How to Successfully Ask for a Raise from Insurance Companies as a Private Practice Provider

For mental health professionals in private practice, reimbursement rates from insurance companies are one of the key determinants of financial viability. Yet many clinicians feel stuck with outdated or unfairly low rates, despite delivering high-quality care. If you've been working with insurance companies for at least a year, you're in a stronger position than you think to negotiate a raise—and this post will show you how to do it effectively.

Why 1 Year of Experience Matters

Before reaching out to an insurance panel to request a rate increase, it's essential to have at least 12 months of consistent billing history with that payer. One year gives you:

• A track record of reliability and claim accuracy.

• Demonstrable outcomes and client retention rates.

• An understanding of how your services fit within their network's needs.

Many insurance panels will not consider rate increases until you’ve been paneled for a full year. So if you’ve hit that milestone, now is the time to act.

Step 1: Gather Your Data—Show Your Success

Start by demonstrating your value as a provider. Insurance companies respond to data and outcomes. Include:

• Session volume: How many sessions you've completed in the past 6–12 months.

• Low cancellation/no-show rates: Show that clients engage consistently with your care.

• Client outcomes: If you use outcome measures (e.g., PHQ-9, GAD-7), share improvements.

• Retention: Highlight how long clients typically stay with you and complete treatment.

This shows that you are not only clinically effective but also contribute to cost-effective care for the insurance company.

Step 2: Highlight Your Specialized Training and Skill Set

Providers who offer unique services or serve high-need populations are more valuable to insurers. Be sure to mention:

• Advanced certifications (e.g., EMDR, DBT, trauma-focused CBT)

• Licensure level and years of experience

• Multilingual abilities

• Cultural competence training

• Specializations in high-demand areas (e.g., trauma, substance abuse, LGBTQ+ care, children or adolescents)

Make it clear how your background distinguishes you from other providers in the network.

Step 3: Align with the Insurance Company’s Needs

Insurers want to keep their networks robust and responsive to client needs. Identify the demographic groups you serve—especially underserved populations—and explain how you help the company meet its goals. For example:

“I specialize in working with BIPOC teens who have experienced trauma. There are few clinicians in the area who serve this population with trauma-informed care, which reduces risk for long-term mental health costs and improves engagement.”

The more your practice fills a network gap, the stronger your case for increased reimbursement..

Step 4: Address Inflation and the Rising Cost of Practice

Economic reality plays a role too. Frame this professionally:

“Since joining your panel in [year], the cost of maintaining my private practice has increased significantly. Rent, software subscriptions, continuing education requirements, and general inflation have all risen. To continue providing quality care and maintain practice sustainability, I am requesting a rate adjustment.”

Reference specific data if possible (e.g., “Consumer inflation has increased by X% over the past year.”)

Step 5: Write a Professional Raise Request Letter

Here’s a structure to follow:

• Introduction: Your name, credentials, and how long you've been paneled.

• Performance: Briefly outline your success metrics.

• Training and Value: Highlight your certifications and unique services.

• Client Demographics: Explain the population you serve and why it matters.

• Financial Reasoning: Cite inflation and increased operating costs.

• Request: Be specific. Ask for a particular rate increase or “reimbursement reconsideration.”

Sample language:

“I am respectfully requesting a rate increase to $125 per session for CPT code 90837, reflective of my experience, specialized services, and the increased cost of maintaining a high-quality private practice.”

Step 6: Follow Up

Be persistent but professional. Follow up after 30 days if you haven’t received a response. Some providers get approvals only after multiple inquiries. Keep documentation of all communications.

Negotiating higher reimbursement rates with insurance companies isn’t just possible—it’s necessary for sustaining ethical, client-centered care in a private practice setting. With at least one year of data, a clear demonstration of your clinical value, and a professional approach, you have the tools to advocate for yourself and your business.

You’re not just asking for a raise—you’re showing why you’ve earned one.

Interested in learning more about starting your own private therapy practice?

If you’re a friendly, professional clinician, ready to take the next steps toward private practice in the south shore, we would love to speak with you.

Please contact Karen Peabody: 774-222-3196 | Email: info@forgewellsolutions.com

Karen Peabody, LICSW is a therapist and business consultant for social workers and therapists interested in starting their private practice. She founded Forgewell Solutions in East Bridgewater, MA. Her office is a great place to start a private practice. Visit her FOR THERAPISTS page to learn more.