What Staying on Insurance Panels Is Actually Costing You
It's Memorial Day weekend. The unofficial start of summer. And if you're anything like the therapists I talk to, your caseload is starting to get a little lighter and your anxiety about that gets a little louder every year. I get it. Summer slow downs are not uncommon.
But before you spiral into what a slower July means for your income, I want you to look at something with me. Don't look at the empty slots on your calendar. Instead, let's look at the system you're depending on to fill them because that system is changing...and not in your favor.
The squeeze you're probably already feeling
Insurance companies are cutting reimbursements. Again. Some panels are also moving to discourage the 53-minute session (CPT 90837) in favor of the 45-minute (90834) because the 90837 pays more. That's exactly why they're pushing back on it. So the session length that actually lets you do your job is getting squeezed out.
Meanwhile, prior authorizations are getting longer and more arbitrary. Clawbacks are getting more common. You're spending Sunday nights and Tuesday evenings doing billing work you weren't trained for and aren't being paid for. And then you're also managing a client who cancels because they can't afford their copay this month, or because they found a $30 app that promises to do what you do.
You are losing your Sunday evenings. You are losing your Tuesday nights. And in exchange, you are getting reimbursements that have not kept pace with inflation while the cost of running your practice has. That's not a personal failure. It's the math.
Staying on insurance panels feels safe
I know that. The fear is what if I leave and no one finds me? What if I can't fill my caseload at $175 or $200 a session when clients have been paying $25 to $40?
That fear is real, and I'm not going to talk you out of it by telling you it's irrational. But I will gently but frankly point something out...staying on panels is also a risk. Just a risk you've normalized.
You are already losing revenue to clawbacks. You are already subsidizing the insurance company's administrative burden with your time. You are already one policy change such as a panel closure, credentialing audit, or reimbursement cut away from a significant income shift you didn't choose and can't control.
You're living a version of the instability you're afraid of on the private-pay side already. It just has a familiar name on it.
I started private pay in Florida in 2018.
I had no referral network because I moved to a state where I knew nobody. That year, I was planning our wedding, buying a house remotely (before this was more common during Covid), and my mother had just been diagnosed with stage 4 ovarian cancer. Plus, my mother-in-law, who was living with us, was in the early stages of memory loss.
It was one of the hardest years of my adult life, and I built a private-pay practice inside of it. Obviously not because the timing was perfect, but because I ran the numbers and I couldn't afford — financially or emotionally — to keep doing it the other way.
When COVID hit in 2020, a lot of my peers went back on panels. I stayed private pay. Was it uncertain? Yes. Was it still better than what I'd left? Also yes.
In 2025, I hit a referral dip...the kind that makes you second-guess everything. But, as has been my road, I rebuilt without going back to insurance. Even the hard version of private pay was better than what I'd left.
I'm not telling you that to make it sound easy or hard. I'm telling you because I want you to know that the math works...not just in theory, but in years that included grief and uncertainty and rebuilding from scratch.
Summer is not a crisis...it's a window.
Here's the thing about a lighter summer caseload: you have bandwidth you don't normally have. You have a Tuesday afternoon that isn't fully booked or a Friday that ends at noon. You have...for the first time in months...some actual thinking space.
And the one thing I'd ask you to do with that space is look at the numbers concretely. Not "what would private pay mean for me someday" but "What would 15 private-pay clients at $175 mean for my annual income, versus 25 insurance clients at $85 after billing"? Ask yourself "What would cutting my caseload in half and going fully private pay actually do to my take-home"?
Most therapists haven't run that math all the way through from a calm body. They go to the worst case scenario and don't finish out the math. Often they're exhausted, and running a scenario that might honestly break their current belief system takes energy they don't have on a Sunday night after billing.
I'm asking you to run it now. Before summer is over. Before you go back to a full schedule and a full set of prior auths and tell yourself there's no time.
The math, made easy
I built a calculator specifically for this because I watched too many therapists dismiss private pay based on vague fear rather than actual numbers.
It's called the Insurance to Private Pay Calculator, and it takes about five minutes. You put in your current caseload, your current reimbursement rates, your hours, your billing overhead. It shows you what private pay could realistically mean for your income that is also in alignment with someone of your experience.
It's $27. It's one piece of movement forward; not the full transformation. If you want (or need) the numbers before you can let yourself think about this clearly, that's where to start.
The system you're depending on is paying you less and asking for more. Summer is here. This is the moment to look at what staying is actually costing you. You don't want to do this instantly, or without a plan, but now is the right time to look.
