Resources
Why shrinkMD Doesn't Accept Insurance
shrinkMD operates as a cash pay telepsychiatry practice to preserve clinical time, diagnostic depth, and continuity of care. Insurance networks often compress visits and add administrative layers that reduce clinical availability. Our model supports comprehensive evaluations, structured follow up, and responsible prescribing without those constraints.
Medically reviewed by Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Published June 7, 2026 · Last reviewed June 8, 2026 · Editorial policy
Why cash pay
Protecting what makes care work
Initial psychiatric evaluations at shrinkMD run 45 to 60 minutes, and follow ups are structured to allow thoughtful medication review, risk assessment, and longitudinal planning. Insurance reimbursement often incentivizes shorter visits and higher volume. Our structure protects evaluation depth and diagnostic clarity.
Insurance also requires prior authorizations, billing reviews, appeals, and documentation layers that consume clinician time. When administrative burden goes up, availability goes down. Operating outside insurance contracts lets us spend more time on care and less on paperwork.
Consistency
The same standard in every state
shrinkMD operates through state specific professional entities across the states we serve. Insurance contracts vary by payer and by state, while a cash pay model lets us maintain consistent clinical standards everywhere.
Virtual care must meet the same expectations as in person psychiatry. Accessibility should not reduce accountability.
What you get
What cash pay protects
Our structured model supports the standards that responsible psychiatric care requires.
- Diagnostic clarity and unhurried evaluations.
- Careful risk assessment and defined follow up intervals.
- Documentation integrity and ongoing symptom monitoring.
- Responsible, non controlled prescribing, built on protocols rather than volume incentives.
You always know the cost up front. We also provide a superbill you can submit for out of network reimbursement.
The mechanics
What insurance billing does to psychiatric care
Insurance does not just pay for care; it shapes it. Network reimbursement pushes practices toward shorter visits, prior authorizations delay medication changes by days or weeks, and every claim places your diagnosis into insurer databases that follow you to life insurance and beyond.
Many of the best psychiatrists have quietly left networks for exactly these reasons, which is why the list your insurer gives you so often leads to full voicemail boxes. We simply made the same choice transparently, and built the practice around what protects care.
The honest tradeoff
What you give up, and what you get back
What you give up is the copay price tag. What you get back: 45 to 60 minute evaluations instead of rushed intakes, follow ups long enough to think, medication decisions made between you and your clinician with no third party approval step, complete privacy of your records from insurers, and pricing you see before you book.
If you have out of network benefits, a superbill may recover part of the cost. If self pay is genuinely out of reach, community mental health centers and the SAMHSA helpline can point you to lower cost options, and we would rather tell you that than pretend otherwise.
Keep exploring
Keep exploring
Frequently asked questions
Good questions, clear answers
Is cash pay psychiatry more expensive?
Not necessarily. Transparent cash pay avoids surprise bills and the hidden costs of rushed, fragmented care. We also provide a superbill you can submit to your insurer for possible out of network reimbursement.
Can I use my insurance at all?
We don't bill insurance directly, but we provide a superbill that many patients submit for out of network reimbursement. Check your plan's out of network mental health benefits.
Why does visit length matter in psychiatry?
Accurate diagnosis, risk assessment, and safe medication decisions take time. Longer, unhurried visits protect the quality and safety of your care.
How does a superbill actually work?
After your visit we provide an itemized receipt with the codes insurers expect. You submit it to your plan through their out of network claim process, and reimbursement, when available, comes directly to you. We will show you exactly what to send.
How do I find out if my plan has out of network benefits?
Call the member number on your card and ask two questions: do I have out of network outpatient mental health benefits, and what is my out of network deductible? Those two answers tell you what a superbill is worth to you.
Can I use HSA or FSA funds?
Yes. Psychiatric care is a qualified medical expense, and HSA and FSA cards work like any other payment method at booking.
Is cash pay psychiatry even normal?
Very. Psychiatry has one of the lowest insurance participation rates in medicine, precisely because networks compress visit time below what careful psychiatric care requires. We are unusual mainly in saying so up front.
Does avoiding insurance really protect my privacy?
Meaningfully, yes. No claims means no diagnosis codes in insurer databases, which are queried for things like life and disability insurance underwriting. Your records stay between you and your clinician, released only with your written authorization.
Transparent care, no surprises
Clear pricing, real clinical time. Choose your state, complete the intake, and book your evaluation online.
Join Our Waiting List