I’m a Physician and My Mortgage Doesn’t Accept My Insurance
When people hear that some psychiatrists don’t take insurance, the reaction is often confusion—or even frustration. “Why wouldn’t you accept my plan?” The honest answer? Most of us would love to. But for many physicians, especially in private practice, the numbers don’t add up.
Becoming a psychiatrist requires over a decade of training. Most physicians graduate with more than $200,000 in medical school debt (Youngclaus et al., 2017). During residency, we earn about $60,000 per year while working 60–80 hours a week. When we finally begin to practice independently, we encounter another barrier: insurance companies that reimburse mental health care at a fraction of what’s sustainable.
Psychiatric visits are often reimbursed at rates that don’t cover the cost of running a practice—rent, staff, billing systems, EMRs, malpractice insurance, and the time it takes to provide thorough, evidence-based care. We aren’t protected by unions. We don’t have salary guarantees. In this reality, many psychiatrists are left with a difficult choice: burn out—or move toward private-pay models.
I understand both perspectives, because I live in both worlds. At Empathy Wellness Center, I currently operate as a cash-based provider—but I’m in the process of joining insurance panels. Soon, I’ll offer both private-pay and insurance-based care. And for context—cash-pay isn’t new. Barbers, nail technicians, and other professionals have long operated this way. Even the IRS has a reputation for appreciating cash… though that’s more of a joke than a business model.
Private pay isn’t about abandoning patients—it’s about preserving the capacity to offer thoughtful, high-quality care. And accepting insurance isn’t always about volume—it’s about access. We need a system that supports both patients and providers.
References:
Youngclaus JA, Fresne JA. (2017). Education Debt Manager for Matriculating and Graduating Medical Students. AAMC.
Pingleton SK, Davis D, Dickey N. (2017). The Case for Workplace Mental Health. Academic Psychiatry, 41(5):620–623.
