Here’s the maddening truth about private practice: you can pour yourself into the delicate, exhausting work of caring for people, tracking symptoms, documenting progress, and holding another person’s pain, only to then watch the money you’re owed evaporate in the form of an insurance denial.

Denied claims aren’t just irritating scraps of paperwork. They’re structural. They’re systemic. They are one of the ways our profit-driven health system reminds therapists that their time, labor, and expertise are negotiable.

The numbers bear it out: almost 12% of all healthcare claims are denied (Change Healthcare, 2023). In behavioral health, the rates are worse: the Mental Health Treatment and Research Institute’s 2024 Behavioral Health Parity Report report found mental health claim denial rates are 85% higher than comparable medical services. Translation: the more invisible, stigmatized, or subjective the work, the harder you’ll fight to get paid for it.

But here’s the other truth: some denials are preventable and avoidable. And when they happen, they’re not the final word.

Insurance Denials are a Hidden Tax on Your Practice

Especially for therapists in private practice, denials aren’t just about money. They’re about stability and sustainability. A single unpaid claim can ripple into hours of phone calls and resubmissions, that averages out to about $25-117 to rework a single denied claim (HealthRev). That time doesn’t just represent lost income, that’s your evening, your family time, and your bandwidth for client work.

The deeper insult? According to a 2023 report about Medicare Advantage prior authorizations published by the Kaiser Family Foundation, 81.7% of denials that were appealed got overturned. Which tells you what you probably already suspect: that much of this is about insurance companies betting you won’t have the time, resources, or energy to fight back.

Why Claims Get Denied (and Why It’s Not Always About You)

Insurance companies are skilled at making denials feel like they’re your fault. And yes, sometimes, because you’re human, they are. Maybe you mistyped a CPT code, or turned in something late. But often, the denials are structural, designed to hold onto money longer or discourage payment entirely. The most common reasons include:

• Coverage and eligibility traps. A client’s policy quietly excludes telehealth, or only covers therapy with in-network providers, or their coverage mysteriously “wasn’t active” on the day you saw them.
• Pending limbo. Claims can sit “on hold” while insurers wait for Coordination of Benefits (does the client maybe have other insurance?) or demand your progress notes before processing payment.
• Submission errors. The wrong ICD-10 code. An incomplete form. A claim sent to the wrong address.
• Timely filing deadlines. Sixty to ninety days is standard. Miss it and your work is automatically worthless, no matter how necessary or skillful.
• Clinical denials. The insurance company decides your treatment wasn’t “medically necessary,” or your notes don’t justify the frequency or length of sessions.

The Financial and Emotional Toll

Denials are expensive. They’re demoralizing. And they’re wildly inefficient. 50-65% of denied claims are never resubmitted (Onpoint Medical Solutions), which means millions of dollars in clinician labor simply vanish into the void.

For therapists, the toll isn’t just financial. It’s existential. Every hour spent fighting an insurer is an hour you’re not building community, not deepening your practice, not resting. It’s a kind of slow-drip burnout, a reminder that even as you do life-saving work, the system treats you like a line item to be minimized. The good news is that around 31% of denials are potentially avoidable (Onpoint), which means that prevention is the key.

Strategies That Can Shift the Odds

So what can therapists actually do? None of this is magic, and no single tactic eliminates the problem, but there are real steps that can move the needle. Consider the following strategies:

Front-load the verification: Before a first appointment, check eligibility and benefits. While another phone call, another portal login is tedious, catching that a client’s coverage has lapsed or that their plan excludes mental health saves you from hours of appeals later. Many clinicians delegate this to an admin, but even solo practitioners can build it into their intake workflow with scripts and checklists.

Document like someone is going to read it suspiciously (because they are): Insurance companies comb through notes looking for reasons to deny. That means vague language (“client is improving”) or generic treatment goals can trigger red flags. Instead, anchor documentation in specifics: symptoms, frequency, measurable changes. “Client reports three panic attacks this week, down from five last week” leaves less room for denial than “client doing better.” While it can feel maddening to translate human progress into bullet-point metrics, it reduces ammunition for denial.

Double and triple check your codes: Claim denials often stem from coding mismatches: the CPT code doesn’t line up with the diagnosis code, or the billed service is not covered under the plan. Keep a running list of the codes you use most often, and update it at least quarterly. Cross-reference your codes with payer-specific guidelines, because what one insurer accepts, another might reject. This is the kind of grunt work that could feel beneath your clinical expertise, but it’s often the deciding factor in whether you get paid.

Track your denials like a detective: Patterns emerge when you stop treating denials as isolated flukes. Is one insurer repeatedly rejecting telehealth sessions? Are most denials tied to one diagnosis code? Whether in a spreadsheet, EHR report, or even a notebook, keep a denial log, as it lets you spot trends and adjust. It also arms you with data if you decide to challenge the payer or join forces with colleagues to press for systemic change.

Appeal, but don’t appeal blindly: Appeals are their own exhausting ecosystem, but sometimes they’re worth it. The key is to know your strike zone: appeal when you have clear grounds (for example, if the denial cites missing information you can easily provide), but don’t waste hours on every $75 claim. Setting your own rules about what’s worth fighting saves energy for the bigger battles.

Leverage your community: One therapist may not have the bandwidth to stay current on every shifting insurer quirk, but ten therapists pooling experiences can. Professional listservs, local networks, and even private Facebook groups often share denial reasons in real time. If Blue Cross suddenly starts rejecting a common telehealth code, you’ll hear it from a colleague faster than you will from the insurer.

Push back where possible: None of this is fair, and it’s not all on therapists to adapt. Filing formal complaints with your state insurance commissioner, joining advocacy efforts, or supporting professional associations lobbying for claims reform may feel distant from the day-to-day grind, but this is how change creeps forward.

Of course, these strategies won’t make denied claims disappear. But they can reduce their frequency and blunt their impact, buying you back some of the time and energy that denial letters siphon off. And perhaps more importantly, they remind you that you’re not powerless in the face of a system built to make you feel that way.

Fighting Back When Denials Still Happen

Insurers want you to think that denials are final. They are not. Here’s what can help: ‍

File quickly. Each plan has a different appeal window, and missing it means game over.

Write a pointed appeal letter. Name the denial reason, provide the documentation, and defend medical necessity.

Call. Sometimes the fastest way through is a human conversation with a rep who can push your claim forward.

Remember parity law. If mental health services are being treated less favorably than comparable physical health care, cite it. Put the insurer on notice.

It’s easy to accept claim denials as “just part of the job,” another headache to absorb into an already crowded day. But the truth is, every denial is more than a form to refile. The unpaid time you spend appealing denials could otherwise be spent with clients or managing other essential practice tasks. Each denied claim is another hour you don’t get to spend with clients, another disruption to the fragile balance of running a practice where you are simultaneously clinician, bookkeeper, and front-office staff.

Reducing denials, then, isn’t only about money. It’s about reclaiming enough breathing room to focus on what you were trained to do: help people heal. When you know the steps you can take to prevent denials, you are not just protecting your revenue. You are protecting your ability to keep practicing, to keep showing up for your clients with energy intact. And in the day-to-day life of a therapist, that preservation matters just as much as the paycheck.