Abundant Practice Podcast

Episode #688: Deciding Whether To Take Insurance Or Go Private Pay
Host: Allison Puryear
Release Date: September 20, 2025

Episode Overview

In this episode, Allison Puryear addresses one of the most pivotal early decisions for therapists going into private practice: should you start out taking insurance, or launch your practice as private pay only? Drawing from her extensive experience supporting thousands of therapists, Allison unpacks the practical, emotional, and financial realities of both routes. She provides actionable strategies, honest encouragement, and a free resource to help listeners clarify which path is right for them at this moment in their careers.

Key Discussion Points & Insights

The Real Question Behind "Insurance or Private Pay?"

• Allison frames the question as a deeply personal one, not something to be determined by peer pressure, trends, or other therapists’ stories.
  • “Your decision needs to be grounded in your unique circumstances, your values, and your goals.” (03:15)
  • She urges therapists to “get really honest about why you’re asking this in the first place.”
    • Is it about fear, scarcity, or financial pressure?
    • Is it about having permission to build the practice you want?

Realities Where Taking Insurance Makes Sense

• When should you consider insurance?
  • Little or no savings.
  • Working in a draining agency job you need to leave ASAP.
  • Bills, dependents, or sole-provider responsibilities.
  • Low energy or limited time for marketing.
• Benefits of accepting insurance upfront:
  • “Taking insurance in the beginning can bring clients in the door more quickly. It reduces the amount of time you need to hustle to build up referrals.” (04:45)
  • Adds financial stability for a smoother transition out of agency work.

Trade-Offs of Taking Insurance

• Lower pay:
  • “You're going to get paid less... In many places, you might be getting 50% or even less of your private pay rate. That means you need two or three insurance clients to make the same as one private pay client. That's not just about the money, it's about the time.” (06:00)
• More paperwork, more sessions, more emotional labor.
• Transitioning later is hard:
  • “If you start with insurance and then decide to transition to private pay... you're eventually going to need to have an uncomfortable conversation with every client...” (06:53)
  • Many therapists stay stuck with insurance panels out of anxiety or fear of letting clients down.
  • But: “The conversation almost always goes better than people expect... many will stay, especially if you've built a strong therapeutic relationship...” (07:37)
• Insurance is increasingly unpredictable:
  • More audits and clawbacks: “Clawbacks are where the insurance company says you didn’t document adequately and you have to pay them back the money that they already paid you for those sessions.” (08:19)

Practical Tips for Navigating Insurance

• If considering insurance, start credentialing paperwork ASAP:
  • “Getting credentialed takes time. On average it's about three months... Even if you're on the fence, get the process started.” (09:09)
  • “You don't have to sign the contract if you change your mind, but if you wait until you're desperate for income, that's going to feel like an emergency.” (09:30)

When to Go Private Pay from the Start

• If you’re financially flexible or have a support system:
  • Six+ months of savings.
  • Partner/household support.
  • Agency job isn’t draining; you can start part-time.

Benefits of Private Pay

• Simpler logistics:
  • “While it's slower to build, it’s cleaner. You're not dealing with insurance paperwork, not waiting on reimbursements, not navigating the awkward 'I'm dropping your insurance' conversation.” (09:51)
• You’re building the exact practice you want from the beginning.
• In many cases, you may hit your income goals just as quickly—or even sooner.
  • “If insurance is only paying you $80 a session and your private pay fee is $175, you don't need nearly as many clients to hit your income goal.” (10:18)

Do the Math & Know Your Numbers

• “I'm always recommending doing the math. Get your actual numbers. Find out what insurance companies are paying in your area. Compare that to what your private pay fee would be.” (10:35)
• Consider both client volume and realistic marketing capacity.

Mindset & Values-Driven Decision Making

• No “right” answer—only what fits “you right now.”
  • “If you want to take insurance for the rest of your career, amazing. If you want to be private pay, amazing... what I care about basically is you make the choice that really, truly serves you.” (10:56)
• There IS room to change your mind later:
  • “It's not permanent. You get to evolve as your life evolves.” (11:28)

Notable Quotes & Memorable Moments

• “You are allowed to build the practice you want. You can have a successful, full, profitable, private pay practice—that is absolutely possible.” (05:01)
• “There is no one right way. There’s only the way that works for you.” (03:00)
• “The conversation [about private pay transition] almost always goes better than people expect.” (07:37)
• "I've created a free worksheet to help you through this exact decision... It's going to help you think through your values, your needs, your current financial reality, your energy capacity, your goals." (10:40)
• “This isn’t about what’s right or wrong. It’s about building a practice that works to support your life, one that you can grow into, not out of—one that supports you as a human being, not just as a therapist.” (11:08)
• “You're doing great. You're asking the right questions. You're building something meaningful. And I'm really proud of you for doing it with integrity.” (11:32)

Important Timestamps

• 01:27 — Listener question introduction: Should you take insurance at first or start private pay?
• 03:00 — The real question and how to approach it.
• 04:45 — When insurance is the best short-term choice.
• 06:00 — Trade-offs: Lower pay, more paperwork.
• 06:53 — Later transitions: The “uncomfortable conversation.”
• 07:37 — Most clients handle transition better than expected.
• 08:19 — Increasing challenges with insurance: audits & clawbacks.
• 09:09 — Credentialing logistics: Why to start paperwork early.
• 09:51 — Benefits of building private pay from the beginning.
• 10:35 — Do the math: Compare insurance reimbursement to private rates.
• 10:56 — No one-size-fits-all answer—make the choice that serves you.
• 11:32 — Encouragement and closing thoughts.

Action Steps and Resources

• Download the Free Worksheet:
  • To clarify your decision-making, DM the word "sheets" to Allison, or visit abundancepracticebuilding.com.
• Do your own numbers:
  • Calculate client needs, income goals, and compare insurance vs. private scenarios.
• Start credentialing paperwork if considering insurance, even if undecided.
• Trust your process:
  • Know decisions are not permanent and can be revisited as your circumstances change.

Tone and Takeaway

Allison’s tone is warm, direct, and deeply encouraging. She brings clarity and compassion, reassuring new private practitioners that they have full permission to design a practice that fits their needs and values right now—with practicality and self-compassion at the core.

“This isn’t about what’s right or wrong. It’s about building a practice that works to support your life... I’m really proud of you for doing it with integrity.” (11:08, 11:32)

For more resources, free checklists, and support, visit abundancepracticebuilding.com.