The Real About Insurance: Access, Limits & What You Deserve
When I first started seeing clients privately, I was struck by how many people assumed that insurance would make therapy simple.
“They take my insurance—so it should be covered, right?”
“I have benefits, but I’m still paying out of pocket?”
“Why does this feel more complicated than it needs to be?
”These weren’t rare questions. They were weekly ones. And I get it. When you finally reach the point where you're ready to invest in your healing, navigating coverage should not be the thing that breaks your spirit—or your budget.
Let’s demystify the real story behind mental health insurance, especially for folks in Black and brown communities who already face more barriers than most.
Insurance ≠ Guaranteed Access
A report from NAMI shows that many insurance companies still reimburse mental health services at lower rates than physical health ones—making therapists less likely to take insurance at all. And for Black clients in particular, the pool of culturally responsive, in-network therapists is tiny.
I've had clients who finally found a therapist that “got them,” only to lose access because of a change in network status or policy rules. It breaks trust. It reinforces the trauma of being dropped or unseen. And it isn’t okay.
Out-of-Pocket Costs Are the Norm, Not the Exception
Even if your therapist is in-network, you may still be on the hook for copays, unmet deductibles, or session limits. And if they’re out-of-network, good luck figuring out how much you'll be reimbursed—if at all.
According to RTI International, people seeking therapy are far more likely to go out-of-network than people seeing a general doctor, resulting in higher personal costs and fractured continuity of care.
For Black folks? We’re not just dealing with affordability—we’re dealing with the additional labor of finding someone who understands us without us having to educate them in-session.
And Then There’s the Cultural Gap
Access is not just about price. It’s about safety.
As DiversityMD notes, cultural mismatches can lead to misdiagnoses, pathologizing normal cultural expressions, or completely missing the mark on trauma-informed care.
As a Black therapist, I’ve heard story after story of someone being labeled “non-compliant” or “resistant” when really… they were trying to protect themselves. Or they were grieving. Or just tired of starting from scratch.
How to Advocate for Yourself
Here are a few steps to get more clarity around your coverage and care:
Ask your insurance:
What’s my deductible, and is it met?
How many sessions are covered per year?
Do I need a referral or prior authorization?
Are virtual/telehealth sessions included?
When speaking with a potential therapist:
Are you in-network for my specific plan?
What’s your full fee and do you offera sliding scale?
Do you provide superbills for reimbursement?
Need a bit more background before starting therapy? Check out this KFF overview on how mental health care use varies across race, insurance type, and income level.
If Therapy Feels Out of Reach Right Now, You’re Not Alone
Healing doesn’t only happen in a therapist’s office. If you're navigating insurance limitations or can’t afford sessions right now, here are a few accessible options:
Verywell Mind’s Mental Health Resources for the Black Community
Peer support spaces (like Holding Space)
Journaling with themed prompts
Healing podcasts and community-centered content
Short, embodied practices: breathwork, somatic affirmations, walking meditations
Healing is a right, not a luxury. But while we’re still fighting to make that a reality, know that you’re not broken or behind if you’re cobbling together your healing in creative ways. I see you.
Final Thoughts
“Access to healing shouldn’t depend on who your provider contracts with.”
Whether you're in therapy, looking for it, or creating your own path, this blog is for you. You’re not alone. You're not asking for too much. And you're not behind.
If this helped bring you clarity or language for what you’ve been feeling, I invite you to:
Bookmark this for when insurance gets confusing
Send it to a friend who’s looking for guidance
Use it to ask better questions, get clearer answers, and move forward on your terms
