One of the first questions prospective patients ask is whether I take insurance. The answer is no—and the reasons matter.

This isn't about maximizing revenue. It's about protecting the kind of care I want to provide and the privacy of the people I treat.

What insurance requires

When a psychiatrist bills insurance, they're entering into a system with rules that shape how care gets delivered.

Insurance requires a diagnosis. Not a working hypothesis, not "we're still figuring this out"—a billable diagnostic code, often from the first visit. That code goes into a database. It follows you. It can affect your ability to get life insurance, disability coverage, or certain professional licenses.

Insurance dictates visit frequency and duration. Reimbursement rates assume a certain appointment length. If your situation requires more time, the math doesn't work. If you're stable and need less frequent check-ins, the system still wants you on a schedule that justifies ongoing billing.

Insurance requires prior authorization for many medications. That means a third party—someone who has never met you—gets to weigh in on whether your treatment plan is "medically necessary." This creates delays, denials, and the administrative burden of appeals.

Insurance pays slowly and unpredictably. Practices that depend on insurance reimbursement need volume to stay viable. That means shorter appointments, larger panels, and less flexibility.

What private pay changes

When you pay directly, the relationship is between you and me. No intermediary. No one looking over my shoulder.

I can take the time the evaluation actually requires, not the time a billing code assumes. I can adjust medications based on clinical judgment, not prior authorization workflows. I can see you more or less frequently depending on what your situation calls for, not what a utilization reviewer thinks is appropriate.

And nothing goes into an insurance database. Your diagnosis, your medications, the fact that you're seeing a psychiatrist at all—that stays between us.

The cost question

Private pay costs more out of pocket than an insurance copay. That's real, and I don't minimize it.

What you're paying for is access to a different kind of care: smaller panel, direct physician involvement, flexible scheduling, genuine privacy. For some people, that tradeoff makes sense. For others, it doesn't.

I'm not the right fit for everyone, and I don't pretend to be. If insurance-based care works for your situation, there are good psychiatrists who accept it. But if you've been frustrated by the constraints of that system—or if privacy is a priority—this model exists for a reason.

What about superbills?

I provide superbills on request. A superbill is an itemized receipt you can submit to your insurance company for potential out-of-network reimbursement.

Whether you get reimbursed, and how much, depends on your specific plan. Some plans cover a significant portion of out-of-network psychiatric care. Others cover very little. I recommend calling your insurer before your first appointment if this matters for your decision.

Keep in mind: submitting a superbill means your diagnosis goes to your insurance company. If privacy is your primary concern, you may choose not to submit it.

The bottom line

I don't accept insurance because doing so would compromise the practice I've built. The tradeoff is that care costs more and isn't accessible to everyone.

If you value privacy, continuity, and a direct relationship with your psychiatrist, this model may be worth it. If cost is the deciding factor, it may not be.

Either way, you deserve to understand what you're choosing and why.

Dr. Faisal Rafiq is a board-certified psychiatrist offering private, membership-based care in New York. To learn more, visit Private Psych MD.