Cash pay
Cash pay online psychiatrist, no insurance needed
Clear prices, longer visits, and the same clinician over time. No insurance required.
Medically reviewed by Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Last reviewed July 17, 2026 · Editorial policy
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Why cash pay
Why we don't take insurance
shrinkMD is private pay on purpose. Billing insurance pushes practices toward short, rushed visits and a rotating cast of clinicians, because reimbursement rates only work if you're seeing patients every 12 to 15 minutes. Paying cash lets us protect visit length, keep continuity with the same clinician, and prescribe based on what actually helps you, not what a plan will approve.
We don't bill or participate with commercial insurance, Medicare, Medicaid, or other government plans. On request we can provide a superbill you can submit to your plan for possible out-of-network reimbursement, though reimbursement is determined solely by your plan and isn't guaranteed.
The trade off is direct: you pay a clear price at the time of care instead of a copay and then a surprise bill months later. In exchange you get a full 45 to 60 minute evaluation, follow-ups that run as long as you need, and the same clinician every visit. That model is what makes real psychiatric care possible.
Pricing
Transparent, the same in every state we serve
| Visit | Price |
|---|---|
| Initial evaluation | From $295 |
| Follow-up visits | $110 to $215 |
| Membership (optional) | $49 per month, first month free |
What you actually get
What $295 to $395 actually gets you
A first evaluation at shrinkMD is a full 45 to 60 minute video visit with a board certified psychiatrist or psychiatric nurse practitioner. That's roughly 3 to 4 times the length of what a rushed, insurance based intake often looks like, and it's what allows an accurate diagnosis instead of a reflex prescription.
During that visit your clinician takes a careful history: current symptoms, past treatments, medical history, family history, sleep, substances, medications, and what your daily life actually looks like. If medication is likely to help, you leave with a plan and, when appropriate, a prescription that day. If therapy is a better first step, you leave with an honest recommendation and a referral path.
Follow-up visits at $110 to $215 are shorter but not rushed, and they're with the same clinician who saw you for the intake. That continuity is where treatment actually builds, because your clinician remembers your baseline, sees the arc of your response over time, and adjusts the plan based on you rather than starting over each visit.
Superbills and reimbursement
How the superbill and out-of-network reimbursement work
A superbill is an itemized receipt with the codes and diagnoses your insurance needs to process an out-of-network claim. Many PPO and POS plans include some level of out-of-network mental health coverage, so a portion of what you pay us may come back to you as a reimbursement check from your insurer once you've met your out-of-network deductible.
The process is: you pay us at the time of your visit, we email you the superbill, you submit it to your insurance either through their member portal or by mail. Reimbursement rates vary widely. Some patients get 40 to 70 percent back, others get less, and HMO plans usually cover nothing out-of-network. We can't predict what your specific plan will do, and we recommend calling your insurance before your first visit and asking two questions: what is my out-of-network deductible for mental health, and what percentage do you reimburse for out-of-network psychiatry after that deductible is met.
If your plan covers zero out-of-network care, or if you have Medicaid or a strict HMO, cash pay at shrinkMD is simply the whole cost and there's no reimbursement path. That's honest to say up front.
Is cash pay right for you?
When cash pay psychiatry makes sense, and when it doesn't
Cash pay psychiatry makes the most sense if you value predictable pricing, longer visits, the same clinician over time, and quick access to care. It's often the practical choice for adults whose in-network psychiatry options either don't exist in their state, have months long waitlists, or offer only 15 minute medication checks with a rotating team.
It's also a common fit for people with high deductible health plans, where you'd pay the first several thousand dollars out of pocket anyway before insurance kicks in. In that situation, the cash pay difference is small and the care experience is usually much better.
Cash pay isn't the right choice for everyone. If you specifically need controlled substances like stimulants for ADHD or benzodiazepines for anxiety, shrinkMD isn't the right fit regardless of payment, because we don't prescribe them. If you have strong in-network psychiatric coverage and access to a practice you like, that plan will usually cost less out of pocket than we do. And if paying $295 up front would prevent you from getting care at all, we recommend using 988, calling your state's mental health crisis line, or looking into community mental health centers that offer sliding scale fees.
Want the longer version of why we made this choice? Read why we don't accept insurance, or see the full pricing breakdown with membership details.
“Dr. Refai is very quick to respond to questions in the portal, and his team makes sure you get seen quickly so problems get handled before they go too far.”
Individual experiences. Outcomes vary. Care is personalized to each patient.
Frequently asked questions
Good questions, clear answers
Does shrinkMD take insurance?
No. shrinkMD is a cash pay practice, on purpose. We can provide a superbill on request that you may submit to your insurer for possible out-of-network reimbursement, but reimbursement is determined by your plan and isn't guaranteed.
How much does an online psychiatrist cost at shrinkMD?
Initial evaluations start at $295, follow-up visits run $110 to $215 depending on length and complexity, and an optional membership is $49 per month with the first month free. That's the whole cost. There are no surprise bills.
Is cash pay cheaper than using insurance?
It depends on your plan. Cash pay means a clear, predictable price with longer visits and continuity. If you have strong in-network psychiatric coverage and can actually get an appointment, an insurance based practice may cost less out of pocket. If you have a high deductible plan or your in-network options have long waits, cash pay often works out similar or better.
What's a superbill and how does out-of-network reimbursement work?
A superbill is an itemized receipt with diagnosis and procedure codes your insurance needs to process an out-of-network claim. You pay us at the visit, we email the superbill, you submit it to your insurer. Many PPO plans reimburse a portion after your out-of-network deductible is met. Call your insurance and ask what your out-of-network mental health deductible is and what percentage they reimburse for out-of-network psychiatry.
Can I use my HSA or FSA to pay?
Yes. Health Savings Account and Flexible Spending Account funds can be used for psychiatric visits at shrinkMD. We provide receipts that meet HSA and FSA documentation requirements.
Why do so many good psychiatrists not take insurance?
Reimbursement rates for psychiatry from most insurance plans are low enough that a practice generally has to run short visits at high volume to stay open. Many physicians who want to spend real time with patients, and provide continuity, have moved to cash pay for exactly that reason. It's a widespread pattern, not an outlier.
Do I have to pay upfront for the whole thing?
You pay for each visit at the time of that visit. The initial evaluation is $295 and is paid before the appointment. Follow-ups are billed after each visit. There's no lump sum, no annual commitment, and the optional $49 per month membership can be canceled anytime.
What if I can't afford $295?
We understand cash pay isn't accessible for everyone, and we're honest about that. If cost is a barrier, community mental health centers often offer sliding scale fees, and county 211 lines can point you to local resources. Federally qualified health centers must serve patients regardless of ability to pay.
See if shrinkMD fits
Cash pay, physician led online psychiatry for adults, with no controlled substances and the same clinician over time. Join the waitlist for your state.
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