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 and we'll bill your plan for you, so you're not fronting the whole cost or chasing paperwork. What you actually pay is your copay or coinsurance, and your plan sets that, not us, so we'll tell you what we know going in and we'll never pad a bill on our end. If you'd rather skip insurance and pay cash, those rates live on the appointments page.
Nothing lands by surprise. If anything on our end changes, you hear it from us first.
We bill your plan
In-network with most major plans.
We take most of the big commercial plans and bill them for you, so you're not fronting the whole cost or chasing paperwork. What you pay is your plan's copay or coinsurance, not a number we set.
No surprise bills
You hear what we know before you sit down.
Most major carriers
In-network with most of the big plans. Out of network? We still send a Superbill so you can claim reimbursement, usually 50 to 80% of the allowed amount.
What you actually pay
Your copay or coinsurance, which your plan sets, usually somewhere around $30 to $80. We can't set that number, but we'll tell you what we know going in.
Before you book
Three calls to make to your plan. →
Payment options
Card on file is the default. If that doesn't work, ask us before the appointment.
WA and OR, in person and telehealth
Not sure how your plan works for this?
Tell us your plan and we'll tell you what we know. A real person replies within a business day.
Ask the care teamIn-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.
What you actually pay.
Here's the part most clinics fudge, so we won't. If you've got insurance, we bill your plan and you just cover your part of the visit, the copay, the coinsurance, or whatever's still going toward your deductible. How much that comes to is set by your own plan, so it runs a little different for everyone, but for most people it's a copay somewhere around $30 to $80. If you're on a high-deductible plan and haven't met the deductible yet, you'll pay more until you do, then it settles back to your copay. We handle the billing, you'll see the breakdown on the explanation of benefits your insurer mails you, and while we can't promise your exact number to the dollar the way we can with cash, we'll tell you what we know going in and never pad it or spring a surprise 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've got payment plans and CareCredit, and we can talk through the money part before it becomes the reason you do nothing. 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 and CareCredit exist, and we can talk through the money part before it becomes the reason you do nothing.
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.
Other payment options
Card not your thing? If money is tight, tell us before the appointment so we can talk through payment plans or CareCredit.
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's 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.
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's 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.
Can I pay cash to keep a diagnosis off my insurance record?
Yes, and for some people that's the whole point. When a visit runs through insurance, the diagnosis lands in the carrier's records, and over a long enough stretch that can surface in places you didn't expect, like life-insurance underwriting or a security-clearance review. Paying cash keeps your care out of that third-party trail, you still get a full chart and everything the law requires, it just doesn't flow through your insurer. It costs more up front than a copay, so whether it's worth it depends on your situation, and we're happy to talk it through. The cash rates live on the appointments page.
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've got payment plans and CareCredit, 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.