Insurance is the only thing where you pay for it, hope you never need it, and then when you finally use it, they’re like, “Hmm… we’ll allow 17 minutes and only if you pronounce it correctly. (A joke inspired by Jerry Seinfeld)

A transparent look at why some speech therapy practices choose to be out-of-network—and what that really means for families.

If you’ve ever reached out to a private speech therapy practice and heard, “We don’t take insurance,” you may have felt confused, frustrated, or unsure what that actually means for you.

It’s a fair question. Therapy is an investment. And as parents (or adults seeking services), you want to make informed decisions.

So let’s break it down clearly and honestly.

First: What Does “Not Taking Insurance” Actually Mean?

When a practice is in-network, it has signed contracts with insurance companies. Those contracts determine:

What services can be provided
How long sessions can be
What diagnosis codes must be used
How progress must be documented
How much the therapist is paid

When a practice is out-of-network, it has chosen not to enter into those contracts. Families pay the practice directly, and depending on their insurance plan, may submit their payment receipts for out-of-network reimbursement.

That’s the structural difference.

Now let’s talk about the why.

Why Would a Practice Choose Not to Take Insurance?

1. Clinical Freedom

Insurance companies often dictate:

Frequency of sessions
Length of care
What counts as “medically necessary”
When services must be discontinued

But communication challenges don’t always fit neatly into those boxes.

Speech therapy is highly individualized. Some clients need longer sessions. Some need parent coaching built in. Some adults need flexible scheduling. Some clients benefit from collaboration with schools, physicians, or other therapists.

When a practice is out-of-network, therapists can:

Create truly individualized treatment plans
Adjust frequency at any time based on clinical need—not insurance approval
Discharge when appropriate—not when benefits expire
Focus on functional outcomes, not just billable codes

It allows therapy to be guided by professional expertise, not policy limitations.

2. Time Spent on Therapy (Not Paperwork)

Insurance billing is complex and time-consuming. It requires:

Pre-authorizations
Ongoing progress reports
Utilization reviews
Denials and appeals
Strict documentation requirements
Administrative staffing to manage claims

For small, relationship-based practices, that often means:

Higher overhead
More administrative burden
Less time available for direct care and collaboration

Many private practices choose to streamline this so their energy goes toward:

Session planning
Parent education
Collaboration with teachers and other providers
Ongoing professional development

In other words—toward your care.

3. Fair Reimbursement for Specialized Care

Insurance reimbursement rates are often significantly lower than the true cost of providing high-quality, individualized therapy.

Rates are determined by insurance companies—not by the therapist’s:

Years of experience
Specialized training
Advanced certifications
Time spent outside of sessions preparing and collaborating

In some cases, reimbursement does not even cover the full cost of delivering the service.

By setting private rates, practices can:

Sustain small caseloads
Avoid overbooking
Hire experienced clinicians
Invest in continued education
Maintain high-quality service

4. Relationship-Based, Not Volume-Based Care

Insurance-based models often require higher caseloads to stay financially viable.

Out-of-network practices can:

Keep smaller caseloads
Offer consistent scheduling
Provide longer sessions when appropriate
Build deeper relationships
Prioritize continuity of care

For many families, this is one of the biggest differences they notice.

But What About Cost?

This is the part that matters most.

When a practice does not take insurance:

You pay the practice directly.
You may be able to submit a superbill to your insurance for out-of-network reimbursement.
Reimbursement depends entirely on your individual plan.

Some plans reimburse a significant portion. Some reimburse partially. Some do not cover out-of-network services at all.

It’s important to:

Call your insurance company
Ask about “out-of-network speech therapy benefits”
Ask about deductible, reimbursement percentage, and allowed amount

We always encourage families to gather this information so they can make an informed decision.

Is One Model Better Than the Other?

Not necessarily.

In-network therapy can be a wonderful option for many families. There are excellent providers who work within insurance systems and do incredible work.

An out-of-network practice is simply a different model. It prioritizes:

Autonomy
Flexibility
Clinical decision-making
Individualized care
Sustainability of small, specialized teams

The right choice depends on your family’s needs, priorities, and financial situation.

What You’re Really Choosing

When you choose an out-of-network private practice, you’re often choosing:

A smaller, more personal experience
Direct access to experienced clinicians
Collaboration and parent coaching
Flexible treatment planning
Therapy that focuses on real-life carryover
A relationship-centered approach

For many families, that investment feels aligned with their goals.

For others, using insurance coverage is the right fit.

Both are valid.

Transparency Matters

We believe families deserve clarity—not confusion—around this topic.

If you ever have questions about:

Fees
Out-of-network reimbursement
How to submit claims
Whether services are a good fit

Ask. The right practice will walk you through it.

Because at the end of the day, speech therapy isn’t just about coverage.

It’s about connection.
It’s about growth.
It’s about meaningful communication in real life.

Contact Us

What’s the Deal with Not Taking Insurance?