Insurance & Billing
What it actually costs.
How we handle money
The whole thing, upfront and in plain English.
We take most of the major carriers, we'll bill your plan for you, and if you're paying out of pocket the cash-pay intake is a flat $425, and that's the one number we can quote you to the dollar. Everything else depends on the visit and your plan, so we'll tell you what we know going in, and we'll never pad a bill on our end.
Nothing lands by surprise. If anything on our end changes, you hear it from us first.
How we handle money
The whole thing, upfront and in plain English.
We take most of the big commercial plans, we'll bill them for you, and if you're paying out of pocket the numbers are right here on the page. Nothing's hidden, and we'll never pad a bill on our end.
Cash-pay intake
$425
The one price we can quote you flat. The full evaluation, history, screening, and the first cut at a plan.
No surprise bills
You see the number before you sit down.
Most major carriers
We take most of the big commercial plans and we'll bill them for you. If yours isn't in-network, we'll still send a Superbill so you can get reimbursed.
Pay however you want
Insurance, cash, CareCredit, a card on file, Venmo, CashApp, Zelle, or Bitcoin all work, and we'll figure out the one that fits you.
Before you book
Three calls to make to your plan. →
Zelle & BTC discount
Zelle: 5% off your total. BTC: 10% off. We're kind of nerds and we think crypto is cool.
Cash rates you can see
Nothing's hidden.
In person and telehealth, Washington and Oregon
Not sure how the money side works for you?
Talk to a provider
A real person replies
We'll work it out before you commit. →
In-network
Who we work with directly.
We're in-network with most of the major commercial carriers in Oregon and Washington. A few of them are our preferred networks, the ones where the coverage actually works the way it's supposed to, and we take a long list beyond that too.
Preferred networks
Also accepted
Not on the list? No problem, because most plans cover 60-80% of your visit out-of-network, and we'll send a Superbill so you can submit it for reimbursement. Call your insurance, ask about your out-of-network benefits, they'll tell you exactly what's covered.
We don't take Medicare or Medicaid. With Medicare specifically, we technically could see some patients through a couple carriers, but geriatric care is its own specialty and it's not ours, so we'd rather point you to someone set up for it than take it on and put safety second.
Self-pay
If you're paying out of pocket
Here are the cash rates, and the full fee schedule lives in your welcome packet, so if anything changes you hear it from us first.
What you actually pay.
Here is the part most clinics fudge, so we won't. If we're in-network with your plan, you pay whatever your plan says you pay for a specialist visit, typically a copay somewhere between $30 and $80, sometimes higher if you have a high-deductible plan and you haven't hit the deductible yet, in which case you pay the negotiated rate, which on a high-deductible plan typically runs $300 to $500 for the intake and $200 to $350 for follow-ups, until you do. We bill your plan, you get an explanation of benefits in the mail a few weeks later, and the EOB might land differently than the estimate, especially if you haven't met your deductible yet, because that part's between you and your plan. What we won't do is pad it or spring a mystery charge on you.
If you're using the out-of-network reimbursement route, you pay the full cash rate up front and we send you a Superbill, which is just an itemized receipt with the diagnosis code and the procedure code on it. You submit that to your insurance, and depending on your plan they reimburse somewhere between 50% and 80% of what they consider the "allowed amount," which is almost never the same as what you actually paid. Translation: don't expect to be made whole. Expect to recover most of the cost but not all of it, and budget like the cash rate is what you're actually paying, because for the first stretch of the year it usually is.
One more honest note. If money is the thing standing between you and starting, say so. We have payment plans, we've CareCredit, and there's a Zelle and BTC discount that meaningfully shaves the total. Telling us the budget is tight isn't embarrassing, it's information, and we would rather work it out up front than have it blow up the treatment three visits in.
The honest read
- In-networkYou pay your copay, usually somewhere between $30 and $80, or the negotiated rate while you're still working off a deductible.
- Out-of-networkYou pay the cash rate up front, send the Superbill, and recover 50 to 80% of their allowed amount, so don't expect to be made whole.
- Money is tightSay so, because payment plans, CareCredit, and the Zelle and BTC discount all knock real money off the total.
On Medicare and Medicaid.
The short version, we don't take either. Some Medicare Advantage plans run through carriers we work with, so technically we could see a few of those patients, but geriatric care is its own specialty and it isn't ours, and we'd rather keep our focus where we're actually strong and put safety first than take it on. Straight Medicare and Medicaid we're not enrolled with, so those we genuinely can't bill, even for cash. If that's you, the community mental health agencies and the big systems (OHSU, Providence, Kaiser) all take Medicare and Medicaid and have psychiatry departments, so that's the place to start.
Payment options
However you want to handle it
CareCredit, 0% Interest Financing
Still working on your deductible? It's rough out there before benefits kick in, but it doesn't have to stop you from getting started. We've partnered with CareCredit for interest-free financing on medical, mental health, and wellness services. Learn more or apply →
Card on file (default)
We keep a card on file and run the charge before your appointment. Unless we've worked out something different.
Venmo / CashApp / Zelle / Bitcoin
Card not your thing? You can pay through Venmo or CashApp, though honestly we'd rather you use Zelle or Bitcoin, because those come with a discount that's worth your while. Zelle: 5% off your total. BTC: 10% off. We're kind of nerds and we think crypto is cool.
Cancellations
Less than 48 hours notice = full appointment fee charged to the card on file. Your provider may waive or reduce to $200 in some situations. Life happens, but short notice makes it tough to fill the spot, and our time (like yours) is valuable.
How insurance actually works for psychiatry.
