After years of private pay, I’m accepting insurance for therapy. Here’s why.

A few months ago, I made the big decision to start accepting insurance at Winding Path, after eight years of only offering out-of-pocket payments.

This wasn’t a decision I took lightly. The vast majority of private practice therapists I’ve spoken to, both here in Colorado and in other states, prefer to avoid the hassles of insurance, despite the benefits. After all, running a private practice by yourself and attracting new clients isn’t easy, and insurance companies are a reliable source of referrals. Choosing the right therapist is also super important — I’ve lost count of the number of great-fit clients who I’ve had to turn away because they were looking for someone in-network.

But, for me, all the extra complication that comes along with accepting insurance has always outweighed the benefits of becoming paneled. Researching the best panels to join, submitting mountains of paperwork, and waiting months for claims to be paid all eat up time that I simply can’t afford to waste as a solo practitioner. Reimbursement rates tend to be lower than private-pay, even though clients can often end up paying nearly the same amount before hitting their deductible. 

Another downside is that most insurance companies require a mental health diagnosis before approving treatment — a label that sticks with you indefinitely on your medical record, potentially affecting your ability to get healthcare coverage in the future.

But recently, all this became much simpler, thanks to Alma — a creative new therapy platform that puts providers first, giving therapists the autonomy of running their own private practice while taking care of the painful parts of accepting insurance and managing payments. For clients, Alma makes finding the perfect therapist a breeze, with free personalized matching services and a directory of licensed and vetted therapists in multiple states across the country.

So today I want to take you behind the scenes of my decision to join Alma as a provider and start accepting insurance in my private practice. But first, I want to explain a little more about why it’s so difficult to find a great therapist that takes your insurance.

Disclosure: This post contains affiliate links for Alma. If you choose to join Alma through one of these links, I may earn a commission at no cost to you. I only recommend products and services I use myself, and all opinions expressed here are my own.

Jump ahead:

• Why it’s so hard to find a therapist that takes insurance
• How Alma helped me reconsider accepting insurance
• Alma’s application process is a breeze
• The insurance credentialing process was just as simple
• Is Alma worth the investment?
• Accepting insurance is a big change, but a worthwhile one

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Since starting Winding Path in 2014, I’ve chosen to only accept private-pay clients, and provide a superbill for clients seeking reimbursement from their insurance companies — and all in all, things have worked out pretty well. My FAQs on my website clearly lays out why I haven’t accepted insurance, and there are many clients who are able to pay out of pocket.

But, like every private practice therapist, I’ve had my fair share of client inquiries who need to see a therapist who accepts their insurance plan — clients I’ve had to turn away, even though many of them would have been a great fit.

Licensed therapists have two options for accepting insurance. The first, and more common option, is to join a provider panel. You first apply to join a specific insurer’s preferred provider panel — a process which can take several months to complete and become approved. You also need to apply separately for each insurance provider for which you’d like to be paneled. After you’re accepted, though, you’ll be paid for your services directly by the insurer. Each panel membership also gives you another potential source of clients, as most insurers have a list of recommended therapists that potential clients use to find you.

The second option — and the one I’ve offered clients on request for a few years now — is to offer services as an out-of-network provider. After each session, you give your clients a superbill — essentially a fancy receipt that includes all the details an insurance company will need to process the claim for that service. It’s then the client’s responsibility to submit this superbill to their insurer and seek possible reimbursement for the session. This makes the process easier for you, the therapist, but for clients, they still need to pay out-of-pocket at the time of the session and there’s no guarantee that the claim will be accepted or that they’ll be reimbursed.

Both in-network and out-of-network insurance have their respective benefits, but each has several downsides for both therapists and clients — hurdles tall enough to turn many therapists (myself included) off insurance entirely:

The credentialing process is long and cumbersome

Applying to join an insurance provider’s preferred panel is a long process. First you need to research the best panels to join. Different insurers are more popular in different areas, offer different reimbursement rates, and require different types of documentation from the therapist. It’s up to you to research which companies to join, as the big panels will give you access to a much wider network of potential clients.

Once you’ve chosen the best insurance providers, you need to apply to join their panel. Applying requires you to submit extensive information about your license, practice, and insurance, and frequently involves a period of back-and-forth communication with the insurance provider if they request additional information or documentation. On average, it takes five months for individuals to become credentialed with each insurer (as a comparison point, Alma was able to process my credentialing with three panels here in Colorado in just six weeks). 

