The first question many prospective patients ask our office is some version of “Do you take my insurance?” The honest answer is that Resilience Psychiatry is an out-of-network private practice. We do not bill insurance directly. For a meaningful number of patients, that answer ends the conversation. They assume out-of-network care is too expensive, and they move on.
For many of those patients, that assumption is wrong. The real cost of out-of-network psychiatry, after superbills, after HSA or FSA reimbursement, and after factoring in time and travel, is often closer to in-network care than people expect. Sometimes it is actually less. This article walks through the math honestly, so you can make a real decision rather than walk away from a question you have not actually answered.
The Real Numbers, Said Plainly
Our practice is direct about pricing on the first phone call. The exact numbers depend on the visit type and the clinician, but the rough framework is this.
The Adult Psychiatric Evaluation is a sixty to ninety minute first appointment that establishes the diagnosis and the treatment plan. It is the longest, most clinically intensive visit, and it is the visit where you and the clinician decide whether you are a good fit for ongoing care.
Follow-up visits for Medication Management are twenty-five to thirty minutes. The cadence depends on your situation. Stable patients on a known regimen typically come every eight to twelve weeks. Patients in active titration or acute symptoms may be every two to four weeks. Most patients average roughly four to six follow-ups a year once stable.
Psychotherapy sessions are typically forty-five to sixty minutes, with weekly to biweekly cadence during active treatment and longer intervals during maintenance.
We will quote you exact dollar figures on the first call. We do not have hidden fees, sliding charges based on perceived ability to pay, or surprise billing. The federal No Surprises Act gave patients additional protections in this area, and we operate consistently with that framework.
How Out-of-Network Reimbursement Actually Works
Here is the part most patients do not fully understand until they have done it.
If you have a PPO plan, a POS plan, or any commercial plan with out-of-network benefits, your insurance will reimburse you for a portion of out-of-network care. The amount depends on your specific plan. Some plans reimburse fifty percent of the allowed amount after the out-of-network deductible is met. Some reimburse sixty or seventy percent. A few plans reimburse less, and a small number reimburse more.
To collect this reimbursement, you ask us for a superbill after each visit. A superbill is a detailed itemized receipt that includes the diagnosis code, the procedure code, the date of service, the clinician’s information, and the amount paid. We generate these on request, and most patients ask for them at the end of each appointment or on a monthly basis.
You submit the superbill to your insurance company. Some plans have online portals. Some require mailing. Most reimburse within four to eight weeks.
The math, simplified, looks like this. Suppose your follow-up visit cost was $250 (hypothetical, not our actual number; your number will be quoted by our office). Suppose your plan reimburses sixty percent of the allowed amount after the deductible. Your net cost per visit after reimbursement might be $100 to $150, depending on how your plan calculates allowed amounts.
For the initial evaluation, the math runs the same way at a higher dollar figure. For four follow-ups a year, the annual net cost after reimbursement may be a few hundred dollars rather than the full sticker price you saw on the first call.
What HSA and FSA Accounts Do
For patients with Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), psychiatric care is generally a qualified medical expense. That means you can pay for visits using pre-tax dollars.
For a patient in a 24 percent federal income tax bracket, plus state income tax in New York, the pre-tax advantage of paying from an HSA or FSA is roughly 30 percent. A $250 visit paid from your HSA effectively costs you about $175 in after-tax dollars. For families with HSAs accumulated over multiple years, this can make a substantial dent in the cost of care.
If you do not currently have an HSA or FSA but you are employed and have access to one through your job, opening one is worth considering. The contribution caps are set by the IRS each year. The National Alliance on Mental Illness (NAMI) maintains general information about financing mental health care that may be useful.
The Time and Travel Math
The out-of-pocket cost is one part of the story. The time and travel cost is another. This part is harder to put a dollar figure on, but it is real.
Many in-network psychiatric practices have waitlists of three to six months for new patients. Many have appointments only during working hours. Many require in-person visits. Many do not return calls between visits.
Out-of-network practices, including ours, typically have faster access to first appointments, more flexible scheduling, telehealth options that save travel time, and direct contact between the clinician and the patient (or a designated team member). For a patient who would otherwise miss work for a half day to keep an in-person appointment, the time savings of a thirty-minute telepsychiatry visit can be worth substantially more than the cost difference.
For a patient who has been waiting four months for an in-network appointment, the cost of starting care now rather than starting it next quarter is real, especially if symptoms are escalating in the meantime. The National Institute of Mental Health (NIMH) has documented for years that earlier engagement with mental health care can improve outcomes across many psychiatric conditions.
