by Jessica Smith, Director of Operations and Dr. Kendra O’Hora, Owner
Reading Time: 10 minutes

Insurance, Therapy, Dollar Signs – Oh My!

If you’ve ever wondered why some therapy is free (pro-bono), some only requires a small copay, ($15-40), and some can be upwards of $150-300 per session, you’re not alone. 

At Wellness & Co., we believe that therapy is one of the most valuable investments you can make in yourself.

We have some very intentional reasons why we’ve built the business model we have and choose not to partner with insurance. If you’re used to paying for healthcare with your insurance card, you might wonder why we don’t work directly with insurance companies. Good question!

We know using insurance can feel like the easiest and most affordable option, and it’s never our goal to create barriers to treatment. We want to be open about why we’ve chosen a different path…

We Desire for Therapy to be: Personal, Private, and Flexible. 

For us, it comes down to keeping therapy as personal, private, and flexible as possible, without the limitations and red tape that can come with insurance. 

We actually see our process as creating less barriers in exchange for serious long-term gains in the mental health and emotional health department.

In this post, we’ll walk you through the key reasons behind our private-pay model, how it benefits our clients, and the values that guide this choice.

Five Limitations of Insurance-Based Therapy

Limitation #1: Insurance Requires Diagnosis to Cover Care

Imagine going to therapy just to manage stress from a new job, but being told you need a mental health diagnosis like “anxiety disorder” or “Bipolar II” for coverage to kick in! 

That label might not truly fit—but insurance wants a diagnosis code before you can get support, often required by the third session when the provider is still assessing your needs. Many people seek therapy without meeting the criteria for an official mental health diagnosis, yet they can still benefit immensely from support, guidance, and coping strategies. 

Limitation # 2: Insurance Can Limit the Number of Sessions You’re Allowed

Your insurance likely *already* has a number of sessions they cover and allow. Similar to doctors appointments and how your policy may have a number of well visits and sick visits covered each year, they also have limits on mental health/therapy. After those allowed sessions, it’s all on you to cover the cost of those appointments or procedures. 

But therapy isn’t like walking into an urgent care to be treated. Establishing a safe and connected/fulfilling relationship with your provider is actually one of the biggest predictors of your change and growth (that’s why it’s listed on our website – the research backs this up BIG time). If your insurance carrier only covers six sessions and then you have to pay the full fee anyway, you’re stuck. You’re stuck with a provider that may not be the best fit for your needs and now you also HAVE to pay out of pocket. 

Limitation #3: Insurance Requires Treatment Justifications vs. Clinical Expertise

Building off the previous limitation…not only does insurance require diagnosis and restrict session quantities, but they also can require documentation that justifies treatment. So, rather than our documentation demonstrating that you’re growing, even if slowly, many times a provider needs to indicate that you’re still struggling.

In their world, you need to be “ill” to “deserve” more sessions. Doesn’t that feel icky?

These administrative requirements can affect the therapy experience. When therapists work with health insurance companies, they must follow strict billing guidelines, maintain detailed documentation, and comply with audits or periodic reviews. While these procedures are designed to ensure accountability, they can be incredibly time-consuming and add stress for therapists, taking attention away from the heart of therapy: the client. 

The need to justify each session, track progress in specific ways, and adhere to administrative requirements can sometimes influence how therapy is structured, what topics are addressed, or even how a therapist frames a client’s experiences. Picture your therapist spending an hour filling out insurance forms after your session instead of preparing and sending thoughtful resources or planning the best next step for your growth.

At Wellness & Co., we mitigate all of this by refusing to adhere to the red tape of session limitations and justifications. Here, we can document that you’re growing *and* that you still benefit from ongoing care. We can kick six sessions or ten sessions to the curb and work with you for years, if you’d like. Long-term care with a provider can offer so much stability and security as you’re healing.

What’s the natural consequence of treatment justification and administrative protocol?…clinical stifling. 

When insurance companies require extensive justification for mental health treatment, providers may feel pressured to conform to standardized models of care, which can inadvertently diminish their clinical judgment and the individualized approach essential to effective therapy.

Are there evidence based, effective ways to treat specific mental health conditions? Yes, absolutely! And at Wellness & Co. we do those treatments when the path is indicated and makes sense. Other times, people aren’t so typical and neither is their pain. They need tailored, customized approaches that come from clinical discernment and a unique relationship with the client.

At Wellness & Co., we prioritize creating a space where therapy remains focused on your growth, healing, and well-being, free from external pressures that can dilute the process. By remaining a fee-for-service practice, our clinicians can devote their full energy to you, making thoughtful decisions based on your needs rather than insurance mandates.

That’s the kind of work we’re all about.

Limitation #4: Insurance Billing Requirements, Payment Delay, and Red Tape

Let us hit you with a couple “Didja know’s?”…

Did you know that if you are in the middle of a breakthrough during a session, your therapist might decide in the moment that 90 minutes is needed for further processing instead of stopping at the 57-minute mark? With insurance, your therapist wouldn’t get paid for that extra time. With a private pay system, your therapist has the freedom to prioritize the process—not the clock (and get appropriately paid for it).

Did you also know that some insurances reimburse less for couples therapy than individual therapy? 

