It’s one of the quieter indignities of being a therapist in private practice: you go through years of training to learn how to sit with pain, guide healing, and build trust. And yet, a not-insignificant chunk of your professional life is spent explaining the definition of a deductible. Or walking someone through what a superbill is. Or clarifying why their out-of-network reimbursement hasn’t come through yet.

None of this is therapy or why you went into the profession. And yet, clients turn to you because their insurer might not give them clear answers. Which means you end up doing the work of insurance policy education work for free. While this is understandably frustrating and draining, there are ways you can protect your time while still supporting your clients with compassion. 

Why Clients Are Confused in the First Place

The American insurance system is a labyrinth, and that’s not by accident. The complexity (e.g., deductibles, copays, coinsurance, allowed amounts, “reasonable and customary” rates) is part of the design. When your clients don’t understand the system, they’re more likely to overpay, give up on reimbursement, or never question a denial.

Roughly 50% of patients are able to correctly calculate out-of-pocket costs for services they receive (Leavitt (2015). That’s worth pausing on – only half. So if your client is staring at a benefits statement that looks like it was designed to confuse them, it’s not a failing on their part. And when they ask you, mid-session, why they owe you more money than they expected, it’s because they trust you to translate what their insurer won’t. 

The Hidden Costs of Explaining Insurance

This insurance educator role isn’t listed in any CPT code. There is no reimbursement for it. And yet it consumes real time, energy, and attention.

• Time costs: Every 10 minutes you spend breaking down deductibles is 10 minutes you’re not writing notes, prepping for a session, or just catching your breath between clients. Multiply that across a caseload of 20 or 30, and you’ve got hours of invisible labor every month.
• Financial costs: In group practices, this hidden labor scales. Admin staff may absorb some of it, but often the clinician still fields the tricky questions. And in solo practice, it’s unfortunately all on you.
• Emotional costs: To say the least, insurance confusion is emotionally charged. Clients can feel angry, betrayed, or ashamed, and those feelings sometimes land on you. You become the face of a system that you don’t control.

This unpaid explanatory work is part of why so many therapists feel stretched to the breaking point. It means that you’re not just clinician, scheduler, and biller – you’re also an impromptu health policy educator.

How to Explain Common Insurance Terms to Clients

Why do I have to pay upfront if you’re out-of-network? What’s a superbill? Why won’t my insurance reimburse me for telehealth? Perhaps you’ve fielded some of these greatest hits from clients. Each of these questions is understandable from the client’s perspective. They are also maddeningly complex to answer, because the “right” response depends on the specifics of a client’s plan and health policy. You can give general education, but you can’t (and probably shouldn’t) guarantee what their insurer will do. 

The key is to strike a balance: offer clarity without becoming your client’s unpaid insurance representative. Below are some plain-language scripts you can adapt.

Deductible

• What it is: The amount you pay out-of-pocket for care before your insurance starts sharing costs.
• Example: If your deductible is $1,500, you pay the full session fee until you’ve spent $1,500 on eligible services. After that, your insurance begins reimbursing part of the cost.
• What to say: “Think of your deductible as the amount you pay before your insurance starts sharing costs. For example, if your deductible is $1,500, you’ll pay the full session fee until you’ve spent that amount on eligible care. After that, your insurance begins reimbursing part of the cost.”

Copay

• What it is: A fixed amount paid each time you see a therapist, even if your insurance is covering part of the session.
• Example: If your copay is $30 per session, you pay $30 at each appointment, and your insurance covers the rest.
• What to say: “Your copay is a set amount you pay for each session, no matter what your insurance covers. For example, if your copay is $30, you pay $30 at each appointment, and your insurance pays the remaining portion of the fee.”

Superbill

• What it is: A detailed receipt your therapist gives you that includes: your name, diagnosis codes, session type and duration, and fee charged
• How clients can use it: Submit it to your insurance company if your plan reimburses out-of-network services. Keep a copy for your records.
• What to say: “A superbill is like a detailed receipt that I create for you. It lists the codes and fees for your session. You send it to your insurance company, and if your plan includes out-of-network benefits, they may reimburse you directly.”

Out-of-Network vs In-Network

• What it is: Describes whether your therapist has a contract with your insurance company. Being in-network means that a therapist has a contract with your insurance. Sessions usually cost less, and your therapist may bill your insurance directly. Being out-of-network means that a therapist does not have a contract with your insurance. You usually pay upfront and submit a superbill to your insurance for reimbursement.
• Example: In-network therapists usually cost less, and may bill your insurance directly. Out-of-network therapists may require you to pay upfront and submit a superbill for possible reimbursement.
• What to say: “In-network means your therapist has a contract with your insurance, so sessions usually cost less, and they can bill your insurance directly. Out-of-network means your therapist doesn’t have a contract with your plan, so you usually pay upfront and can submit a superbill to request reimbursement from your insurance.”

Reimbursement Timelines

• What it is: How long it can take for your insurance company to process a claim and reimburse you.
• Example: Insurance companies may take several weeks or even months to process claims and send reimbursement for out-of-network sessions.
• What to say: “Reimbursement timelines are the amount of time your insurance company may take to process a claim. For example, it can take several weeks or even months to receive reimbursement for out-of-network sessions. Keeping your superbills and receipts organized can help speed things along.”

These explanations and scripts don’t erase the systemic problem, but they help you answer quickly and consistently without spending extra time reinventing the wheel.

Ways to Protect Your Time and Boundaries

Here’s the heart of it: you can’t keep clients from being confused about insurance, but you can decide how much of yourself you pour into solving that confusion.

Create an FAQ handout or webpage: List out the most common questions (What’s a deductible? What’s a superbill?) with clear, simple answers. Keep it one page if possible. This becomes something you can hand clients at intake or link in your welcome email.

Automate your onboarding. Build insurance education into your intake packet. Many EHR platforms allow you to include custom documents. A simple “What to Know About Using Insurance” guide can preempt half the questions you’ll otherwise field in session.

Use template responses. Instead of writing the same explanation repeatedly in email, save text snippets (your EHR, Gmail, or even a Notes app can store these). When a client asks about deductibles, you paste in your standardized explanation so you’re done in 15 seconds instead of five minutes.

Set verbal boundaries. Sometimes you’ll need to gently redirect. For example, “I can give you a general overview, but for details about your specific coverage, it’s best to call your insurance provider. I’ll provide the documents you need, and they can walk you through your benefits.”

Encourage insurer accountability. Whenever possible, direct clients back to the source. Suggest they call the customer service number on their insurance card. Frame it as empowering: “You deserve to get clear answers directly from your insurer. I’ll support you with the documentation, but they’re the ones who can tell you what’s covered.”

Track your time. If insurance explanations are eating into your workday, start logging them. Even if you never bill for it, seeing the numbers can clarify just how much uncompensated labor you’re providing. That awareness can help you decide where to draw firmer boundaries.

Keeping Your Focus Where It Belongs

The work of a therapist is demanding enough without moonlighting as an unpaid insurance rep. Still, clients will keep asking, because the system is built to confuse them. Your job is not to fix that system singlehandedly, but to decide how to navigate it without letting it erode your practice.

That might mean sending out a superbill and a one-page FAQ instead of spending half an hour parsing an Explanation of Benefits line by line. It might mean redirecting clients back to their insurer with compassion but firmness. It might mean reminding yourself, as often as necessary: this is not my burden to carry in full.

The point isn’t to leave clients in the dark. It’s to shine just enough light that they can walk the next part of the path themselves. All while you keep your focus, your time, and your energy on the part of the work that only you can do: therapy.