Why I’m not ‘In Network’

Rachel Gabrielle, MA, LMHC
2 min readDec 12, 2022
Photo by Vlad Deep on Unsplash

The majority of clients I see do not have a “mental illness.” They are often highly capable women sick of being asked to adapt to a sick society or broken system. Why should they get a stigmatizing diagnosis?

But in order to use your insurance for therapy, insurance companies require a “billable diagnosis,” even for the first session. This means that in under an hour — I am supposed to give you a label that could follow you forever, and potentially be used against you. If you are a couple seeking treatment, one of you becomes the “identified” patient and this person is supposed to have a “billable” diagnosis that warrants treatment for the couple.

Insurance companies often ask for additional clinical information that compromises your privacy, and if they don’t like what they see they can dictate your treatment, stop paying, or demand previous payment be sent back months — sometimes even years later or after treatment has ended.

Insurance companies have the power to restrict your treatment or require a specific type of treatment. They also determine your provider’s reimbursement rates, which are arbitrary at best, do not account for inflation, nor do insurance companies negotiate rates. In fact, reimbursement rates started stagnating in the 1980s as more and more women joined the field. What a co-inkie-dink!

By not billing insurance, you are not required to have a diagnosis and your mental health treatment remains private. By not billing insurance, I am able to use my decade of clinical experience and my education to guide your treatment instead of allowing an administrator to dictate your care. By not billing insurance, my time isn’t spent on hold, hunting down my reimbursement, or negotiating my value. Additionally, our relationship will be able to be about the work and not administrative tasks.