The Short Version, With Actual Numbers

Psychiatry has a pricing culture problem. Fees are treated as something to be revealed late, after you have invested enough time that leaving feels wasteful. I would rather you know before you call.

Free fifteen-minute consultation. A phone call to decide whether I am the right provider for what you are carrying. No card, no obligation, no charge.

$250 for the initial evaluation. Sixty minutes, by secure video. History, screening instruments, a working formulation, and an initial plan.

$150 for follow-up medication management. Thirty minutes, spaced to clinical need rather than a template. Most people are seen every two to four weeks at first, then less often.

Visits that run materially shorter or longer than a standard follow-up are billed accordingly. The patient handout carries the complete fee schedule, including cancellation terms and records fees.

Why "No Insurance" Does Not Mean "No Reimbursement"

This is the part most people get wrong, and it is the difference between a $150 visit and an $80 one.

Not billing insurance is not the same as insurance being irrelevant. Many plans carry out-of-network mental health benefits. Under those, you pay the provider at the visit, then submit a receipt to your insurer and they reimburse you directly.

That receipt is called a superbill. It is an itemized document with the diagnosis code, the procedure code, the date, and the amount paid. I generate one automatically after each session and provide it free of charge. You submit it; the money comes back to you, not to me.

Reimbursement is never guaranteed. Coverage varies enormously between plans, and some have no out-of-network benefit at all. But a meaningful number of people who assume cash-pay is out of reach discover their plan covers a real share of it.

A Worked Example

Numbers make this concrete. Suppose your plan has a $1,500 out-of-network deductible that you have already met, and it reimburses 70% of what it calls the allowed amount.

  • You pay $150 for a thirty-minute follow-up at the visit.
  • Your insurer's allowed amount for that code is $100.
  • They reimburse 70% of $100, so $70 comes back to you.
  • Your effective out-of-pocket cost is $80 for that visit.

Two things drive that result, and neither is the sticker price: whether your deductible is met, and what your plan decides the allowed amount is. Those vary by plan, which is why the only honest answer to "what will this cost me" starts with a phone call to your insurer.

The posted fee is the easy number. The one that matters is what your plan calls allowed.

The Questions That Decide Your Real Cost

Call the member services number on the back of your card and ask these. It takes about ten minutes and it is the highest-value phone call you will make about your care.

  • Do I have out-of-network benefits for outpatient mental health services?
  • Is telehealth covered the same as in-person for out-of-network providers?
  • What is my out-of-network deductible, and how much of it have I met this year?
  • After the deductible, what percentage of the allowed amount do you reimburse?
  • What is the allowed amount for CPT 90792 (initial psychiatric evaluation) and CPT 99214 (medication management follow-up)?
  • Is there an annual out-of-pocket maximum for out-of-network services?
  • How do I submit a superbill: online portal, mail, or fax?

What the Hour Actually Buys

Cost only means something next to what you get. A sixty-minute initial evaluation is not the industry norm; twenty to thirty minutes is more common, and fifteen is not unheard of.

An hour is enough time to take a history rather than a checklist, to ask what changed and when, to look at sleep and alcohol and work and grief as part of the clinical picture instead of as background noise, and to leave you with a formulation you could explain to someone else. Screening instruments are completed before we meet so the hour goes to the parts that need a person.

That is the actual trade. You are paying out of pocket for time and continuity with one provider, rather than paying a copay for a shorter visit inside a system that may rotate you between prescribers.

Your Right to a Good Faith Estimate

Under the federal No Surprises Act, patients who are uninsured or who choose not to use insurance have the right to a written Good Faith Estimate of expected charges before a scheduled service. This is federal law, not a courtesy, and it applies to any provider you consider, not just this one.

You will be offered one when you schedule an initial evaluation, and you may request one at any time. If a final bill exceeds the estimate by $400 or more, there is a federal dispute process available to you. Learn more at cms.gov/nosurprises.

If a practice will not put expected costs in writing before you commit, that is information about the practice.

When Cash-Pay Is the Wrong Choice

It would be easy to write this section as a sales pitch. It is not one, and there are people for whom paying out of pocket is a bad decision.

If you have solid in-network psychiatric coverage and a plan that gives you reasonable access, use it. If money is tight enough that a $250 evaluation would displace rent, groceries, or medication, that is not a trade worth making, and community mental health, a federally qualified health center, or your plan's in-network network is the right first call. If you need care this practice does not provide, cost is beside the point.

Cash-pay makes sense for a narrower group: people who want longer visits, continuity with one prescriber, scheduling that is not months out, and no insurance-driven diagnosis on their record. That is a real set of reasons, but it is not everyone's.

Frequently Asked Questions

How much does a psychiatrist cost without insurance in Washington?

In this practice, an initial psychiatric evaluation is $250 for a full sixty minutes and follow-up medication management is $150 for thirty minutes. The first fifteen-minute phone consultation is free and requires no card. Because there is no insurance billing, the posted price is what you pay at the visit.

Can I still use my insurance if the practice does not bill it?

Sometimes, through out-of-network benefits. After each paid visit you can request a superbill, an itemized receipt with the diagnosis and billing codes, and submit it to your insurer yourself. Reimbursement goes directly to you and is never guaranteed. Superbills are provided free of charge.

Do you charge for the first phone call?

No. The initial fifteen-minute consultation is free, and no card is required to request it. It exists so we can both decide whether this practice is the right fit before anyone pays for anything.

What if I cannot afford the medication you recommend?

Most psychiatric medications have inexpensive generics, and cost is a clinical variable worth naming out loud. Tell me on the consultation and we will factor it into what gets prescribed rather than discovering the problem at the pharmacy counter.

Will I get a Good Faith Estimate before I am charged?

Yes. Under the federal No Surprises Act, patients who are uninsured or not using insurance have the right to a written Good Faith Estimate of expected charges before a scheduled service. You will be offered one when you schedule, and you may request one at any time.

When to Book a Consultation

If the numbers above work for you and the model sounds like what you have been looking for, the next step is a short phone call. If they do not work, I would rather tell you that in fifteen free minutes than after you have paid for an hour.

No card is required to ask. Bring your insurance card if you have one, so we can talk through the out-of-network question with real information rather than guesses.