Cost transparency
What might your insurance reimburse for your shrinkMD visits?
You pay shrinkMD directly at published prices, and if your plan has out-of-network mental health benefits, part of that comes back to you. Here's what to expect for every shrinkMD visit type, at every common reimbursement rate, member and non-member. It's an honest estimate, not a quote.
Medically reviewed by Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Last reviewed July 22, 2026 · Editorial policy
Educational estimate only. The numbers on this page are illustrative. shrinkMD does not guarantee any specific reimbursement, does not bill insurance, and is not affiliated with any insurance carrier. Your actual reimbursement is determined solely by your insurance plan and its proprietary methodology for calculating "allowed amounts."
Always confirm with your carrier before assuming a specific dollar amount. This page tells you exactly which two questions to ask.
Start here
How out-of-network reimbursement actually works
shrinkMD is cash pay. You pay us at the time of your visit at published rates. If you want to try for insurance reimbursement, we hand you a superbill on request. That's just an itemized receipt with the diagnosis and CPT (procedure) codes your insurer needs to process an out-of-network claim.
You submit the superbill to your insurance. If your plan includes out-of-network mental health benefits and you've met your out-of-network deductible, your insurer typically pays you back a percentage of what they consider the "allowed amount" for that visit. The reimbursement check or direct deposit comes to you, not to shrinkMD, usually within a few weeks.
The whole thing turns on that "allowed amount," and honestly, no one on the outside knows exactly what it is. Insurers calculate it with their own proprietary methodology. Some benchmark against Medicare, some use FAIR Health data, some use their own regional tables. That's why any online estimator (including this one) can only give you a range, not a precise number. If any tool promises exact reimbursement in advance, it's promising something it can't deliver.
Two questions
The two questions to ask your insurance
Before your first shrinkMD visit, spend fifteen minutes on the phone with your insurance. Call the member services number on the back of your card and say: "I want to check my out-of-network mental health benefits." Then ask these two questions and write the answers down. That's it. Those two answers are what determines what you'll get back.
- What is my out-of-network deductible for mental health, and how much of it have I met this year? Deductibles reset every plan year (usually January 1). Until you've met it, your insurer pays nothing on OON claims; you pay 100%. Once met, reimbursement kicks in.
- After my deductible is met, what percentage of the allowed amount do you reimburse for out-of-network outpatient psychiatry? Typical answers: 50%, 60%, 70%, or 80%. Some plans reimburse zero even after deductible (see "When cash pay is your full cost" below).
The math
How to compute your rough estimate
Once you've got the two answers, the math is one line:
- Reimbursement = (insurer's "allowed amount" for the CPT code) × (your OON coinsurance percentage), IF your OON deductible is met.
- The "allowed amount" for CPT 90792 (initial psychiatric evaluation, 45 to 60 minutes) typically falls in the $300 to $500 range nationally based on FAIR Health regional benchmarks.
- The "allowed amount" for CPT 99214 (follow-up medication management) typically falls in the $150 to $220 range nationally.
- shrinkMD's nurse practitioner charges are at or below the typical regional allowed amount, which means reimbursement is often calculated on close to what you actually paid, and your net cost drops sharply.
shrinkMD prices, in one place
Every shrinkMD visit price on the superbill
Reimbursement depends on which visit you had and which clinician you saw, so let's put every published shrinkMD price in front of you before the scenarios. These are the exact numbers that'll show up on your superbill. Membership lowers every follow-up but not the initial evaluation.
- Initial evaluation with a psychiatric nurse practitioner (PMHNP): $295 (45 to 60 minutes, CPT 90792). Same whether you're a member or not.
- Initial evaluation with a psychiatrist: $395 (45 to 60 minutes, CPT 90792). Same whether you're a member or not.
- Follow-up with a nurse practitioner, pay-per-visit: $165. Follow-up with a nurse practitioner, Serenity Squad member: $110.
- Follow-up with a psychiatrist, pay-per-visit: $215. Follow-up with a psychiatrist, Serenity Squad member: $145.
- Therapy session, Serenity Squad member rate: $120.
- Serenity Squad membership: $49 a month, first month free, cancel anytime. Membership lowers every follow-up price above and adds unlimited messaging, priority scheduling, and free apps. See membership details.
Why membership matters here. The Serenity Squad ($49/month, first month free) lowers your follow-up charge, which lowers what you pay upfront. When you then submit your superbill and your insurer reimburses a percentage on top of that, your net cost per visit can drop into the $20 to $60 range depending on your plan.
