Thanks for sharing this. I'm not at all surprised by some of the reasons. i see an out-of-network therapist (my insurance reimburses nearly half to me, but I have to pay him up front), and he's mentioned a few of the reasons in the article as to why he doesn't take insurance (including insurance limiting care and needing to spend lots of time dealing with them).

He does offer a sliding scale though--I have a slightly reduced rate, but he's mentioned being able to make accommodations for a much lower rate if, say, my husband were to lose his job (which has the insurance policy). And that he sees, for example, some college students for much less--maybe similar to what an insurance co-pay would be.

And I got a first-hand look at the differences in rates by having a one-time session with an in-network psychiatrist (I opted not to continue with him). I could see on my insurance statement that he billed $500 for the intake appointment (it was nearly 90 minutes), but insurance is only going to pay him the allowed amount of $173. If he was self-pay/out-of-network, then he would have made the entire $500 (Insurance might have given part of that back to *me*, but he would still get the full amount).

However, this all creates great inequities in the availability of care. (I know I'm lucky in being able to afford what I can.)