Quick primer because most people have never had it explained, and the front desk at most clinics isn't going to walk you through it. In-network means a clinic has a contract with your insurance carrier and has agreed to accept a negotiated rate as full payment, which the insurance company then partly pays for and you partly pay for via your copay or coinsurance. Out-of-network means no contract, so the clinic bills whatever it charges and your insurance reimburses based on their internal "allowed amount" table, which is usually lower than the bill. The gap is on you.
For mental health specifically, the federal Mental Health Parity and Addiction Equity Act says your insurance has to cover psychiatric visits at the same level it covers regular medical visits. Same copay structure, same deductible, same visit limits, same prior auth rules. That is the law. In practice, plans sometimes find creative ways to make mental health harder to access (narrower networks, more aggressive utilization review, slower claims processing), and if you ever feel like you're getting the runaround, you can file a parity complaint with your state insurance commissioner. People don't know that exists, so they don't use it, and the carriers count on that.
Before you book anywhere, call the member services number on the back of your card and ask three things. One, is this clinic in-network for outpatient psychiatry under my plan, and if so, what's my copay or coinsurance for a specialist visit. Two, do I have a deductible for mental health services, and if so, how much of it have I already met this year. Three, do you require prior authorization for psychiatric visits or medications. Write down the answers, the rep's name, and the reference number for the call. If something later goes sideways, that reference number is what fixes it.
If a claim gets denied, appeal it.
If you're using the out-of-network reimbursement route, the questions are slightly different. Ask what your out-of-network deductible is, what the coinsurance percentage is once you've met it, and what the "allowed amount" is for CPT codes 90792 (the intake) and 99214 with 90833 (the typical follow-up). They might tell you, or they might give you the runaround. Be persistent. Those numbers are what tell you whether out-of-network is worth pursuing or whether you're basically paying cash either way.
Last bit. Insurance companies don't pay for psychiatric care because they like you. They pay because the contract says they have to. If a claim gets denied, appeal it. Most denials are administrative (wrong code, missing modifier, expired auth) and get reversed on appeal. We help with that on our end when it's on us. When it's on the plan, we'll tell you what to do.
Three calls to make
- Am I in-network?Ask whether the clinic is in-network for outpatient psychiatry, and what your copay or coinsurance runs for a specialist visit.
- Where's my deductible?Find out whether mental health has its own deductible, and how much of it you've already met this year.
- Any prior auth?Ask whether they require prior authorization for psychiatric visits or medications, and write down the reference number for the call.
Why we still keep a cash option.
We take most of the major plans and most people just run it through insurance, which is the simple call and usually the cheap one. But we keep a cash option open on purpose, and here's the honest reason. When a visit goes through a carrier, the carrier gets a say in some things you might not want them having a say in, like what gets written down about you. Once a diagnosis is in a chart it's in your insurance company's database, and that database talks to other databases, and over a long enough stretch it can turn up in places you didn't expect, like life insurance underwriting or a security clearance review.
Paying out of pocket sidesteps a chunk of that. There's still a chart, still a treatment record, still everything we're required to keep by law, it just doesn't flow through a third party that has its own incentives about what gets logged and how. For a guy who cares about privacy, who works in a field where a mental health record can get used against him, or who just doesn't want his carrier deciding which medication is reasonable, paying cash buys back a real amount of control. It's not the default, it's an option, and for some people it's worth it.
Either way, the visit is the length the visit actually needs to be. Insurance reimbursement for a typical psychiatric follow-up assumes about fifteen to twenty minutes of face time, which is fine for a quick med check and ridiculous for anything more tangled than that. We don't run the clock like that, so if a situation needs forty-five minutes we spend forty-five minutes, and the visit isn't a budgeting puzzle for either of us.
It's not the default, it's an option.
The tradeoff's on you. Cash costs more out of pocket up front than a copay does, and we're not going to pretend otherwise. Whether the privacy and the extra control is worth that depends on what you're coming in for, what kind of work you do, and what your budget looks like, and that's a real question with no single right answer. We're happy to talk it through before you commit to anything, because we'd rather sort it out now than find out later the money side doesn't work for you.
Honest answers
Billing questions we get a lot
I'm not on your in-network list. Can I still come in?
Yes, and most plans cover 60 to 80% of your visit out-of-network anyway, so we send a Superbill you can submit for reimbursement. Call your insurance, ask about your out-of-network benefits, and they'll tell you exactly what's covered before you commit to anything.
What is a Superbill?
It's just an itemized receipt with the diagnosis code and the procedure code on it, the thing you submit to your insurance. Depending on your plan they reimburse somewhere between 50% and 80% of what they consider the allowed amount, which is almost never the same number you actually paid.
Will I get a surprise bill months later?
From us, no, there's nothing hidden going on. At the visit you pay your copay if your plan has one, and honestly the rest of it is as much a mystery to us as it is to you until your insurance adjudicates the claim and tells us what they're actually covering. So if a balance turns up later, that's not us springing something on you, it's just how your plan settled up, and we'll help you make sense of it.
What if I can't afford it?
We run a financial assistance program for folks with commercial insurance, on a pretty limited basis. If money is the thing standing between you and getting seen, ask our care team for an application and we'll see what we can do.
What if money is tight right now?
Say so, because telling us the budget is tight isn't embarrassing, it's information we can work with. We have payment plans, we've CareCredit, and there's a Zelle and BTC discount that meaningfully shaves the total, and we would rather sort that out up front than have it blow up the treatment three visits in.
Can you see me on Medicare or Medicaid?
No, we're not enrolled with either, which means we can't see you on those plans even if you offer to pay cash, and that's the rule rather than us being difficult. The local community mental health agencies and the larger health systems (OHSU, Providence, Kaiser) all take Medicare and Medicaid, so start there.
Questions about coverage?
We'll work it out before you commit to anything. Drop a line.