Scenario A
PPO plan, out-of-network deductible met, 60% coinsurance
| Your shrinkMD visit | You pay upfront | Est. reimbursement | Est. net cost |
|---|---|---|---|
| Initial with nurse practitioner | $295 | About $175 | About $120 |
| Initial with psychiatrist | $395 | About $180 | About $215 |
| Follow-up with nurse practitioner (non-member) | $165 | About $100 | About $65 |
| Follow-up with psychiatrist (non-member) | $215 | About $110 | About $105 |
| Follow-up with nurse practitioner (Serenity Squad member) | $110 | About $65 | About $45 |
| Follow-up with psychiatrist (Serenity Squad member) | $145 | About $85 | About $60 |
Scenario B
PPO plan, out-of-network deductible met, 70% coinsurance
| Your shrinkMD visit | You pay upfront | Est. reimbursement | Est. net cost |
|---|---|---|---|
| Initial with nurse practitioner | $295 | About $205 | About $90 |
| Initial with psychiatrist | $395 | About $210 | About $185 |
| Follow-up with nurse practitioner (non-member) | $165 | About $115 | About $50 |
| Follow-up with psychiatrist (non-member) | $215 | About $125 | About $90 |
| Follow-up with nurse practitioner (Serenity Squad member) | $110 | About $75 | About $35 |
| Follow-up with psychiatrist (Serenity Squad member) | $145 | About $100 | About $45 |
Scenario C
PPO plan, out-of-network deductible met, 80% coinsurance
| Your shrinkMD visit | You pay upfront | Est. reimbursement | Est. net cost |
|---|---|---|---|
| Initial with nurse practitioner | $295 | About $235 | About $60 |
| Initial with psychiatrist | $395 | About $240 | About $155 |
| Follow-up with nurse practitioner (non-member) | $165 | About $130 | About $35 |
| Follow-up with psychiatrist (non-member) | $215 | About $145 | About $70 |
| Follow-up with nurse practitioner (Serenity Squad member) | $110 | About $90 | About $20 |
| Follow-up with psychiatrist (Serenity Squad member) | $145 | About $115 | About $30 |
Scenario D
PPO plan, out-of-network deductible NOT yet met
Until you've met your out-of-network deductible for the plan year, your insurer reimburses zero on any out-of-network visit. What you pay shrinkMD applies toward your deductible, but no money comes back to you until the deductible is fully met.
Once you've spent enough on out-of-network care to meet the deductible (for shrinkMD alone, that could be one to a few initial evaluations plus a handful of follow-ups depending on your deductible size), reimbursement kicks in at your plan's coinsurance rate. From that point, refer to Scenario A, B, or C above.
If you're not sure whether you've met your deductible this year, log in to your insurance member portal or call member services. They'll tell you your year-to-date accumulator.
Scenario E
HMO, Medicare, Medicaid, or plans with no out-of-network benefits
Reimbursement is zero. Not partial, not "depends on your plan." Just zero. What you pay shrinkMD is your full cost. We'd rather tell you that clearly than have you disappointed later.
This applies to almost all Kaiser Permanente plans, Original Medicare and most Medicare Advantage plans, all Medicaid plans, and most EPO (Exclusive Provider Organization) plans. Some ACA Marketplace bronze and silver plans also have no out-of-network coverage. If any of these describe you, budget for the full shrinkMD published price without expecting reimbursement.
You can still use HSA or FSA dollars to pay for shrinkMD visits, which effectively saves you 20 to 35 percent because those funds are pre-tax. And if you plan to see us for ongoing care, the Serenity Squad membership lowers every follow-up regardless of insurance, and pays off quickly for anyone visiting monthly or more often.
These are illustrative examples using public regional benchmarks (FAIR Health Consumer estimator). Your actual allowed amount, deductible, and coinsurance will differ. This is not a quote. Last refreshed 2026-07-17. Next scheduled refresh 2026-10-17.
When it doesn't work
When cash pay is just your full cost
Some plans reimburse nothing for out-of-network care, full stop. If any of these apply to you, budget for the full shrinkMD price without any reimbursement coming back. We'd rather tell you that up front than have you disappointed later:
- HMO plans (most Kaiser Permanente plans, many employer HMOs) typically have no out-of-network benefits at all.
- Medicare (Original Medicare and most Medicare Advantage plans) does not reimburse out-of-network psychiatric visits with providers who are not enrolled with Medicare.
- Medicaid plans generally do not reimburse out-of-network claims.
