What care costs, stated plainly
Fees, insurance, and the practical terms of working with this practice — set out before you book rather than after.
Why the practice is built this way
Psychiatric care is bought in two currencies: time and attention. How long an appointment runs, how many patients a physician carries, how much of the work happens between visits — records requested and actually read, outside clinicians called, a plan revised because a symptom diary showed something — these are the decisions that determine both what care costs and what it can accomplish. They are choices, not accidents of a billing schedule, and a practice should be willing to say which ones it has made.
[Write two to four sentences, in your own voice, explaining the actual rationale for how you have structured this practice — appointment lengths, panel size, direct access to you rather than to staff, time reserved for imaging and records review. Patients read this paragraph as the justification for every number in the table below it, so describe what the fee buys. Do not apologise for the fee and do not compare yourself to insurance-based clinics by name.]
Nothing on this page is a quote for your particular care. The written Good Faith Estimate described further down is.
| Service | Duration | Fee |
|---|---|---|
| Initial psychiatric evaluation | [Scheduled length of the first visit, in minutes. Use the block you actually hold on the calendar — it determines which code the visit supports (90792, or an E/M code with a psychotherapy add-on) and it must agree with the Good Faith Estimate you hand the patient.] | [Initial evaluation fee, in dollars. This must be the amount you genuinely charge: a published fee that differs from the billed fee is a consumer-protection exposure, and California AB 1020 plus the federal No Surprises Act both assume the written estimate matches the posted figure.] |
| Follow-up visit (standard) | [Scheduled length of a standard follow-up, in minutes. Keep it consistent with the code you bill for that block so the superbill and this page tell the same story.] | [Standard follow-up fee, in dollars. State one amount. If your fee varies by complexity rather than by length, say that here instead of publishing a range you do not actually use.] |
| Follow-up visit (extended) | [Scheduled length of an extended follow-up, in minutes — and define what makes a visit extended: a psychotherapy component, a cross-taper, a family meeting, a post-hospitalisation review. Patients need to know which visit they are being booked into before they arrive.] | [Extended follow-up fee, in dollars, matching what you bill for the longer block.] |
| Second-opinion consultation | [Total scheduled time for a second opinion, including any separate feedback visit at which you deliver the impression.] | [Second-opinion fee, in dollars. State explicitly what it includes — records review, collateral contact, a written summary to the patient or referring clinician — because patients otherwise assume it is priced and structured like a first visit.] |
| Between-visit clinical work — letters, forms, care coordination, prior authorizations | [The unit you bill in (for example, per 15 minutes) and the threshold below which you do not charge at all. A stated free threshold prevents most disputes about small items.] | [Rate for between-visit clinical work, in dollars, and the scope it covers: disability and FMLA paperwork, school and employer letters, prior authorizations and appeals, calls with therapists or other treating physicians, records review. Most of this work is not reimbursable by any payer, so patients must be told the rate before they request it.] |
[Confirm this list matches the services you actually provide, and delete any row you do not offer. Add nothing that is not currently available — a service listed on a fee schedule reads as a service on offer today.]
[Payment terms: when payment is due, which methods you accept, and how receipts are issued. Patients decide whether to book on this line, so it belongs here rather than only in the intake packet.]
Interventional and neuromodulation care is billed on a different basis from office-based psychiatric care, and taking part in a research protocol is not the same thing as receiving treatment. [State plainly which neuromodulation services, if any, are available clinically through this practice and how they are charged, and which of your TMS, focused ultrasound and kTMP activities are research-protocol-only and therefore not something a patient can purchase here. Say where research participation is billed to a study rather than to the patient. This distinction is the single most misread thing on a psychiatry fee page.] Research activity is described on the Research & Trials page.
Insurance and reimbursement
[State your network status in one plain sentence: whether the practice is in network with any commercial plan, or out of network with all of them. Name a plan only if the contract is executed and current — patients choose a psychiatrist on this line, and listing a plan you are not contracted with is a misrepresentation they relied on.]
How out-of-network benefits generally work
Many commercial plans reimburse part of the cost of care delivered by a physician outside their network, under an out-of-network mental health benefit. The mechanics are broadly the same across plans: the patient pays the physician directly, the physician provides an itemised receipt known as a superbill, and the patient submits that receipt to the plan. The plan then applies its own out-of-network deductible and its own allowed amount, and reimburses a percentage of that allowed amount — which is frequently lower than the fee charged.
A superbill is a receipt, not a claim filed on your behalf. It ordinarily carries the dates of service, the procedure (CPT) codes, a diagnosis code, the amount paid, and the rendering physician's identifiers. Two consequences follow that are worth knowing before you start: a diagnosis must be recorded for the claim to be processed at all, and the percentage a plan quotes is a percentage of its allowed amount rather than of the fee.
Questions worth asking your plan before a first visit, in these words:
- Do I have an out-of-network outpatient mental health benefit?
- What is my out-of-network deductible, and how much of it have I met this year?
- Once the deductible is met, what percentage of the allowed amount is reimbursed?
- What is the allowed amount for CPT codes 90792, 99204/99205, and 99213/99214 with an add-on such as 90833?
- Is prior authorisation required, and is there a visit limit?
