“Do You Take Insurance?” How to Talk to Clients About Self Pay Therapy
Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.
In Short…
If you’re wondering how to talk to therapy clients about insurance and self-pay therapy, here’s what you need to know:
- The insurance medical model is designed for clinical treatment—not personal development or coaching.
- Clearly explain what you do and why it isn’t covered by insurance.
- Reframe your self-pay model as an investment in transformation.
- Communicate your value, not just your fee.
- Don’t apologize for charging your worth. Educate with compassion and confidence.
- Self-pay clients are often more engaged, motivated, and rewarding to work with.
Now let’s dive deeper into how to make this conversation a game-changer instead of a deal-breaker.
How to Talk to Therapy Clients About Insurance
Have you ever wrapped up a dreamy consultation call, only to hear those fateful words: “But do you take my insurance?” Yep. That question has single-handedly tanked more perfect therapist-client connections than I care to count.
If you’ve been in private practice for more than five minutes hoping to work as a self pay therapist, chances are this one’s hit you right in the professional gut. On this episode of Love, Happiness and Success for Therapists, I tackled this exact moment head-on. Let’s break it down together, therapist to therapist.
What Do You Say When a Therapy Client Asks, “Does My Insurance Cover Therapy?”
Short answer: You answer with clarity, compassion, and confidence—not panic.
Longer answer: When a prospective client hits you with the “do you take insurance?” question, it’s not just a logistical issue—it’s a test of how well you can communicate your value. In my practice, when someone asks that, I take it as a cue to educate.
I say something like:
“That’s a great question. I don’t work within the insurance model because the work I do isn’t clinical treatment. It’s deep, transformative personal growth, and it’s not something insurance typically covers. My approach is about outcomes, not diagnoses.”
This response to their inquiry about insurance does three things:
- Validates the client’s question.
- Educates them on the distinction between therapy and growth-oriented work, such as coaching.
- Highlights the unique value of what you do.
The more fluent you become in this language, the more natural and confident you’ll feel in these moments.
Why Don’t Some Therapists Take Insurance?
Because the insurance / medical model was designed to treat illness, not foster growth.
To bill insurance ethically and avoid therapy insurance fraud, therapists must:
- Diagnose a mental health condition.
- Create a treatment plan that targets symptom reduction.
- Document progress in clinical terms.
But many of our ideal clients:
- Don’t meet diagnostic criteria.
- Aren’t in crisis.
- Want to grow, evolve, and create new outcomes in their lives.
Trying to shoehorn coaching or developmental work into a clinical model is not just a bad fit—it can create ethical problems:
- Misrepresenting non-clinical services as treatment.
- Risk of insurance audits.
- Potential liability if your records don’t support the diagnosis.
Bottom line: Growth work is valuable. And it deserves a model that supports it honestly.
To learn more on this, check out my free CEU-accredited training, Think You’re Coaching? 8 Red Flags You’re Actually Doing Therapy. You’ll earn 1 CEU upon completion.
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How Can I Help Therapy Clients Understand the Difference Between Therapy and Coaching?
By being crystal clear about what you’re offering and how it helps.
Clients often assume that anything labeled “therapy” is covered by insurance. Here’s how to draw a clear and empowering distinction:
Therapy is:
- Designed for clinical treatment.
- Focused on mental health diagnoses.
- Often past-oriented or insight-based.
- Guided by symptom reduction goals.
Growth-focused work, such as Coaching, is:
- Goal-oriented and future-focused.
- No diagnosis required.
- Emphasizes action, accountability, and forward momentum.
- Great for motivated, high-functioning individuals seeking transformation.
I often explain it this way:
“Coaching helps you get clear on what you want and then take actionable steps to move forward. It’s goal-oriented, future-focused, and designed to create real change.”
Here’s a deeper dive into coaching ethics for therapists.
How Do I Stop Feeling Guilty About Charging Self Pay Therapy Rates?
Therapist, listen: your time, training, and energy are valuable.
We therapists are often conditioned by years of underpaid internships and agency work to believe that earning a good living is somehow “wrong.” But here’s the truth:
- Charging sustainable fees for therapy sessions is not greedy. It’s responsible.