You also need to apply to each company individually — so go ahead and multiply all this time and paperwork by two, three, or even more, depending on how many providers you want to work with.

Claims processing is slow and inconsistent across insurers

Running a solo private practice means you’re responsible for submitting each claim to the correct insurance company, adding extra time after each session — time you could be spending helping more clients.

Once you’ve submitted each claim, the clock starts ticking. In general, insurers are supposed to pay a claim within 30 days — but COVID has meant many claims take even longer. And if the claim is denied, you’ll need to spend more time appealing. Worst case scenario, you don’t get paid at all.

Each company pays out different rates for the same type of session, whether you’re seeing clients for individual therapy, couples counseling, or group sessions. Reimbursement rates are often much lower than a therapist’s standard private-pay rates — sometimes as low as half — eating into margins and making running a private practice less sustainable. Therapists also have to negotiate individually with insurers in order to get their rates increased over time.

Not every service is covered by insurers

While the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008 requires that insurers cover therapy and other mental health services at similar rates to physical health coverage, the specific services each insurer will accept varies a ton. You have to fight for coverage on certain services — like postpartum counseling — or diagnose clients with a specific mental health condition before insurance companies will accept a claim.

Using insurance to pay for therapy means you’re required to provide your clients’ diagnoses and treatment notes to their insurance company in order to get paid. Insurers will also request to audit a client’s entire file on occasion. This undermines the confidentiality on which the best therapy relationships are built, gives more people access to your clients’ private health information than they might be comfortable with, and makes it more difficult to provide the right care for clients.

A diagnosis might not sound like a big deal on the surface, but I’ve long preferred to avoid diagnosing clients whenever possible. I want to be able to look at each person as a whole — after all, many clients see me for personal and relationship exploration and growth, not because they have a serious mental illness. Insurance companies, on the other hand, are built on efficiency, and personal growth isn’t a great reason for seeking therapy in their view. A diagnosis also becomes a permanent part of your medical record and history, even for a temporary condition like postpartum depression.

There’s a shortage of qualified therapists

Running a private practice isn’t cheap, and making a livable wage means therapists must balance how many private pay versus insurance clients they accept, despite wanting to be able to provide care to any who need it.

The only problem? There are far more people needing care than there are providers. Over 153 million people — nearly half the U.S. population — live in an area with too few mental health care providers and services, according to the Health Resources & Services Administration, with nearly 8,000 additional mental health providers needed to fill the gaps. That shortage of therapists means more patients choosing to pay out of pocket for each provider — and therefore fewer providers accepting insurance. Those with the most intensive needs are often unable to access the care they need.

So what’s a therapist to do? It’s no wonder so many of us choose not to deal with the hassles of insurance.

It’s not all doom and gloom, though. There are some very good reasons to accept insurance as a therapist. Working through insurers means we can offer our services to a more diverse range of clients, especially those with limited financial resources. Becoming paneled also boosts your credibility with potential clients, opens up a steady source of referrals, and means clients who might otherwise drop out can stay in therapy and receive the care they need.

But despite all of these good reasons, I was not able to overcome the logistical hurdles involved in taking insurance until I came across a new mental health platform called Alma.

Launched in 2018, Alma’s therapist-first approach to mental healthcare is the polar opposite of Headspace and other mental health “services”. For clients, Alma offers a directory of vetted therapists, along with a free, curated one-to-one matching service where they’ll pair you up with the perfect therapist in your area.

For private practice providers, an Alma membership unlocks high-quality client referrals and increased exposure through their provider directory. Each provider can customize their public therapist profile  (here’s an example of mine) with details on their specialties, location, insurance coverage, and share a few details to help attract clients (and to help the Alma team match you with the right clients). Joining also gives you access to a range of digital tools to power your private practice, along with access to their members-only community where you can enroll in courses to earn CE credits and attend frequent educational workshops.

Most importantly, though, Alma takes all the headaches out of accepting insurance. They walk you through the process of becoming credentialed with majorinsurers in your area, shaving months off the process. Alma offers competitive pre-negotiated rates, they cover online therapy services at the same rates as in-person sessions, and they guarantee payment for therapy sessions within 2 weeks, even if a claim is delayed. Sure, it might not be quite as much as you could get on your own, but often it’s difficult for individuals to negotiate competitive rates without the bargaining power of a large provider like Alma.