Did you also know that within the Mid-Atlantic region two insurance companies can pay a significantly different amount for the exact.same.service. The differential between two different types of insurance can be drastic and lead to provider resentment, frustration, or prioritization of higher-paying clients.

When Dr. K worked for a practice who took insurance, one local insurance provider would reimburse the therapist $48 for a couples therapy session and another would reimburse $98 for a couples therapy session. 

At Wellness & Co. we want our clinicians to operate with the highest level of integrity and ethics in the care they provide. We want to eliminate as much bias, inconsistency, or scarcity mindset as possible. Some insurances don’t pay providers for weeks or months after they complete a session. Not us! Our providers are paid for every single session they complete within the next two weeks.

No delays and no frustration = your clinician is operating from their highest level of health and wellbeing. 

Limitation #5: Insurance Does Not Prioritize Privacy

How can they? We don’t blame them for needing information to determine if what they are paying for is worth it. It’s just categorically not our style. 

We want our clients to feel comfortable and open in the process of therapy. 

These requests from insurance are intended to make sure care isn’t extended unnecessarily but they also mean that sensitive information about you is being shared with parties outside the therapy room. At Wellness & Co., we take your privacy seriously. 

By remaining a fee-for-service practice, we ensure that your records stay more private and confidential, giving you the peace of mind that your treatment truly belongs to you and you alone. 

OK, Wait… One More Limitation: Insurance Does Not Cover Coaching

While not a quintessential limitation in our conversation today because the scope of care between therapy and coaching is different, there are many similarities between the services. And for that reason, and many others, we feel it’s a shame that coaching is not covered by insurance (or even reimburseable).

In many cases, coaching is a better fit than therapy and deserves to be viewed as a preventative, proactive, and supportive way to prioritize and maximize mental health. 

We’ll circle back soon to discuss the differences between therapy and coaching but here’s the piece we really want to speak to: we deeply value the work our coaches do and the support they provide. Our coaches bring skill, dedication, and insight to helping clients set goals, build skills, and navigate life transitions. Though insurance may not cover these services, we see the immense benefit they offer and celebrate the positive impact our coaches have on the lives of our clients. 

If you’ve ever met Amanda, Rebecca, Dylan, or Kaileen you know they are the bees knees – check them out! Their knowledge, care, and commitment to their work is beautiful. 

Our Bottom Line: We’re All About Clinician Well-Being and Freedom Because it Benefits YOU!

By removing time-consuming administrative tasks, our model allows clinicians to focus on what matters most: providing high-quality, personalized care. With fewer distractions from paperwork and insurance requirements, our therapists can dedicate more attention to each session and be fully present with our clients. This structure also creates space for ongoing professional development and training, helping our clinicians stay sharp, informed, and inspired in their work. Prioritizing clinician well-being in this way doesn’t just benefit the therapist; it directly enhances the therapeutic experience, ensuring clients receive thoughtful, attentive, and consistent care every step of the way. 

Simply put – an insurance company is not the trained expert in the field (your provider is). Insurance shouldn’t be dictating the number of sessions, when and what to diagnose, how to treat, how to document treatment, or how to bill. 

At Wellness & Co., we believe therapy should be about you and your unique journey. 

We believe that when clinicians are compensated well and timely, when they have freedom to make clinically sound decisions, and when they have clear structures and processes to follow that promote their autonomy and passion, they provide the best possible care. 

Ok, Ok, I Agree With Your Model But I Still Can’t Afford It! 

While our model offers many benefits, we do want to hold space for the reality that a private pay model can create financial barriers for some clients. Therapy is an important investment in your well-being, but we understand that the cost can sometimes feel challenging or impossible. 

At Wellness & Co., we acknowledge this openly and strive to make care as practical and accessible as possible. 

Sometimes this looks like your provider having an honest conversation with you about your current resources and allocation. They aren’t trying to undermine your decision making. We respect if someone wants or has to use insurance. But sometimes a strategic conversation can go a long way. We’ve had clients pause a gym membership, commit to not eating out for a few months, or even pay for therapy on a credit card. These are tough and important conversations.

We also have a passion for helping the community, where we can. 

We Have a Serious Give Back Mentality

Did you know that because our providers are compensated well and are held to a healthy work/life balance we encourage them to “give back” to the community through reduced fee and pro bono spots? 

By offering flexible payment options, pro bono slots, and superbills (i.e. receipts that can be submitted to your insurance company for reimbursement), we aim to ensure that the benefits of therapy—privacy, personalized attention, and a focus on your unique journey—are prioritized and available. 

Final Thoughts: Our Values in Action

Choosing a therapist is a personal decision, and we want you to have all the information you need to decide what’s right for you. For us, stepping outside of the insurance system allows us to protect your privacy, provide care that’s truly tailored to you, and create a sustainable practice where both clients and therapists can thrive.

If you have questions about how our private-pay model works, how to use a superbill for possible reimbursement, or whether we might be a good fit for your needs, we’d be happy to talk it through. Therapy works best when it starts with clarity and trust, and we’re here to offer both from the very beginning.

Learn more about our providers and schedule a free consultation here!

With gratitude,

Jessica & Kendra

Jessica Smith( LCPC )

Jessica works with growth-minded individuals and couples motivated to deepen connections with themselves and in their relationships. She encourages her clients to consider new perspectives so they can gain insight and understanding while also exploring new tools for communication and coping.

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