In-network vs. out-of-network: What’s best for you and your practice?

One of the most common questions I get from my private practice coaching clients is: What insurance is best to panel with? Often quickly followed by: "I don't even want to take more insurances, I actually want to take fewer, but I don't know if that's a good business decision." The fact is there's no "right" answer, but there might be a right answer for you and your practice at this stage.

The truth is, I've worked with — and even run — practices that thrived fully out-of-network and others that built profitable and sustainable in-network practices. The "right" decision depends on your practice, your clients, your location, your goals, and your values. So rather than giving you the answer, I want to help you determine how to make a confident decision about what is right for you.

Let's Start With the Real Trade-Off

At its core, this decision comes down to access vs. autonomy — and the money vs. time cost that come with each.

Staying or Going in-network means your time will be spent on billing — yourself or through a biller. But many feel this is worth it for two reasons: access and referral flow. You're often accessible to clients who can't afford to pay local out-of-network rates, and insurance panels are inherently a steady referral source that keeps your schedule full without having to spend much time (or money) on marketing. The downside, of course, is you're locked into whatever rate the insurance company decides to pay — and those rates aren't often great. You're subject to their policies, their paperwork, the timeline in which they pay, and their willingness (or not) to pay for your services.

Going out-of-network (OON) means your time will be spent on marketing. (If you haven't already, check out my recent post on how to better market your practice — it's a good place to start.) But many feel this is worth it for two reasons: financial security and clinical freedom. You're able to control your own rate and can even offer a sliding scale to clients who may otherwise have a higher cost due to a high deductible. You're also able to charge for your services without worrying about whether the therapeutic modality you work from is "medically necessary" or feeling forced to fit a client into a DSM F-code diagnosis simply to have their insurance approve your work with them. The downside, of course, is that your marketing should be pristine and you're limiting the pool of prospective clients who would be able to afford your services.

Neither path is inherently better. Both have costs — literal and figurative. The question is what is a better use of your time and resources, given your goals.

The Factors That Actually Matter

Here's where I want you to take some time to reflect on what route might be best for your practice. I encourage you to jot these down, as visualizing your answers will process differently.

1. Your Client Base and Community

Who do you work with, and who do you want to work with? What's your niche? If you love working with clients who rely on insurance to access care, going OON may not align with your values, which matters. But if your ideal client is someone who values your expertise and is willing to pay for it, OON opens that door. There's no wrong answer here.

2. Your Local Market

This is critical. Look at what other therapists in your area are charging — don't use it to set your rates, but use it as a frame of reference. If you're in an area with a lot of other OON therapists, is your niche different enough to set yourself apart? If you're in an area with a lot of in-network therapists, does that mean insurance is the expectation for clients? Your market should never dictate your decision — it should simply inform it. What's common in Manhattan likely isn't common in rural Iowa, but it doesn't mean it won't work. Telehealth practices were a rarity prior to the pandemic, but they were still successful.

3. Your Niche

If you have a niche that's in high demand — trauma, couples, disordered eating, neurodivergence — clients are more likely to seek you out and pay your rate. If you're a generalist in a saturated market, the in-network referrals might be what keeps you full. Be honest with yourself about whether your clients are coming to you because of your niche or because you accept their insurance.

4. Your Financial Needs

What do you need to make per session to sustain your practice and pay yourself fairly? There is a way to reverse engineer this, and I have a calculator to help you do so. Compare that number to your current in-network rates. If there's a gap, how would you address it — by raising your rate, by dropping lower-paying insurance panels, or by taking on more clients? Run the numbers. Don't assume. Keep in mind, in-network you will be full faster, so ensure you have the financial ability to take a short financial hit when waiting to fill your caseload when going out-of-network at first.

5. Your Administrative Bandwidth

Let's be honest — in-network billing is more work. Credentialing, claim submissions, denials, appeals — it can be a lot. If you love the clinical work and hate the admin side (or can't afford a biller), that's a real factor. OON still has some admin, but not nearly as much. If you're already drowning in paperwork, that's worth thinking about before adding more insurance panels.

The Option Most don’t consider - a hybrid

You don't have to be all in or all out. Many of the practices that work best use a hybrid model — they accept one or two insurance panels and keep the rest of their caseload private pay or OON. This gives you the stability of referrals and the flexibility of controlling part of your income.

If you're already in-network and considering a change, you don't have to get rid of all the panels at once. You can phase out of a panel, test the waters, and see how your practice responds. You can learn as you go and build your confidence with it over time.

The Bottom Line

Here's what I want you to take from this — there is no universally correct answer, but there is a correct answer for you. It's the one that aligns with your clients, your market, your finances, your values, and your bandwidth — and each of you will have different levels of each.

The therapists who struggle the most aren't the ones who picked the "wrong" choice. They're the ones who never made an intentional choice and just went with whatever felt most helpful in the moment. Don't let your gut be your sole driver.

Want Help Thinking Through Your Decision?

This is exactly the kind of conversation I have with practice owners weekly. If you're at a crossroads with this decision — if you're going solo, growing into a group, or rethinking your current model — let's talk through it. Book a coaching session with me and we'll decide the right path for your practice.