I first came across Alma on social media about six months ago. Accepting insurance was something I’d been hoping to explore for a while, so I reached out via their inquiry form, only to be disappointed when they responded that Alma wasn't yet offering services in Colorado. But just a couple months later, I got an email from Alma’s community growth manager, Brian, that Alma was now available in Colorado, along with an invitation to book a short inquiry call. 

Brian and I hopped on a call and talked through my background with Winding Path, and how Alma might be able to help. He shared how I was the first provider in Colorado he had met with, and how Alma was purpose-built for independent private practices like mine who don’t have the team behind them or the time to take care of credentialing and billing themselves.

After talking through all the details with Brian, I decided to give Alma a try, and the next day they opened up the onboarding and credentialing process. The first stage in the process was a short onboarding survey that took about 30 minutes to complete. The form asked for basic details around my practice, my therapy license and in which states I’m licensed to provide therapy. Alma uses some of the information on this form to build your public therapist profile, such as the types of services you provide, the types of couples you serve, and the typical rates you charge for a session. It was nice to see questions on gender identity and pronouns as well, which reassured me they were dedicated to providing flexible therapy options for clients.

After I completed the form, I received another email from Alma that they were ready to start the credentialing process, along with a link to another form. This form was the most time-consuming part of the process — it took me about 45 minutes to complete — but it captured all the required information for credentialing. I entered details on my education, work history, and professional liability insurance, which the Alma team then submits to CAQH on your behalf. 

CAQH is a standardized database of professional and practice information that insurers and healthcare companies can access to support credentialing. Normally, if you were applying for credentialing as an individual, you’d complete your CAQH profile yourself, but Alma’s form simplifies the collection process and means their team can submit your information to CAQH on your behalf.

After submitting the credentialing application, the final step in the onboarding process was attending a mandatory insurance training webinar. The webinar took about an hour, but was totally worthwhile — over Zoom, the Alma team walked me and a handful of other therapists through the process of adding clients to the Alma portal, how to submit claims for sessions, and how their payout system works. They also left plenty of time to answer any questions we had, and sent out a recording of the call and a copy of the slide deck after the call.

Once all the paperwork and training was complete, the waiting process began. 

The remarkable thing about this process was how unremarkable it ended up being. Alma’s team takes care of everything for you. They quote an average of 45 days for your credentialing process to be processed, but that time depends heavily on how quickly the insurance companies respond to your application. It ended up being about 55 days from when I submitted the credentialing form to when I received a notification email that I was successfully paneled. This was still far faster than submitting everything individually (Alma shared during the onboarding webinar that most individuals end up waiting for closer to 5 months when they go it alone).

Throughout the waiting period, Alma kept me up to date with frequent emails that shared company news, resources for therapists, and helpful tips for optimizing my public profile and updating my disclosures and other paperwork.

To save even more time, Alma posts your public profile in their therapist directory before the credentialing process is complete. In fact, it was only a few days before I received my first client inquiry through Alma’s website. Because Alma makes it easy to work with both private-pay and insurance clients, I had the option to bring this client into my practice while we waited to hear back from the insurance companies.

There’s no getting around it: becoming an Alma member is an investment. At $125 a month (they do offer discounts for annual membership), it’s certainly more expensive than Psychology Today and other similar directories.

But for private practice therapists like myself, time is money, and joining Alma has been worth it for the time savings alone. Instead of taking weeks or even months of unpaid time, the credentialing process took less than an hour, and Alma’s portal makes submitting claims a breeze. Besides, it only takes a single new client session each month to cover the additional cost.

After just a couple months working with Alma, I’m already seeing the benefits in my practice. I got my first client referral within a week of my profile going live, and have so far received several great-fit client referrals through Alma’s network. 

Without Alma’s support, I would have continued to avoid the huge hassle of becoming paneled, and would still be turning away clients who otherwise would be a great fit for my practice. My goal is to fill my practice with an even mix of private-pay and insurance clients, and if I keep getting the same number of referrals from Alma I’ll reach that goal much sooner than expected.

So you’re a therapist who’s on the fence about taking insurance in your private practice. Do you go it alone, or should you join Alma?

For me, working with Alma is a no-brainer. I would never have gone in-network without the support that Alma provides, and I’m excited to offer therapy to more of the clients who need help the most and close the mental health care gap.

If you’d like to check out Alma, you can reach out to their team here to learn more and start the process. [Full disclosure: I earn a small commission if you join using this link]. And if you have any questions about my experience with Alma — or you’re looking for an experienced couples therapist (who now accepts insurance!) in Colorado — feel free to send me a message or set up a free consultation.