Insured but Unseen: A Therapist’s Truth

In recent months, conversations about healthcare reform have surged back into public consciousness. The Lowering Costs for American Families Act, often referred to in the media as “The Big Beautiful Bill”, has captured national attention. Introduced as a sweeping piece of legislation, the bill aims to cap insurance premiums, expand subsidies under the Affordable Care Act, and penalize pharmaceutical companies for excessive pricing. In theory, it’s a major step toward equitable healthcare access. In practice, it raises both hope and concern—especially in the world of mental health care.

What the Bill Promises—and What It Complicates

At the heart of the bill is a promise to lower costs for working families. According to a fact sheet released by the House Committee on Ways and Means, this legislation seeks to make permanent the premium subsidies first introduced during the pandemic (Source: Congressional Research Service, 2024). This means that more individuals and families will qualify for reduced insurance costs—potentially allowing millions more to afford coverage.

But here’s where nuance matters: Access to insurance does not guarantee access to care.

Many of my clients already have insurance. And yet, again and again, I hear the same story: “I called five therapists on my plan, and none of them called me back.” Or, “The only person who accepted my insurance had a four-month waitlist.” Or, more painfully, “They didn’t feel like the right fit, but it’s all I could afford.”

Insurance networks are often limited, outdated, and inaccurate. The National Council for Mental Wellbeing reports that nearly 60% of U.S. counties have no practicing psychiatrists, and one in three Americans lives in an area lacking adequate mental health professionals (Source: Mental Health America, 2024). Even where providers are listed as in-network, many are not accepting new clients, no longer accept insurance, or do not have availability that works for those juggling multiple jobs, caregiving, or other life demands.

On top of that, identity matters in therapy. Clients often seek providers who share or affirm their race, gender, sexual orientation, faith background, or lived experiences. But insurance networks rarely reflect that level of specificity. For marginalized clients, this lack of representation within provider lists can be disheartening and, in some cases, retraumatizing.

So while expanded insurance coverage sounds like progress—and in many ways it is—it doesn’t resolve the bottleneck of mental health accessibility. More people insured can also mean more people competing for a limited number of providers, many of whom are already overburdened and underpaid.

Why I Don’t Bill Insurance

As a psychotherapist committed to deep, relational, long-term healing, I made a difficult decision early in my career: I chose not to work directly with insurance companies.

This decision wasn’t about avoiding red tape (although the paperwork is daunting). It was about protecting the integrity of care.

Insurance companies often dictate the number of sessions a client “should” need based on diagnosis codes. They require clinical justification for continued care, sometimes requesting notes that expose deeply personal client details to auditors far removed from the therapeutic process. That compromises trust. It compromises safety. It limits the ability to tailor therapy to a client’s lived reality.

Furthermore, reimbursement rates from insurance are notoriously low. Therapists are paid a fraction of what their services are worth, which often leads to burnout, quick turnover, and a push toward high caseloads to stay afloat. This is not the soil where meaningful healing grows.

So instead, I’ve chosen a different route: I collaborate with nonprofits, community-based organizations that center equity and access. These partnerships allow me to provide sliding-scale services, trauma-informed care, and long-term support for individuals who may otherwise fall through the cracks. It’s not always the most lucrative path, but it’s one that honors continuity, cultural relevance, and the kind of therapeutic relationship that fosters transformation.

Legislation Is Only Part of the Picture

I support policies that reduce healthcare costs, protect consumers from surprise bills, and expand access. But I also know from sitting across from clients every day that real access isn’t just about affordability—it’s about sustainability, choice, and dignity. Legislation like the Big Beautiful Bill may help some families inch closer to coverage, but it’s up to providers, advocates, and community networks to ensure that coverage actually translates into care.

If you're reading this and wondering why it’s still so hard to find a therapist who gets you, who has time for you, who doesn't feel like they’re rushing through sessions—it’s not your fault. It’s not even always the therapist’s fault. The system itself isn’t built for slow, relational healing. It’s built for symptom management and diagnostic boxes.

That’s why I opt out.

Not because I don't believe in access, but because I believe in it too much to compromise its meaning.

Where Do We Go From Here?

If you have insurance, I hope the legislation makes it easier for you to seek care. If you’re uninsured or underinsured, there are nonprofits and community organizations still doing the work, often quietly, underfunded, and behind the scenes. If you’re a therapist, I see the weight you carry—and I encourage you to imagine creative, community-rooted ways of practicing.

And if you’re someone simply trying to find space to heal: You deserve care that isn’t rushed, dictated, or diluted. You deserve care that holds your whole self—not just your symptoms.

Until the system reflects that, many of us will continue working outside of it—not in protest, but in protection of what healing should truly be.

Disclaimer:

The content provided on this blog is for informational and educational purposes only and is not intended as a substitute for professional psychological advice, diagnosis, or treatment. The information shared here does not constitute a therapeutic relationship and should not be relied upon as mental health treatment.

Although the author is a licensed mental health professional in the state of Georgia, the content is general in nature and may not be applicable to your individual circumstances. Always seek the advice of a qualified mental health provider or other medical professional with any questions you may have regarding a mental health condition.

If you are experiencing a mental health emergency, call 911 or go to your nearest emergency room. You can also contact the National Suicide & Crisis Lifeline by calling or texting 988 for free and confidential support, available 24/7.