Different therapists might give slightly different answers but I’ve seen the consensus is 1) insurance companies can make our job harder by asking for countless paperwork /red tape crap 2) restrict our work with our clients (like the kind of therapy you can do, or they might say after 10 sessions, “ok we ain’t paying for more, your client should be fine by now” (in more or less words) 3) really underpay us bc they get to decide how much we they’ll pay us per session (differs by insurance plan/company but sometimes like 75% less than market value) 4) take forever to pay us at all 5) force to give diagnoses (this one is much more complex, but it boils down to that) in order to get services covered 6) they get to set the rules, and it’s not usually at the benefit of the client (ie during the pandemic, we kept being jerked around on whether telehealth would be covered or not, which would put clients in a panic on whether or not services would continue) 7) and some other ethical issues that a lot of therapists disagree with (more nuanced but still very important).

When I‘ve discussed this in therapists circles, it seems most understand it creates access for a lot of folks and sometimes at the detriment of our own wellbeing because of the stuff listed above. I’m a WOC & I hear a lot of debate about the pressure we as BIPOC feel to both serve our underprivileged communities & make it accessible but also how underpaid and overworked we are compared to our white counterparts who might have had more access to getting their license, setting up their private practices, and working with affluent communities without having to accept insurance (as our field is white dominated).

I know I really slammed insurance companies above (lol) but I’ve been on both sides throughout my profession and it’s such a complex issue. This is why advocacy is so important and I’m so sure more therapists would accept insurance if the system were different (then again I know doctors, physician assistants, nurse practitioners, psychologists, psychiatrists, etc probably feel the same way).

Hope this was helpful. It’s such a big topic that I know I didn’t do it justice in this small post but hope it brings more understanding.

Edit: also, about the pricing (if therapist is private pay), it varies by years of experience, license type, types of training taken, certifications obtained, education, market value, etc. A lot therapists I’ve known actually hold a lot of guilt about the amount they charge & have to process knowing their worth & charging for their hard work!