- EPO plans (Exclusive Provider Organization) usually have no OON benefits.
- Some ACA Marketplace bronze and silver plans have limited or no OON coverage. Check your Summary of Benefits and Coverage.
- Some large employer plans with restricted networks. Check your plan documents or call member services.
Maximize your reimbursement
How to get the most out of your out-of-network benefits
A few practical moves that often make the difference between a small reimbursement and a meaningful one. None of these are secrets. Most patients just don't know they exist:
- Submit your superbills promptly. Most insurers have a 90- to 180-day filing deadline from the date of service. Late submissions get denied.
- Use HSA or FSA funds first. These are pre-tax dollars, effectively saving you 20 to 35 percent on the portion you're paying out of pocket. shrinkMD visits are eligible HSA/FSA expenses.
- Track deductible progress. If you're close to meeting your OON deductible, cluster non-emergency visits toward the end of the plan year to maximize the reimbursement period.
- Keep every EOB (Explanation of Benefits). If your insurer denies a claim or reimburses less than expected, the EOB explains why. Denials can often be appealed.
- Ask about tele-mental-health specific benefits. Many plans still have expanded telehealth mental health coverage from the pandemic era. It's worth asking specifically.
- If your plan has an out-of-pocket maximum, everything you spend on covered OON care counts toward it. Once you hit the OOP max, your insurer covers 100 percent of allowed amounts for the rest of the year.
How to submit
How to submit your superbill, step by step
Once you complete a visit, shrinkMD sends you the superbill (usually within a day or two). It's a one-page itemized receipt with your name, date of service, diagnosis code, CPT (procedure) code, the fee, and your clinician's information. That's everything your insurance needs to process an out-of-network claim. Here's the full process:
- Step 1. Save the superbill somewhere you'll find it. Email it to yourself, save a PDF, or take a photo. You'll need it for both the initial claim and any future appeal or year-end reconciliation.
- Step 2. Log in to your insurance member portal. Look for "Claims," "Submit a claim," or "Out-of-network claim submission." Most major insurers (BCBS, Aetna, Cigna, UHC, Anthem) accept digital claim uploads now. This is the fastest path and takes about 10 minutes per superbill.
- Step 3. If your insurer doesn't accept digital submission, download their paper claim form from their website (search "[insurer name] out of network claim form"). Fill it out, attach the superbill, and mail both to the claims address on the back of your insurance card. Keep a copy.
- Step 4. Wait two to six weeks. That's how long insurers typically take to process out-of-network claims. Reimbursement arrives as either a check mailed to your address on file or a direct deposit if you've set that up in your portal.
- Step 5. Read every EOB (Explanation of Benefits) that arrives. The EOB is the document that shows what your insurer decided about the claim: the allowed amount they applied, the coinsurance percentage they used, how much of your deductible was consumed, and how much they're paying you. Save every EOB in the same place as your superbills.
- Step 6. If reimbursement is lower than expected or the claim is denied, you can appeal. The EOB includes appeal instructions and a deadline (usually 180 days). shrinkMD will provide any additional clinical documentation you need for the appeal, at no cost.
- Step 7. Submit each visit's superbill on its own, promptly. Don't stockpile them. Most plans have a 90 to 180 day filing deadline from the date of service, and stockpiled claims sometimes get bumped up against the deadline.
Prefer someone else handle the submission? Third-party services like Mentaya can submit out-of-network claims for you for a small percentage of the reimbursement. shrinkMD is not affiliated with Mentaya, but we mention them because some patients prefer the hands-off approach. Whether you submit yourself or use a service, we provide the superbill either way.
Bottom line. For most PPO patients with a met out-of-network deductible, combining Serenity Squad membership with insurance reimbursement often brings follow-up net cost into the $20 to $60 range, comparable to or below many in-network copays. Patients on HMO, Medicare, Medicaid, or plans without out-of-network benefits pay the full published shrinkMD price. Two fifteen-minute calls to your insurance company (before your first visit, and after your first EOB) will tell you exactly what to expect on your plan.
Disclaimer. This page is provided for general informational and educational purposes only. It is not medical advice, financial advice, insurance advice, or a guarantee of reimbursement. shrinkMD does not bill insurance, does not verify benefits on your behalf, is not a licensed insurance broker, and is not affiliated with any insurance carrier. The regional benchmark figures on this page are based on publicly available data from the FAIR Health Consumer estimator (fairhealthconsumer.org) and are refreshed quarterly. Actual insurer "allowed amounts" and reimbursement calculations use proprietary methodology that varies by plan, carrier, region, and CPT code, and no online estimator can predict them precisely. Reimbursement decisions are made solely by your insurance plan and are not guaranteed. If cost is a barrier to care, community mental health centers often offer sliding-scale fees, and dialing 211 can connect you with local resources. If you are in crisis, call or text 988, or call 911. Data on this page last refreshed 2026-07-17. Next scheduled refresh 2026-10-17.