- Self-pay clients tend to be more invested in the therapeutic process.
- You can’t pour from an empty cup—therapists deserve to be supported, too.
Let’s reframe the narrative:
- You’re not charging for your time.
- You’re charging for the results your time helps create.
- You’re not just being paid. You’re being entrusted.
And remember: you’re modeling healthy boundaries and self-worth. That alone is therapeutic.
I have a great podcast episode on financial therapy for therapists here.
What Should I Say When Clients Push Back on Paying Out of Pocket?
Get grounded in the truth of your value to adjust your relationship to your fee—and help them see it too.
When clients hesitate, it’s often because:
- They haven’t yet internalized the value of what you offer.
- They’re comparing based on cost, not outcome.
Here’s a script that can shift the dynamic:
“You could absolutely use your insurance to see someone else. But if you’re looking for insight and action—a deep understanding plus a concrete plan to create the life you want—that’s what I specialize in. This work is about growth, not just symptom relief.”
Follow up with specific examples:
- The types of goals you help clients reach.
- What makes your approach different.
- How clients describe the outcomes of working with you.
This is not about convincing. It’s about clarity.
You can learn more about messaging and how to market yourself as a therapist on this podcast episode or through my free CEU-accredited training Build and Market Your Therapy Private Practice.
Is Being a Self Pay Therapist Worth It?
YES. A million times yes. Here’s what you gain as a self pay therapist:
- Freedom to do the kind of work you love.
- Flexibility in how you structure sessions and pricing.
- Financial success to support your own well-being.
- Clients who are motivated and invested in the process.
Of course, stepping into the self pay therapy model requires a few foundational shifts:
- You need to truly believe in the value of what you offer. Confidence in your worth as a provider is essential if you’re going to ask clients to invest in themselves through you.
- You need to develop clear, consistent messaging about what you do, who you serve, and why it’s effective.
- You must stay deeply rooted in ethical alignment—always being honest about what you’re offering and staying within your scope of competence.
But in return? You build a practice that feels aligned, fulfilling, and deeply impactful.
How Can I Attract Self Pay Therapy Clients?
If you’re longing for a practice that aligns with your passion for growth work—it might be time for a new approach.
In my BCC-Accredited Coaching Certification for Therapists, I guide licensed clinicians just like you to:
- Ethically expand beyond the limitations of the insurance model
- Work confidently with self-pay clients who are motivated and ready to change
- Learn the language, structure, and mindset of transformational coaching psychology
- Build a sustainable practice doing the work you actually want to do with your dream clients.
This program is BCC-accredited and rewards up to 50 CE hours. Come learn how to create a thriving, ethical, and fulfilling practice from someone who’s walked this road.
👉 Enroll by 7/14 to take advantage of our current Expert Experience summer bonus: a free month of coaching client referrals to your private practice. Learn more here.
And hey—if we haven’t connected on LinkedIn yet, let’s do so! I’d love to follow your journey, cheer you on, and swap notes on what’s working (and what’s not) in our evolving world of therapy and coaching. Come say hi and connect with me right here.
Xoxo
Dr. Lisa Marie Bobby
P.S. If this article helped you, think about who else needs to read it. Forward it to a friend, share it with your colleagues, or drop it in your favorite consultation circle. Let’s keep lifting each other up.
Resources:
Allen, A. (1971). The fee as a therapeutic tool. The Psychoanalytic Quarterly, 40(1), 132-140. https://www.tandfonline.com/doi/pdf/10.1080/21674086.1971.11926555
Shipton, B., & Spain, A. (1981). Implications of payment of fees for psychotherapy. Psychotherapy: Theory, Research & Practice, 18(1), 68. https://psycnet.apa.org/record/1982-26248-001
Myers, K. (2008). Show Me the Money: (The “Problem” of) the Therapist’s Desire, Subjectivity, and Relationship to the Fee. Contemporary Psychoanalysis, 44(1), 118-140. https://www.tandfonline.com/doi/abs/10.1080/00107530.2008.10745956
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