A Note on Why So Many Psychiatrists Are Out of Network
This is worth a brief honest word.
Most outpatient psychiatrists in the United States who run private practices are out of network. The American Psychiatric Association (APA) workforce reports and multiple peer-reviewed studies have documented this trend for more than a decade. The reasons are structural. In-network reimbursement rates for psychiatric care are typically lower than the cost of running a practice that delivers thorough, careful, individualized care. The math does not work for many clinicians, especially board-certified psychiatrists with significant training and experience.
The result is a two-tier system that is not the fault of the patients, the clinicians, or any individual party. It is a feature of how the U.S. insurance market has structured mental health reimbursement. The American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) both advocate for better mental health parity in insurance markets, and progress is uneven.
What this means in practice is that if you are looking for a board-certified psychiatrist with a small caseload, a thorough evaluation, and the kind of ongoing relationship that allows real treatment planning, you will often end up at an out-of-network practice. The question is not whether to use one. The question is whether the financial math works for your specific situation.
How To Run Your Own Numbers Before You Call
Before you reach out to any out-of-network practice, including ours, the following exercise will give you a realistic picture.
Look at your insurance card or your plan documents. Find the section on out-of-network mental health benefits. Note the deductible, the coinsurance percentage, the annual out-of-network maximum, and any explicit mental health coverage details.
Call your insurance company. Ask specifically: What is my out-of-network deductible? How much of it have I met this year? What percentage of the allowed amount do you reimburse for outpatient psychiatric services after the deductible is met? What is your allowed amount for CPT codes 90792 (initial evaluation), 99214 with 90833 (follow-up with psychotherapy), and 90834 (psychotherapy only)? Write down their answers.
Estimate your annual visit count. One Adult Psychiatric Evaluation , four to six follow-up visits for Medication Management each year, and Psychotherapy if applicable, depending on your treatment plan.
Do the math. Multiply your estimated visit cost by your estimated visit count. Subtract the projected reimbursement. Adjust for HSA or FSA pre-tax savings if applicable.
The resulting number is your honest annual net cost. Compare it to the time and convenience tradeoff you actually want.
When Out-of-Network Does Not Make Sense
In fairness, out-of-network care does not work for everyone. Patients on Medicaid or Medicare with limited supplemental income, patients with HMO plans that do not provide out-of-network benefits, and patients in acute financial distress are often best served by community mental health centers, Federally Qualified Health Centers, or sliding-scale clinics with in-network coverage.
We will tell you honestly on the first call whether we are likely to be a good financial fit. For patients for whom we are not, we will help identify alternative options on Long Island and across New York.
How To Start
If you are an adult on Long Island, in New York, or in Florida, and you would like to start the cost conversation honestly before deciding, contact our team. The first call is short, the dollar figures are direct, and there is no obligation to schedule a visit.
If you are in crisis right now, please call or text 988 (Suicide & Crisis Lifeline) or visit our Crisis Resources page before working through the financial planning.
We see patients at our East Setauket office in person and across New York and Florida through secure telepsychiatry services. We work in English and Spanish.
Out-of-network psychiatry is not for everyone. For more patients than initially assume, it is more affordable than the sticker price suggests, more accessible than the waitlist for in-network care, and structured around the actual clinical relationship the patient needs. The only way to know which category you are in is to do the math.
Practical Tips for Submitting Superbills
A few specifics that save time and improve the chance of full reimbursement on your out-of-network claims.
Submit superbills monthly rather than waiting until the end of the year. Many plans have time limits on out-of-network claim submission, and a backlog of twelve months of receipts is harder to chase down if anything is missing.
Keep a simple tracking spreadsheet. Date of visit, amount paid, date submitted to insurance, date reimbursed, amount reimbursed. This makes it obvious if a specific claim is delayed or denied.
If a claim is denied, call your insurance company and ask specifically why. The most common reasons for denial are missing diagnosis codes, missing provider information, or the patient not having met the out-of-network deductible. Each of these is fixable with a follow-up submission.
If the insurance company tells you the “allowed amount” for your out-of-network claim is lower than the actual cost you paid, you can sometimes appeal that calculation. The FAIR Health Consumer website maintains a public lookup of typical regional costs for medical procedures. If the insurance company is significantly below those benchmarks, your appeal has a stronger basis.
Save the superbill receipts and the insurance reimbursement records together for tax purposes. Out-of-pocket medical expenses above 7.5 percent of adjusted gross income are deductible for many filers, and good records make tax time easier.
These are practical tips, not financial advice. For complex financial situations, a qualified accountant or tax professional is the right resource.