As a mental health provider, few things are more frustrating for your clients and for you than learning that their insurance won’t cover therapy. Whether it’s a claim denial, a coverage limitation, or a problem with network status, these situations can be confusing and emotionally charged for clients who are already vulnerable.
How you communicate this news matters. Clear, compassionate conversations not only build trust but also help clients understand their options and stay committed to their care.
Here’s how to navigate those conversations with empathy and clarity, and what to tell clients when their insurance doesn’t cover therapy.
1. Start with Compassion and Clarity
Begin the conversation by acknowledging how frustrating and confusing insurance can be. Clients often feel caught off guard or even embarrassed when claims are denied or benefits are unclear. Lead with empathy and transparency.
What to say:
“I know this isn’t the news you wanted to hear. Insurance can be incredibly tricky to navigate, and it’s frustrating when you’re seeking help and it feels like there are barriers. Let’s talk through what this means and explore your options.”
2. Explain Why the Claim Was Denied or Not Covered
Clients appreciate when you help them understand what happened in plain language. Most insurance-related issues fall into one of these categories:
- You’re out-of-network with their plan
- They haven’t met their deductible
- The session type or diagnosis isn’t covered
- Their plan excludes mental health benefits
- Pre-authorization was required but not obtained
Tip: Avoid blaming language. Instead, explain the system and where things stand.
What to say:
“In this case, your plan doesn’t cover services from out-of-network providers, which I am for your plan. That means they won’t reimburse for sessions, even though they cover mental health more generally.”
3. Offer a Superbill or Reimbursement Help
Many clients don’t know they can still submit claims to insurance, even if you’re not in-network. Offering to provide a superbill or help them submit it gives them more control.
What to say:
“I can give you a superbill, which is a detailed receipt of our sessions. Some clients submit these to their insurance for partial reimbursement, even if I’m not in-network. I’m happy to walk you through how to do that.”
4. Suggest an Appeal (If Appropriate)
If the claim was denied due to a technical error or questionable policy, clients may have the right to appeal.
What to say:
“Sometimes insurance companies deny claims incorrectly. If you’d like to appeal this decision, I can provide you with documentation or help you understand the next steps to challenge it.”
5. Present Private Pay Options With Sensitivity
If insurance isn’t an option, be ready to talk about private pay in a way that feels flexible, not transactional. Avoid making assumptions about what clients can or cannot afford.
You might offer:
- Sliding scale options
- Payment plans
- Lower-cost session options (group therapy, shorter sessions)
- Referrals to lower-cost providers
What to say:
“If you’d still like to continue therapy with me, I want to work with you to find an option that fits your budget. We can talk about payment plans, a sliding scale, or other resources depending on what you need.”
6. Reaffirm Your Commitment to Their Care
Clients need to know that you’re still in their corner, regardless of the financial piece. End the conversation by reaffirming your support.
What to say:
“My goal is to make sure you get the care you need. Let’s figure out the best path forward together, whether that’s with me or through another option that works better with your insurance.”
7. Prevent Future Confusion: Set Expectations Early
To avoid similar surprises down the road, make insurance and payment conversations part of your intake process. Use clear policies and welcome client questions before sessions begin.
What to include in intake materials:
- Your insurance status (in-network or out-of-network)
- Whether you offer superbills
- Payment expectations and cancellation policies
Final Thoughts
It’s never easy to tell a client their therapy isn’t covered by insurance. But with the right language, tools, and empathy, you can turn a frustrating moment into one of trust and support. By helping clients understand their options and empowering them to make informed decisions, you strengthen the therapeutic relationship and make care more accessible.
If billing, claims, or reimbursement issues are taking up too much of your time, Anchor Point Billing Solutions is here to help. We specialize in mental health billing so you can focus on your clients, not paperwork.
Contact your mental health billing team today to learn how we can support your practice and your peace of mind.