I know a psychologist who originally started her practice not taking insurance, because she didn’t want to have to deal with the constraints. After about two years, she started taking insurance, because she was struggling. The number of people willing to pay up-front for mental health care is tiny compared to the number of people who have insurance that will pay for health care. What she found is that she makes less per patient, but she has a lot more patients, and the constraints imposed by the insurance are usually ones she can work within. Her practice is now thriving, and she doesn’t seem to regret the decision at all.