My T gets approximately $60 between insurance and my copay per hour of therapy. With that she has to pay rent, utilities, a billing person (which she finally got because she couldn't figure it out on her own), plus have money for her own personal insurance, food, housing, etc. Obviously she could do better if she went with private pay--no insurance--but we live in a semi-rural area and she would likely have to have an office "down the hill" in a pricier community (which means higher rent, etc) in order to have clients that could afford private pay. I do private pay for my Pdoc but I couldn't afford private pay for a Pdoc and a therapist. When my Pdoc was taking insurance he was being reimbursed $180 per 15 minute appointment. I private pay $200 to see him for a 25 minute appointment. But he also moved his office to Palm Springs which is ultra expensive (it's a beautiful office though). He said when he was taking insurance he had 1000 patients and couldn't keep track of them all like he wanted to. Private pay allows him to see fewer clients but have better control over their care. I'm sure some insurances pay better or worse than mine. I think my T is underpaid.