients to survive. That means less availability, shorter sessions, and burned-out clinicians who can't show up fully. You deserve better than a therapist watching the clock.

"Mental health care should be accessible to everyone."

Yes. Full stop. But the system is designed to maximize insurance company profits, not your access to healing. The Mental Health Parity Act is supposed to ensure equal coverage, but insurers violate it constantly, delaying and denying claims because people with ongoing mental health needs cost them money.

Your frustration is valid. But aim it at the insurance companies making billions while our communities can't access care. Aim it at a healthcare system that treats mental health as optional. The therapist charging what they need to survive and serve you well? That's not your enemy.

So what do we do?

I'm not here to just explain the problem. You need options. Here's what I want you to know:

Check Your Out-of-Network Benefits

If you have a PPO plan, you likely have out-of-network benefits you're not using. Your therapist can give you a superbill which is a detailed receipt you submit to insurance for partial reimbursement. Many people get 60-80% back. It's extra paperwork, but it can make private-pay therapy much more affordable. Call your insurance and ask about your out-of-network mental health benefits before you assume it's not an option.

Another option is a company called Thrizer, who helps clients navigate their out of network benefits with the insurance company. Note: I am not affiliated with or endorsing Thrizer. I just know of their services.

Ask About Sliding Scale

Many therapists, myself included, offer sliding scale fees, adjusted rates based on your financial situation. We can’t offer it to everyone (we have bills too), but most of us keep a few spots available. It's not always advertised, so you have to ask. When you reach out to a therapist, don't be afraid to say, "do you offer a sliding scale?" The worst they can say is no or their sliding scale spots are full right now. But it’s always worth asking.

Community Is Medicine

No, peer support is NOT a replacement for therapy, especially when you're dealing with trauma, family dysfunction, or the kind of deep work that requires a trained clinician. But healing doesn't just happen in 50-minute increments once a week. Between sessions, or while you're on a waitlist or saving up to start, peer support can help you stay connected and remind you that you're not alone in this.

• NAMI (National Alliance on Mental Illness) offers free peer-led support groups nationwide. Find one at nami.org/findsupport.

  
  

• Therapy for Black Girls has a podcast and directory specifically for Black women seeking culturally competent care.

  
  

• Latinx Therapy offers a directory and podcast centering Latinx mental health experiences.

  
  

• Open Path Collective connects people in financial need with therapists offering $40-70 sessions after a one-time $65 membership. Visit openpathcollective.org.

  
  

• 7 Cups offers free emotional support through trained listeners available anytime at 7cups.com.

  
  

• HeyPeers provides over 1,000 free virtual support groups monthly led by certified peer specialists at heypeers.com.

Again, these aren't replacements for therapy when you need clinical support. But the community heals. Shared experience validates. You don't have to do this alone.

What I'm building

Dear Brown Gyal is a community (primarily centered around Black Caribbean women) I am building and exists because I know this gap firsthand, both as a therapist and as someone who's navigated these systems myself. I'm building a space for generational healing, for breaking cycles, for the conversations our families never had but desperately needed.

Through this platform (see IG,Threads and Substack), I offer content, community, and programming designed for us. Not watered-down wellness content that ignores our lived experiences. Real talk about family dysfunction, boundaries, financial trauma, and what it actually takes to heal while still showing up for everyone who depends on you.

Moving forward

The mental health system is broken. Insurance companies have created barriers that hit our communities hardest - the same communities already dealing with systemic stress, generational trauma, and fewer resources. Neither clients nor therapists win. Only insurance companies do.

Don't stop being frustrated. Channel it. Advocate for mental health parity enforcement. Push your employer to demand better mental health coverage. Vote for policies that treat mental health care as essential. Talk openly about therapy in your circles so others know they're not alone.

And in the meantime, use what's available. Check those out-of-network benefits. Connect with community. Explore the resources here. You deserve healing, and we're going to keep finding ways to make it accessible.

Your healing matters. Your family's healing matters. Let's figure this out together.

-Shima

Dearbrowngyal ™

Neurodivergence and Mental Health: What Care Actually Looks Like

Mental health for neurodivergence isn't about managing symptoms or fitting into a mold. It's about understanding how your brain works and honoring that in your healing process.

Think of your mind like a garden. Some plants need more sunlight, others thrive in shade. Your mental health care should tend to your garden with the right balance — not force every plant to grow the same way.

Growing up Caribbean, neurodivergence wasn't a thing. It wasn't talked about, wasn't recognized, wasn't real. It's becoming more mainstream now, but still not fully accepted, especially by the older generation. If you were "different," you were just difficult. Or dramatic. Or too much.

So if you're only now discovering that your brain works differently, you're not late. You're right on time.

Traditional therapy models often assume a one-size-fits-all approach. But if your brain processes information, emotions, and stress differently, you need care that respects that. Not care that tries to make you fit a box that was never built for you.

When you embrace your neurodivergent mental health, you open the door to deeper understanding and authentic healing - on your terms.

What Healing Actually Looks Like

Healing isn't a destination. It's not waking up one day and feeling nothing about what happened. It's not performing peace so people think you're okay or you're OK with what they did

.

Here's what it actually looks like:

Boundaries that don't need an apology. You say no without the guilt spiral. Or maybe the guilt is still there, but you say no anyway.

Sitting with discomfort instead of running from it. The pain might still come. But it doesn't go as deep as it used to. It doesn't take you out like it once did.

Letting go of the rescue mission. You stop trying to save people who didn't ask to be saved - and they did, recognizing that it's not your job. You stop performing your way into belonging.

Tuning into your own needs, and actually caring for them. Not as a reward. Not after everyone else is taken care of. Just because you matter.

Releasing the wait. You stop holding your breath for the acknowledgment that's not coming. The apology that won't arrive. You stop needing them to see it for you to move forward.

Healing isn't about fixing yourself. It's about coming home to yourself...even the parts that are still tender.

You don't have to be all the way healed to be healing.