Medicare
Medicare is a separate question from commercial insurance, and a physician's relationship to it takes one of three forms — participating, non-participating, or formally opted out. The distinction matters practically: a physician who has opted out of Medicare must enter into a written private contract with each Medicare-eligible patient before providing care and before billing them, and neither the physician nor the patient may then submit those services to Medicare for reimbursement. Patients with Medicare Advantage plans are affected by the same rules.
[State your Medicare status here — participating, non-participating, or opted out — and the effective date if you have filed an opt-out affidavit. If you are opted out, say so in the patient's own terms: that a private contract must be signed before the first visit, that no claim can be submitted to Medicare or to a Medicare Advantage plan, and that a superbill will not produce reimbursement for these patients. Leaving this ambiguous is the most common billing complaint in private psychiatry.]
This practice cannot verify your benefits for you, and a plan's pre-service quote is not a guarantee of payment. Reimbursement is a matter between you and your insurer.
Good Faith Estimate
Under the federal No Surprises Act, patients who are uninsured or who choose not to use their insurance have the right to a written estimate of what care will cost.
The right applies to self-pay and uninsured patients, and it works as follows:
- You may request a Good Faith Estimate at any time, before scheduling anything, and it must be provided in writing within three business days of the request.
- When care is scheduled, the estimate is provided automatically: at least one business day before the appointment if it was booked at least three business days out, and at least three business days before if it was booked ten or more business days out.
- The estimate covers the expected charges for the course of care being scheduled, not only the single visit in front of you.
- If the final bill is $400 or more above the estimate, you may challenge it through the federal patient–provider dispute resolution process. A dispute generally must be initiated within 120 calendar days of receiving the bill.
- Keep a copy of the estimate. You will need it to start a dispute.
A Good Faith Estimate is an estimate made in good faith on the information available at the time. It is not a bill, and it is not a guarantee that the total will not change if your care changes.
[Describe how this practice actually issues the Good Faith Estimate: at scheduling by secure message, inside the intake packet, on request by phone or email — and name the address or person who handles it. A written process has to exist before this page goes live, because the federal requirement applies whether or not the website mentions it. If you use a standard template, note that it lists expected diagnosis and service codes.]
More about this federal right is published by the Centers for Medicare & Medicaid Services at cms.gov/nosurprises.
Scheduling and cancellation
An appointment is time held for one person and cannot be given to anyone else at short notice. The policy below exists so that the terms are known in advance rather than discovered in a statement.
[Cancellation window and charge: how far ahead a visit must be cancelled or rescheduled without a fee (in business hours or business days), the amount charged for a late cancellation, and the amount charged for a missed visit if it differs. State whether the window is counted in business days, since a Monday appointment cancelled on Sunday is the case that generates every argument. Give these amounts as figures, not as "a portion of the fee".]
[Card on file: whether a payment method is required at registration, what it may be charged for (visit fees, late cancellations, between-visit work), whether it is charged automatically or only after notice, and how a patient revokes authorisation. Card-on-file authorisation should be in writing in the intake paperwork and this paragraph should match that paperwork word for word.]
[Rescheduling and illness: whether you waive the late-cancellation charge for acute illness, emergencies, or a first occurrence, and who decides. A stated exception is more defensible than an unstated one applied inconsistently.]
Expect a late-cancellation or missed-visit charge to be your own cost. No clinical service was delivered, so there is no code to bill and nothing to put on a superbill, and health plans generally do not reimburse these charges. If your plan is an unusual one, check with it directly rather than assuming either way.
Between-visit communication
Brief clinical questions between appointments are a normal part of psychiatric care. Longer work — a request for documentation, a prior authorisation appeal, a substantive change of plan that would ordinarily happen in a visit — is clinical work, and is treated as such.
[Communication policy: which channel patients should use (portal, phone, practice email — and say plainly that ordinary email is not secure for health information), what counts as a brief question included in ongoing care, at what point a message becomes billable between-visit work, and when you would ask a patient to come in instead. Do not state a response time you cannot meet every week; a range you always hit is better than a promise you sometimes miss.]
[After-hours and coverage: how patients reach the practice outside business hours, what happens when you are away, and who covers. Whatever you write must match the crisis language already in the site footer — that this practice does not provide emergency or after-hours crisis services — and it must not imply 24-hour availability.]
Prescription refills
[Refill policy: how far in advance to request a refill and through which channel, how many business days to allow, how refills are handled between scheduled visits and how far ahead prescriptions are written, and your requirement for a current visit before further refills are issued. If you prescribe controlled substances, state the rules that apply to them separately — visit frequency, early-refill and lost-prescription policy, pharmacy restrictions, and any monitoring you require — because the general policy will otherwise be assumed to cover them.]
Refill requests are not a way to reach the practice urgently. If your situation is urgent, do not wait on a refill message — see the crisis information at the foot of every page.
[Every figure on this page must equal what is actually charged and what appears on the Good Faith Estimate and the superbill. A published fee that no longer matches the billed fee is a consumer-protection and licensing problem, not a stale page. Before launch: reconcile this table against your billing system, have the cancellation and card-on-file language checked against your intake paperwork, and decide who reviews this page whenever a fee changes and on a fixed date each year.]
Questions about fit or cost
If you are weighing whether this practice is the right place for your care, the fee schedule is only part of the answer. Write, and say what you are looking for.