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Looking for a Talkiatry alternative?
A factual look at how shrinkMD compares to Talkiatry, and who each one suits.
Medically reviewed by Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Last reviewed July 17, 2026 · Editorial policy
Talkiatry is an insurance based online psychiatry practice. shrinkMD is a cash pay, physician led practice that doesn't prescribe controlled substances. Here's a neutral, side by side comparison so you can decide what fits.
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Talkiatry and shrinkMD, side by side
| Talkiatry | shrinkMD | |
|---|---|---|
| Insurance | In network with many commercial plans and Medicare. | Cash pay only. We don't bill insurance; a superbill is available on request for possible out-of-network reimbursement. |
| Controlled substances | Can prescribe stimulants and other controlled substances where state telehealth law allows. | Never. No stimulants, benzodiazepines, or other controlled substances. |
| Who you see | Psychiatrists and psychiatric nurse practitioners. | Board certified psychiatrist or psychiatric nurse practitioner. |
| States | Available in roughly 45 states. | Launching in Nebraska and Maine, with more states licensed and launching. |
| Ages | Adults and, in some states, adolescents. | Adults 18 and over. |
| Model | Insurance based psychiatry and medication management. | Full initial evaluation, then the same clinician for follow-ups. |
Is shrinkMD a fit?
Who shrinkMD is, and isn't, for
A good fit if: you'd rather pay a clear cash price than work through insurance, you want the same clinician over time, and you want care without controlled substances.
Not the right fit if: you specifically want to use insurance, or you need stimulant or other controlled medication. shrinkMD doesn't prescribe controlled substances.
Making the switch
Why patients look for a Talkiatry alternative
Talkiatry is a large insurance based online psychiatry practice, which means visits get shaped by what insurance will pay for. That usually looks like tighter 20 to 30 minute follow-ups, prior authorization requirements when the plan wants a step therapy trial before covering a preferred medication, and provider availability that depends on which clinicians are in-network for your specific plan. That model works well for people whose plan has strong mental health coverage and who don't mind those tradeoffs.
The most common reason patients look for an alternative isn't a complaint about Talkiatry specifically, it's about the friction that comes with insurance based psychiatry generally: prior auths that delay a medication change by two weeks, a rotating cast of clinicians when your original provider leaves the network, and short visits that don't always leave room for the full conversation. If any of that sounds familiar, cash pay is a genuinely different model.
At shrinkMD you pay a clear price directly at the time of care, the first visit is a full 45 to 60 minute evaluation, follow-ups are as long as you need, and you keep the same clinician every time. If you have out-of-network mental health benefits, we can provide a superbill you submit to your plan for possible reimbursement. If you don't, the cash price is the whole cost.
How shrinkMD differs
How shrinkMD's model differs from Talkiatry's
shrinkMD is physician led, meaning the practice was built by a board certified psychiatrist to work the way psychiatry actually should: full evaluations, meaningful follow-up time, and clinical decisions driven by what will help you rather than what a plan will approve. We don't have to justify a medication choice to a payer, so we can start with the first line evidence based option instead of the plan preferred one.
We also don't prescribe controlled substances, which means shrinkMD isn't the right fit if you specifically need stimulant medication for ADHD or ongoing benzodiazepine therapy. Talkiatry can prescribe those where state telehealth law allows. If you're looking for non-stimulant psychiatric care and continuity with one clinician, the shrinkMD model tends to be the reason people make the switch.
“Dr. Refai is outstanding. He is prompt, intelligent, and great at what he does. He gets me, and I wish I could clone him.”
Individual experiences. Outcomes vary. Care is personalized to each patient.
Frequently asked questions
Good questions, clear answers
Will shrinkMD accept my insurance the way Talkiatry does?
No. shrinkMD is cash pay. If your plan has out-of-network mental health benefits, we provide a superbill you submit for possible reimbursement. Reimbursement rates vary by plan, so we recommend calling your insurance before your first visit and asking your out-of-network deductible and reimbursement percentage for psychiatry.
Can shrinkMD prescribe the same medications Talkiatry does?
For all non-controlled psychiatric medications, yes. That covers SSRIs, SNRIs, atypical antidepressants, mood stabilizers, atypical antipsychotics, and non-stimulant ADHD medications like atomoxetine and guanfacine. We don't prescribe stimulants, benzodiazepines, or other controlled substances.
If I switch to shrinkMD, will I need to repeat my whole history?
You'll do a full evaluation on your first visit, which lets your clinician build the plan from a complete picture. You can bring records, a medication list, and prior lab work; that context makes the visit more efficient and helps your clinician avoid repeating what's already been tried. With your permission we can also request records from prior providers after the visit.
How fast can I be seen at shrinkMD compared to Talkiatry?
It depends on your state and current availability. Because shrinkMD is a smaller, focused practice, new patient availability is often measured in days to a couple of weeks in the states we serve, without insurance verification or credentialing delays.
Ready to start with shrinkMD?
shrinkMD is physician led, cash pay online psychiatry for adults, with no controlled substances and the same clinician over time. See if it's the right fit, then join the waitlist for your state.
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