In-network Or Private Pay? How To Decide On Health Insurance For Your Private Practice

Choosing whether to contract with a health insurance or not is one of the biggest decisions therapists make – and often grapple with – in private practice.

It's a difficult decision: many therapists contract with health insurance companies as soon as they start their practice, but find the paperwork overwhelming and payment too low; but once they drop the health insurance, they find it much harder to build their caseload.

Not sure whether to contract with health insurances and/or drop insurances? Consider these pros and cons of being an in-network vs. out-of-network provider:

1. Know that, ultimately, the decision for most therapists boils down to payment amount

Ultimately, the decision to be in-network with a health insurance or not boils down to a trade-off between potential hourly income and ease of building a caseload.

"But wait! There are other factors like privacy and time with clients that cause me not to take insurances!" you might say.

Yes, these are all important factors, but when you look across geographies, it's clear: when a health insurance company reimburses more, more therapists are in-network with them.

That said, the decision is nuanced and there are other factors involved; we cover these in further detail below.

2. In-network: Weigh the ease of growing your practice with lower pay and less autonomy

Benefits of being an in-network therapist

While we often only hear the reasons therapists dislike working with health insurance companies, there are benefits to being in-network that help with both work satisfaction level as a private practice provider, and with building a caseload.

For many, being in-network with a health insurance gives them the diversity of clientele they enjoy seeing in their practice, as well as the ability to not worry about referrals and focus on the service they provide.

Limits of being an in-network therapist

On the flip side, low reimbursement, logistical hassle, and limited control over the type of care they can provide are some reasons why therapists choose not to contract with health insurances or drop the health insurances they were paneled with.

3. Private pay: Trade-off between financial benefits vs. investment in growing your caseload

The benefits of a private pay practice essentially reverse all the downsides of being in-network with health insurances.

Benefits to being out-of-network, or private pay only

Limits to being out-of-network, or private pay only


Choosing to join or leave a health insurance panel and/or leave one is a big decision for a private practice therapist – there's a lot of paperwork involved, you need to break the news to existing insurance clients, and it's a decision of investment as well.

If you're willing to put in the investment of time, money, and networking; are able to have the patience to rebuild your caseload; and especially if you already have a solid network of referrals and are known as an expert in your specialty, then private pay may be a good option for your practice.

If you enjoy seeing a diverse clientele, your social justice mission calls to you (especially for social workers), you want to jumpstart your private practice and grow your caseload, you enjoy a steady stream of clients, and/or you're able to sustain a financially healthy practice with your health insurance clients, contracting with health insurances or staying in-network may be the best course of action.

If you're starting private practice or looking to up your marketing game, learn about Zencare to help you grow your online presence, attract your ideal clients, and build your dream practice.