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Clinicians

Overcoming Guilt for Being An Out-Of-Network Therapist

Brandon Grill
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October 27, 2023
3 Experts Comment: Can You Be OON Without Feeling Guilty?

After doing the math on insurance, you decided to become an out-of-network therapist. Insurance just isn’t conducive to being the type of therapist you want to be. Yet now that you’ve kicked insurance panels to the curb, there’s something that keeps coming up for you: Guilt.

You may feel you’re not “accessible enough”, or not “affordable enough”. Maybe you’re getting guilty messages from other therapists or your referral partners, and it’s starting to weigh on you.

So, how can you walk that line between caring for those who need it while also not subjecting yourself to insurance shenanigans?

Dive in as we explore this complex issue, offering insights and perspectives from 3 different therapy business coaches.

Why Some Therapists Feel Guilty for Being OON

Like other therapists, you may pride yourself on being accessible. So, choosing to be an OON provider can sometimes cloud your emotions with feelings of guilt and self-doubt.

I asked Omar A. Ruiz, an LMFT, Business Coach for Therapists, and Founder of Online Private Practice what insights he can share about therapists experiencing OON guilt. Here’s what he said:

"It tends to connect to their value of keeping their services financially accessible to all clients. They tend to feel guilty because they now require clients to pay for their services (out-of-pocket). When this happens, they only have but so many payment options to offer to mitigate the potential financial burden a client may experience…

The guilt continues to set in when other therapists (colleagues/friends/coworkers/referring partners) make judgemental statements towards them for being an OON provider. These other therapists make empty claims about how the OON business model goes against one's code of ethics, when needing to ensure that the service fees they charge are fair, reasonable, and commensurate with the services performed.“

And Omar isn't alone in these observations. Adrienne Wilkerson, CEO of Beacon Media + Marketing, told me this about the guilt OON therapists can feel:

“The single most common thing I hear from therapists around insurance is that they feel guilty about not accepting it because they are concerned that people will choose not to get care from a therapist if they have to pay for it themselves. Many people depend on insurance to cover not only their physical but mental health needs. Unfortunately, the insurance world is not progressive in the mental health space, and this makes it difficult for people to get the help they need and therapists to provide quality care to their patients."

It's evident that while the motivations behind becoming an OON provider vary, the feelings of guilt, primarily stemming from concerns of accessibility and ethics, are shared by many therapists.

Avivit Fisher, a therapy business coach and owner of REdD Strategy, observes the initial allure (and eventual downside) of insurance for therapists:

“Accepting insurance is the easiest way to grow your practice and make therapy accessible to people who can’t pay out-of-pocket fees. In the beginning, it sounds like a winning situation for all but after a while therapists notice that this business model limits their business growth and potential.”


So, what advice can help therapists feel less burdened by guilt when they forego insurance panels?

Strategies and Insights for Navigating OON Guilt

Navigating the decision to be out of network (OON) brings its own set of emotional challenges. Balancing your professional aspirations with client accessibility can sometimes elicit guilt. However, wisdom from those who've walked this path can offer guidance.

Avivit reflects on this transition, noting:

"That’s when the guilt and the moral dilemma kick in. Transitioning to an 'out of pocket' pay often means that you’re limiting access to some of your existing clients as well as new ones. For the most part, successful therapists transition gradually, offering other solutions to clients who can’t afford private pay."

Omar brings a broad perspective to this issue:

"Wherever you practice, especially in a post-pandemic world where services can be rendered online via telehealth, if a client does not have a PPO plan, with OON benefits, they can always access counseling services through different means. Some clients unfortunately may not be a good fit for your practice and that is ok."

And Adrienne emphasizes the collective experience of therapists:

"You are not alone in wrestling with this dilemma. Each therapist needs to weigh the pros and cons and make the decision that fits their model best. Stick with your decision and the reason why you made it, being able to provide the best treatment for your client.”

So, what can you do if you find you’re feeling guilty for being out of insurance networks?

How to Stop Feeling so Guilty About Being OON

For help in trying to stop feeling so guilty and establish a sustainable and ethically sound practice, consider these steps:

Self-Reflection: Find the root of your guilt. Is it from personal values, external pressures, or set notions of therapy's 'ideal'? Knowing if your guilt comes from internal or external sources can be illuminating.

Communication: Connect with peers or mentors. Their stories and experiences might offer fresh perspectives on your feelings. As you know, community sharing can be a great source of healing.

Reframe Your Perspective:
Recognize that ensuring your financial well-being means a longer-lasting practice, which benefits more clients in the long run. It’s in your client’s best interest that you’re not worried about money during therapy!

Educate Yourself:
Equip yourself with the nuances of therapy's financial aspects, understanding both the in-network and OON models' pros and cons.

Seek Supervision or Coaching:
This guidance can offer strategies to manage guilt, ensuring it doesn't hinder your practice's growth. Therapy is beneficial, even if you’re a therapist.

Self-Care:
Prioritize your well-being, be it through meditation, journaling, or therapy. View your decision to go OON as "financial self-care", minimizing insurance hassles.

Help Clients Find Resources:
Direct clients to affordable resources. Many may not know of their OON benefits or might need assistance navigating them. Introduce them to alternatives like group therapy or community resources.

With these strategies and insights from fellow professionals, you can reconcile your practice with your values and ease feelings of guilt. Now let’s address a related question: “Are therapists more prone to feelings of guilt?”

Do Therapists Experience More Guilt Proneness?

As you know, the therapy profession requires deep emotional work. You’re often pushed to be more attuned to your own (and your clients) emotions. But does this heightened emotional awareness make you more susceptible to feelings of guilt?

Emotional Resonance: You were trained to resonate emotionally with clients. This heightened empathy can make you more receptive to feelings of guilt, especially when you perceive your decision to be OON as potentially impacting your clients negatively.

High Standards: Therapists often set high standards for themselves. If you perceive yourself as falling short, guilt can emerge. For therapists who are OON (or are considering it), guilty feelings can arise at the reality of having to turn away clients. 

Nature of the Job: Daily exposure to clients' traumas and challenges might amplify your sense of responsibility, sometimes leading to an inflated sense of guilt when making decisions you believe could limit accessibility.

However, it's essential to note that while you might be more attuned to emotions, it doesn’t necessarily mean you’re innately more guilt-prone.

It’s the context of your work and the environment you’re in that might amplify feelings of guilt. Recognizing this potential predisposition can be the first step toward managing it. Simple awareness can provide the space to change, as well as activism for mental health parity enforcement.

No More Guilt for Being OON

As a therapist, your work revolves around supporting the mental and emotional well-being of others, but it's vital not to forget your own in the process. Decision-making, especially when it comes to matters as nuanced as being an OON provider, can be emotionally taxing. But remember: each choice you make in your practice has an impact on your own well-being and professional satisfaction.

Being OON or in-network is not a black-and-white choice. And neither option is inherently right or wrong. As you traverse this path, be kind to yourself. It's okay to prioritize both your clients' needs and your own career path.

If you're wrestling with this decision or feeling the weight of guilt, you're not alone. Share your experiences, challenges, and triumphs with your peers. Learn from therapists who’ve made the transition before you. 

Lastly, if you're leaning toward or have already embraced the OON route, remember that tools like Thrizer are here to support you. By streamlining the reimbursement process for clients who use OON benefits, Thrizer ensures that both you and your clients can focus on what truly matters: the therapeutic journey.

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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.

About the Author
Brandon Grill

Brandon Grill is a mental health copywriter and marketer based in Las Vegas, NV. He loves helping mental health professionals build fulfilling businesses. You can find Brandon going on a walk with his adorable nephews.