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Frequently asked questions
Good questions, clear answers
How accurate is this estimator?
The examples are illustrative, not a quote. They use public FAIR Health regional benchmarks for what insurers typically consider the "allowed amount" for common psychiatry CPT codes. Your specific plan may use a different allowed amount, different coinsurance percentage, or a different deductible structure. Always confirm with your carrier before assuming a dollar figure.
Why can't shrinkMD just tell me exactly what I'll get back?
Because reimbursement isn't a public formula. Insurance companies calculate the "allowed amount" for each visit using proprietary methodology that varies by plan, carrier, region, and even year. No practice can tell you the exact reimbursement in advance. Even services that check real-time eligibility (like Mentaya) can only estimate a range or read your deductible and coinsurance back to you. The actual dollar amount only shows up on your Explanation of Benefits after the claim is processed.
Do the reimbursement estimates change if I see a nurse practitioner instead of a psychiatrist?
Yes. shrinkMD's nurse practitioner rates are lower ($295 initial, $165 non-member follow-up, $110 member follow-up). Because those charges are at or below what insurers typically consider the "allowed amount" for a psychiatric visit, your reimbursement is often calculated on nearly the full charge, and your net cost drops meaningfully. Psychiatrist visits ($395 initial, $215 or $145 follow-ups) charge above the typical allowed amount, so reimbursement is calculated on the allowed amount and your net cost stays higher.
Does joining the Serenity Squad help me get reimbursed more?
Membership lowers your published follow-up price (nurse practitioner from $165 to $110, psychiatrist from $215 to $145). That lower charge often lands at or below your insurer's allowed amount, which means you pay less upfront AND your reimbursement percentage applies to nearly the full charge. In the worked scenarios on this page, a Serenity Squad member with a 70% PPO can net out around $35 to $45 per follow-up. See full membership details.
What if my plan reimburses less than the examples show?
That's possible. The estimator uses regional 80th-percentile benchmarks, which some plans reimburse below. If your reimbursement comes back lower than expected, review your EOB (Explanation of Benefits). It'll show the allowed amount your insurer applied and why. Denials or unusually low reimbursements can sometimes be appealed, and shrinkMD will provide any supporting documentation you need.
What CPT codes will be on my superbill?
For an initial evaluation with medical services (45 to 60 minutes), the code is 90792. For follow-up visits, the code is typically 99213, 99214, or 99215, sometimes with a 90833 psychotherapy add-on if psychotherapy was part of the visit. The exact codes are on the superbill you receive.
Do I have to pay shrinkMD in full and wait for reimbursement, or can I pay just the difference?
You pay shrinkMD in full at the published rate at the time of each visit. Reimbursement from your insurer comes to you afterward as a separate check or deposit. shrinkMD is not part of that reimbursement transaction and cannot accept partial payment based on expected reimbursement.
Can I use my HSA or FSA?
Yes. Health Savings Account and Flexible Spending Account funds can be used for shrinkMD visits at the time of payment. This effectively saves you 20 to 35 percent on the portion you pay out of pocket, because HSA/FSA dollars are pre-tax. You do not need to wait for reimbursement to use these funds.
What if my insurance denies my claim?
First, read the EOB carefully. It explains exactly why. Common denial reasons include missing information on the superbill, an incorrect diagnosis code, or the plan not covering the specific service. Many denials can be appealed by submitting an appeal letter to your insurance. shrinkMD will provide any additional documentation you need for the appeal on request.
How often is this page updated?
Quarterly. The regional benchmark data underlying the example numbers is refreshed from FAIR Health's public consumer tool each quarter. This page was last refreshed on 2026-07-17. The next scheduled refresh is 2026-10-17. If you find outdated or incorrect information, please let us know.
Does shrinkMD verify my benefits for me?
No. shrinkMD is a cash-pay practice and does not verify insurance benefits on behalf of patients. If you want a full benefits check done for you, third-party services like Mentaya (mentaya.com) can do this for a fee. shrinkMD is not affiliated with Mentaya or any other benefits-verification service.
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