“Why Doesn't Accessibility Include the Provider?” Rethinking Insurance, Private Pay, and Self-Sacrifice
Oct 13, 2026Do your time in community mental health. Burn out. Then you've earned the right to work in private practice. That was the message Kendall Hagensen heard from professors in graduate school, and it's a trajectory many therapists still follow. But what if that path isn't possible for everyone, and what if it shouldn't be the price of admission for building a sustainable career?
In this episode of the Wellness Center Creators podcast, Kendall and Anna Rudel explore the tension between insurance and private pay clinics, and what Kendall calls a “no-win cycle of shame” around money and accessibility. Mental health feels it most, but it shows up in acupuncture, massage, and naturopathic care too. Take insurance, and you may be told you're undervaluing your degrees and your services. Don't take it, and you may be told you're making care inaccessible and aren't a good person or a good clinician.
Anna shares what she has seen in the acupuncture world, where lower price points carry a kind of virtue. Her take is that accessibility doesn't have to mean making every service affordable to everybody, and that there may be some misplaced ego in believing otherwise, because no single small business can solve the entire failure of the American healthcare system. Kendall adds that the servant-leader sentiment from social work often bleeds into psychotherapy, and she describes a colleague's post about how working in community mental health, overworked and underpaid, is a privilege that clinicians who can't physically sustain it simply don't have. She also describes a state licensing board in Washington so understaffed that some clinicians wait 6 to 9 months for approval, which keeps them from working at all.
Kendall shares that her own clinic is private pay and out of network while accepting one insurance in network, and that she has watched many practices move away from insurance because the relationship with insurance companies can be damaging and depleting. She and Anna joke that they do try to close the accessibility gap, but a single clinic can't absorb all of it, and that's not on them.
The conversation turns to the word profit. Anna explains that a buffer to weather a downturn like COVID, give a raise, train new practitioners, and pay the front desk all comes from profit. Kendall notes that a clinic with front desk support, administrative help, and full-time housekeeping needs margin on its services, while other practices keep costs down with no support staff or virtual assistants. There are many ways to run a clinic, and the real conversation is about the moral compass underneath. As Kendall asks, who's to say what's right or wrong?
Then Kendall tackles a common misconception: that insurance always costs less. She walks through a patient who spends a year at a traditional outpatient clinic paying $25 to $60 per copay while chasing mystery symptoms, compared with a patient who pays at the time of service, gets reimbursed 60 to 80% out of network, and finds the root cause in three months. Which one costs more?
Finally, they ask why people routinely pay lawyers and dentists privately, but healthcare got put in a camp where it's seen as not worth investing in. Kendall wonders why accessibility doesn't include the provider, and Anna asks a vulnerable question of her own: have you found yourself being virtuous about overwork? Both admit they have, and both agree clinicians sometimes have to create their own value because society doesn't create it for them.
There are no neat answers here, and the hosts say so. It's an honest pondering for anyone who has felt torn between mission and sustainability, and Kendall invites listeners to send questions and feedback for a possible follow-up.
And for information Bloom and Grow Monthly Mastermind Groups, go to: https://www.wellnesscentercreators.com/group-coaching
Sponsored by Jane App, Jane offers online booking, charting, scheduling, secure video and invoicing on one secure, beautifully designed system: https://jane.app/ Use code wellness1mo for a one-month grace period on your new Jane account.
About Anna Rudel
Anna Rudel, L. Ac is the owner and founder of Lokahi Acupuncture Clinic in San Jose California, founded in 2003. Anna is a master organizer and clinician, and as a Coach she specializes in working with Clinic Owners in the state of California, and Acupuncturists and Acupuncture Clinic Owners, or groups wanting to add Acupuncture worldwide, as well as teams that need support with employee retention and satisfaction. Born in the UK, Anna has traveled extensively in Asia and now has a thriving multi-practitioner clinic in the US!
Anna's Website and Links
- Website: https://lokahiacupuncture.com/
- Learn Group Coaching: https://www.wellnesscentercreators.com/group-coaching
- For info about Individual Coaching: https://www.wellnesscentercreators.com/individual-coaching
About Kendall Hagensen
Kendall is a Somatic Mental Health Therapist, Multidisciplinary Clinic Owner and Business Coach. She specializes in, and is passionate about, working with healthcare professionals to create the businesses of their dreams. Big goals always have a psychological component beneath the surface, so Kendall uses her background in Somatic Psychotherapy and EMDR Therapy mixed with Business Coaching tools to help clients develop a healthy relationship with their business and their strength as a leader.
As someone who lives with a chronic illness herself, Kendall feels that health happens best within community, which is why she takes a holistic, integrative, and collaborative wellness approach to her personal and professional life.
Kendall’s Web/Social Links