Choosing Care · 7 min read
Subscription vs Per-Visit Online Psychiatry
Two of the most common ways to pay for online psychiatry pull in opposite directions: a monthly subscription that bundles everything, or a flat fee for the visits you actually have. Either one can be the better deal, depending on how you use care. Here's how the two models really differ, and how to tell which one fits you. Descriptions of other platforms here reflect their publicly stated practices as of this posting and may change, so confirm current details with each provider.
Written under the clinical direction of Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Last updated November 14, 2026 · Editorial policy
From my practice · Shariq Refai, MD, MBA, FAPA
What a monthly fee can quietly encourage
I don't think subscriptions are evil, but I'm wary of any model where the business does better the more you engage, especially when prescribing is involved. When a company's growth depends on keeping people subscribed and active, the incentives can drift away from what the patient actually needs, which is sometimes fewer visits and less medication, not more.
The per-visit model I use has its own bias, of course: I have to make each visit worth your while or you won't come back. I happen to think that's a healthier incentive. The honest advice I give people is to look at how a service makes money and ask whether that lines up with you getting better and, eventually, needing them less.
How the subscription model works
A subscription charges a recurring monthly fee in exchange for a bundle: some number of visits, often messaging with a provider, and sometimes medication coordination. Platforms such as Cerebral and Brightside use versions of this model. The appeal is simplicity and a sense of ongoing access for one predictable monthly number.
The catch is that you pay the monthly fee whether or not you use it. In months where you don't need a visit, you're still charged, and bundles often include services you may never touch. Subscriptions reward frequent, consistent use and quietly penalize light use.
How the per-visit model works
A per-visit model charges for each appointment you have, typically with a higher price for the initial evaluation and lower prices for follow-ups. shrinkMD works this way. You pay for care when you use it, and nothing when you don't, which makes the cost track your actual needs.
The trade-off is that each visit has a visible price, which can feel larger than a monthly subscription split into small pieces. But over time, if you're seen every few months rather than constantly, per-visit usually costs less and always costs only for what you used.
The frequency question that decides it
The honest way to choose is to estimate how often you'll actually be seen. Early in treatment, visits may be more frequent as a medication is started and adjusted. Once you're stable, many people see their psychiatrist only every few months for maintenance. Your expected frequency is the single biggest factor.
If you expect very frequent contact, including messaging between visits, a subscription bundle might pay off. If you expect periodic visits, especially in maintenance, a per-visit model almost always costs less and avoids paying for months you don't use.
Watch what the bundle incentivizes
Bundled models can create incentives worth understanding. When revenue depends on subscriptions and engagement, a platform is motivated to keep you subscribed and active. That isn't inherently bad, but it's worth noticing, especially where it intersects with prescribing. The documented Cerebral case, in which the company agreed to a non-prosecution agreement and a payment of more than 3.6 million dollars over controlled-substance prescribing allegations per the DOJ, is a reminder to look at incentives.
A per-visit model has a simpler incentive: provide a visit worth paying for. Neither model guarantees good care, but understanding what a business is optimized for helps you read it clearly.
Flexibility and getting out
Subscriptions can be harder to leave than to join. Ask up front whether you're locked into a term, how cancellation works, and what happens to your care and records if you stop. Friction on the way out is a real cost that doesn't show up in the monthly price.
Per-visit care is flexible by design: you simply book a visit when you need one and stop when you don't, with no subscription to cancel. For people who value being able to step back without untangling a recurring plan, that flexibility matters.
Which fits you
Choose a subscription if you want frequent, ongoing contact, will genuinely use the bundled services, and prefer one predictable monthly charge. Choose per-visit if you want to pay only for the care you use, value transparency and flexibility, and expect periodic rather than constant visits.
shrinkMD uses a transparent per-visit model with a board-certified psychiatrist, so your cost tracks your actual care and you're never paying for an unused month. You can read how it works or compare the broader options in our guide to choosing online psychiatry.
Key takeaways
Five things to remember
- Subscription psychiatry charges a recurring monthly fee that bundles services, which is good value with frequent use but costs the same whether you use it or not.
- Per-visit psychiatry charges only for the appointments you have, so the cost tracks your actual needs and you never pay for an unused month.
- Your expected visit frequency is the biggest factor; constant contact favors subscriptions, periodic visits favor per-visit.
- Understand what each model incentivizes; bundled, engagement-based models are motivated to keep you subscribed, which is worth noticing around prescribing.
- Check how hard a subscription is to cancel; per-visit care is flexible by design, with no recurring plan to untangle.
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Frequently asked questions
Good questions, clear answers
What's the difference between subscription and per-visit psychiatry?
A subscription charges a recurring monthly fee that bundles visits, messaging, and sometimes medication, regardless of how much you use. Per-visit charges for each appointment you actually have. Subscriptions reward frequent use and predictable monthly budgeting; per-visit rewards lighter, periodic use and keeps cost tied to your real needs.
Which is cheaper, a subscription or per-visit?
It depends on how often you're seen. If you've frequent visits and use the bundled services, a subscription can be good value. If you're seen periodically, especially once stable on a treatment, per-visit usually costs less because you only pay when you have an appointment. Estimate your expected frequency to decide.
Do subscriptions include medication?
Some bundle medication coordination or management into the monthly fee, and some bill it separately or don't provide it. It varies by platform, so confirm exactly what's included before subscribing. Note that the medication itself, filled at a pharmacy, is a separate cost from any platform fee in most models.
Are subscription platforms bad?
No, they aren't inherently bad; they suit people who want frequent, ongoing contact for one predictable fee. The thing to understand is the incentive: a subscription business is motivated to keep you subscribed and engaged. That's worth noticing, particularly around prescribing, but it doesn't mean the care is poor. Evaluate each platform on its merits.
Why does the Cerebral case matter here?
Because it illustrates why business incentives are worth examining. In 2024 Cerebral agreed to a non-prosecution agreement and a payment of more than 3.6 million dollars over allegations of improper controlled-substance prescribing between 2021 and 2022, according to the DOJ. It's a documented reminder to look at what a platform is optimized for, not just its monthly price.
Is it hard to cancel a subscription psychiatry plan?
It can be, and it varies. Before subscribing, ask whether you're committed to a term, how cancellation works, and what happens to your records and care if you leave. Cancellation friction is a real cost that the monthly price doesn't reveal. Per-visit models avoid this entirely, since there's no recurring plan to cancel.
How often will I actually need to see a psychiatrist?
It varies by person and stage. Early in treatment, when a medication is being started or adjusted, visits may be more frequent. Once you're stable, maintenance visits are often only every few months. Your expected frequency is the key input for choosing between subscription and per-visit pricing.
How does shrinkMD's model work?
shrinkMD uses a transparent per-visit model with a board-certified psychiatrist. You pay for the appointments you have, with the initial evaluation priced separately from follow-ups, and nothing in months you aren't seen. There's no subscription to manage or cancel, and superbills are available if you want to seek reimbursement.
Sources
Sources and further reading
About the author
Shariq Refai, MD, MBA, FAPA
I'm a board certified psychiatrist and the founder of shrinkMD, a telepsychiatry platform built around access, continuity, and clinical rigor. My work focuses on helping people understand their mental health clearly and thoughtfully, without rushing to conclusions or shortcuts. I have clinical experience across a range of settings, including work with high-performing individuals and professional athletes, and I remain committed to care that's careful, individualized, and grounded in sound clinical judgment. shrinkMD provides psychiatric care across multiple licensed states in the US, with an emphasis on responsible telepsychiatry and long-term continuity.
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