Why We Don't Take Insurance — And Why That's Actually Good for You

Let’s go ahead and address the elephant in the room.

When people learn that Sycamore is a private-pay practice, meaning we are not in-network with insurance, the most common reaction is hesitation. Sometimes it's a hard stop. We understand that. The cost of mental health care is a real barrier for a lot of people and we don't want to dismiss that.

But we also believe you deserve to know the full picture including what using insurance for therapy actually costs you, in ways that don't show up on an EOB.

What Insurance Requires (That You May Not Know About)

To bill your insurance for therapy, your therapist must assign you a mental health diagnosis. Not as a clinical tool to guide your care, as a billing code. That diagnosis becomes part of your permanent health record. It can affect life insurance applications, disability claims, and in some cases, employment background checks, depending on what's disclosed and to whom.

Insurance companies also have the legal right to audit your records. This means your session notes, the most private things you've said in the most private space you've been in, can be reviewed by a third party who has nothing to do with your care.

And insurance companies, not your therapist, often determine how many sessions you're allowed, how frequently, and for what. The person making that call has never met you and they often do not have the credentials or training to be making these kinds of clinical decisions.

What Private Pay Gives You Instead

When you pay out of pocket, your therapist answers to you and your clinical needs, not to an insurance authorization. That means:

No required diagnosis unless it's clinically warranted. If you're coming to counseling for growth, a life transition, or relationship work, things that don't necessarily carry a diagnosis, we don't have to label you to serve you.

Complete confidentiality. Your records stay between you and your therapist, with the standard legal exceptions every practice follows. No third-party audits.

Flexibility in treatment. We can use whatever approaches are best for you, meet as frequently or infrequently as makes sense, and adjust as you grow without waiting for an insurance company to reauthorize.

Access to skilled clinicians. Many of the most experienced therapists do not take insurance. Private pay practices attract clinicians who want to work deeply and well, without administrative overhead that pulls them away from actual care.

The Cost — Honestly

Our sessions are $120. That's a real number and we're not going to pretend otherwise.

For context: the average American spends more than that monthly on streaming services, gym memberships, and dining out. We're not saying counseling is more important than everything else in your budget. We're saying it might be worth taking a clear look at what you're investing in and what you're getting back.

Weekly therapy at $120/session is $480/month. For many people, that's significant. It's worth asking: what is the cost of not addressing this? In relationships strained, sleep lost, productivity diminished, physical health affected by unresolved stress? We think that math is worth running.

Out of Network Benefits: A Path Toward Reimbursement

Here's something many people don't know: if you have a PPO insurance plan, you may be eligible for out-of-network reimbursement meaning your insurance may reimburse you for a portion of your therapy costs, even at a private-pay practice like ours.

We partner with a service to help clients navigate this process. We check your out-of-network benefits for you, handle the claim submissions, and help you get money back  without you ever having to fight with your insurance company. Many clients are surprised by what they receive in reimbursement.

We encourage you to ask us about Out of Network Benefits when you reach out. It's not a guarantee, but for many people it meaningfully reduces the total cost of care.

A Final Word

We didn't choose the private-pay model because it's easier for us. We chose it because we believe it lets us do better work for you. Less overhead, more presence. No diagnosis pressure, more honesty. No audit risk, more trust.

If cost is a concern, let's talk about it. We'd rather have that conversation than lose you to a giant mental health agency that bills insurance but can't see you for two months or treats you as a number.

Have questions about our rates or what out-of-network benefits might mean for you? Reach out! We're happy to walk through it together before you ever book a session.