Why I Don’t Accept Insurance
At Silvering Psychological, I do not participate in insurance panels. This is intentional. And it is central to the kind of work I offer.
Insurance Requires a Diagnosis — and the Diagnostic System Has Problems of Its Own
In order for insurance to reimburse therapy, I must assign a mental health diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and demonstrate "medical necessity." That means your distress must fit into a billing category, your treatment must target symptom reduction, and your progress must be documented in a way that justifies continued reimbursement.
For some people, that framework is appropriate. For many of the clients I work with — high-functioning professionals, complex trauma survivors, leaders, and high performers — it is not the most accurate lens.
But the issue goes deeper than fit. The DSM itself, while useful as a shared language among clinicians, has significant limitations as a foundation for treatment. Thomas Insel, former Director of the National Institute of Mental Health (NIMH) — the largest mental health research funding body in the world — has been one of its most prominent critics from within the field. In 2013, Insel publicly acknowledged that the DSM's core weakness is its lack of validity, noting that its diagnoses are based on consensus about symptom clusters rather than objective measures, and that this approach would be considered inadequate in virtually any other area of medicine. He went so far as to redirect NIMH-funded research away from DSM categories entirely. In later reflections, he put it more bluntly: a diagnosis alone tells you remarkably little about what a person actually needs. As one of his mentors once told him, if you tell someone a patient has schizophrenia, you've told them about five percent of what they really need to know. The field, Insel argued, has been asking diagnosis to do far more than it should.
This matters because the insurance model is built on the DSM. When the diagnostic system itself is limited, the treatment model that depends on it inherits those same limitations. Categories that were designed to create reliability among clinicians — so that two professionals use the same term the same way — were never designed to capture the full complexity of a human being's inner world. They describe surface-level symptom patterns. They do not describe the belief structures, attachment wounds, nervous system states, developmental adaptations, or identity-level shifts that are at the heart of the work I do.
You may not be "disordered." You may be navigating complex trauma, identity evolution, nervous system dysregulation, relational patterning, or performance ceilings that don't fit neatly into a diagnostic code — not because they aren't real or significant, but because the system was never built to hold them. That is not pathology. That is depth work. And depth work does not fit into symptom-reduction billing codes.
Insurance Dictates the Structure of Treatment
Insurance companies determine session length, session frequency, whether longer sessions are reimbursable, and when treatment is considered "complete." These parameters are based on actuarial models and cost containment — not on what the clinical work actually requires.
My work often includes 75–90 minute sessions, structured integrative interventions, trauma-informed pacing, and high-level performance integration. I operate outside of standard session limits because transformation does not happen on an arbitrary clock. When we are doing somatic integration, belief restructuring, nervous system regulation work, and identity-level reprogramming, depth and continuity matter. Cutting that process short at 50 minutes because a billing code requires it compromises the integrity of the work.
Insurance reimbursement models were not designed for this kind of treatment. Remaining out-of-network allows me to structure sessions around what you need, not what an insurer will approve.
Your Records Are Not Private in the Same Way
When insurance is involved, diagnoses are submitted to third parties, treatment plans may be shared, records can be audited, and mental health information becomes part of your permanent medical record.
For some people, that is not a concern. For others — particularly physicians, attorneys, executives, public figures, and high-level professionals — confidentiality is paramount. A diagnosis on your record can carry implications for licensing, security clearances, disability determinations, and professional reputation, regardless of the context in which it was assigned.
Operating out-of-network preserves a higher degree of privacy. Your treatment, your diagnoses, and the content of our sessions remain between us.
The Work Is Not Symptom-Only
Insurance is built around acute symptom stabilization, crisis management, and short-term behavioral change. Those are important services, and there are excellent providers who deliver them within the insurance model.
Silvering is structured integration. It is a deliberate, phase-based process of making the unconscious visible, reorganizing belief structures, integrating trauma at the nervous system level, and expanding identity and performance capacity. This is not eclectic therapy — it is a cohesive model with a clear theoretical foundation and a defined progression. It requires freedom from reimbursement-driven constraints that would compress, fragment, or prematurely terminate the work.
The DSM framework asks: What disorder does this person have, and how do we reduce their symptoms? The question I'm asking is different: What programs are running beneath the surface, where did they come from, and what would it take to rewrite them? Those are not the same question, and they do not lead to the same kind of treatment.
Investment Changes Engagement
This part is rarely said aloud — but it matters.
When clients invest directly in their work, something shifts. Attendance improves. Depth increases. Responsibility shifts inward. The therapeutic alliance strengthens. There is a different quality of ownership when the investment is yours rather than a copay subsidized by a system you have no relationship with.
Insurance externalizes payment. Private pay reinforces commitment. And commitment is not a peripheral detail of this work — it is foundational. Transformation is not passive. It requires showing up, doing the work between sessions, tolerating discomfort, and choosing growth over and over again. A financial investment that reflects that reality tends to support rather than undermine the process.
What I Do Offer
While I do not accept insurance, I can provide a superbill for clients with out-of-network benefits. Many plans reimburse a portion of fees, and I am happy to help you navigate that process.
I also offer extended sessions, flexible pacing, no session caps, and telehealth for clients in Massachusetts and Pennsylvania, with in-person services coming soon.
The Bottom Line
If you are seeking short-term symptom management through insurance coverage, there are many excellent providers who participate in panels, and I would encourage you to find one who is the right fit.
If you are seeking structured, depth-oriented, high-precision psychological work — the kind that goes beneath the surface and stays there long enough to change something — Silvering may be a better fit outside that system.
The decision to remain out-of-network is not about exclusivity. It is about protecting the integrity of the work — the time it needs, the privacy it deserves, and the freedom to treat the whole person rather than a billing code.
And ultimately, it protects you.
