From Panels To Private Pay
One of the biggest decisions therapists face when starting a private practice is how to structure payment. Should you be private pay, accept insurance, or do a mix of both? This question feels big because it affects your income, and daily experience as a therapist, from how you conduct consultation calls, to your conceptualization of change, to how you write your progress notes and treatment plans.
When I first opened my practice, I started as private pay. I believed in the value of therapy and wanted the freedom to set my own rates, offer a non-pathologizing approach, and design a schedule that worked for my life. For the first few years, I built slowly and steadily. My referrals came from word of mouth, community relationships, and marketing efforts that created trust with prospective clients.
A few years in, I made the decision to join a several insurance panels. At the time, it seemed like the next logical step. I had started a group practice, wanted therapy to be more affordable for more people, and thought it would make things easier. I expected referrals to flow in faster, caseloads to increase and that all the therapists in my group would become more secure financially.
But it didn’t take long for me to realize that insurance-based work was not a fit for me. I found myself working more hours, navigating billing issues, and feeling frustrated with documentation. The reimbursement rates were very low, especially for couples and family therapy, which is the heart of my work. This led to financial dilemma in which the reimbursement rates for some sessions were less than the pay rate I had offered to my associates. Quickly, I felt disconnected from the freedom and creativity that drew me to private practice in the first place.
After some honest reflection, I made the decision to leave insurance panels and return fully to private pay. I can confidently say I will never go back.
Why I Chose to Stay Private Pay
Private pay allows me to work in a way that feels aligned with my values. I set my own fees, documentation standards, policies, and schedule. I have space to give my best to every client, and I can offer flexibility, pro bono sessions, or reduced fees when it feels right, on my terms, not an insurance company’s.
I also find that private pay clients tend to be more invested in the process. They are choosing therapy because they want change, and they are committed to doing the work. The relationships feel collaborative and energized. I leave sessions feeling fulfilled and grounded, not drained.
Financially, private pay practice has allowed me to create stability. My income reflects the skill, experience, and care I bring to my work. And because I have full control of my caseload and boundaries, I can maintain balance in my life.
Your Practice Is Your Business
Many therapists end up going back to agency or group jobs, not because they cannot make it in private practice, but because they never built a clear plan. Private practice comes with responsibility.
To succeed in private pay practice, you need to start thinking like a business owner and create structure, clarity, and consistency. That means defining your niche, understanding your numbers, designing your schedule, and learning how to market in ways that feel authentic.
Building a Private Pay Foundation
If you are considering private pay, or transitioning away from insurance, here are a few key areas to focus on:
Know your why. Be clear about what you value most in your work and life. Why are you a therapist and how does this align with your purpose?
Identify your ideal client. When you specialize, referrals become easier and more aligned.
Set fees that sustain you. Your rates should reflect your skill, training, and financial goals.
Build referral relationships. Connect with other therapists, professionals, and organizations who understand and value your work.
Create systems. Have structure for scheduling, payments, documentation, and marketing so your energy stays focused on client care.
The Long Game
Building a private pay practice takes time, but it’s worth it. With each intentional step, you create more freedom, alignment, and stability. You learn to trust your value, your expertise, and your ability to attract clients who are ready to grow.
For me, returning to private pay was a business decision that came with a choice to protect my energy, honor my craft, and build a career that feels meaningful and sustainable.
If you are considering making the transition to private pay, know that it’s absolutely possible. With the right plan, support, and mindset, you can create a practice that reflects your values and gives you both professional and personal freedom.
