When you cannot afford to wait three weeks.

A retainer for people whose work does not pause while they wait for an appointment.

What a three-week wait actually costs

Standard psychiatric care runs on standard timelines. Something changes — a medication stops working, sleep collapses, anxiety spikes before a deadline — and the next available appointment is three weeks out. For most people that is an inconvenience.

For some people it is not.

• A litigator billing $700 an hour who loses two weeks of function has lost more than this retainer costs, twice over
• A founder who cannot think clearly during a raise is not losing productivity. They are losing the round.
• A physician whose judgment is slipping is carrying a risk that does not stay contained to them
• An executive who disappears for a month has a board asking questions they cannot answer

The fee is not what psychiatric care costs. It is what not waiting costs.

Where this leaves you

This is for you if

• A three-week wait would have real consequences, not just frustration
• Your schedule is genuinely unpredictable — call, trial, travel, deal timelines
• You are managing psychiatric care alongside other clinicians who need coordinating
• Discretion matters enough that you want one clinician who knows the whole picture
• You have been in the system long enough to know that fifteen-minute med checks do not work for you

This is not for you if your situation is stable, your schedule is predictable, or you are simply willing to pay more for reassurance. Standard care is genuinely better value for most people, and I will tell you so.

What is included

• Direct access. My phone number. Not a service, not a portal. Calls and texts answered the same business day.
• 48-hour appointments. When something changes, you are seen within two business days.
• Hour-long visits. Every appointment, not just the first. No 15-minute medication checks.
• Unlimited frequency. Weekly during a difficult stretch, quarterly when stable. No counting, no per-visit charge.
• Care coordination. I speak directly with your primary care physician, therapist, and specialists. You stop being the messenger between your own clinicians.
• Travel continuity. Telehealth wherever I am licensed, and prescription coordination when you are away.
• Annual comprehensive review. A full reassessment yearly, not incremental drift.

Why the price is what it is

Same-day access is only possible when the schedule is not full. A retainer patient occupies capacity that would otherwise hold several standard patients — held open whether used that week or not. That reserved capacity is the entire product.

It is also why the panel is strictly limited. Past a certain number, the 48-hour promise stops being deliverable, and a promise that cannot be kept is worse than no promise at all. When the panel is full, it is closed until someone leaves.

Your risk in the first 60 days

Common questions

Am I paying more for better medicine?
No, and I would not claim otherwise. The clinical thinking is the same one you would get in a standard evaluation. What the retainer buys is access, time, and coordination. If those are not constraints for you, do not buy this.

What if I barely use it?
Some years you will not. That is what reserved capacity means — it is held for you whether you need it in March or not at all. If you consistently do not need it, I will tell you to drop to standard care at renewal.

Is this concierge medicine?
It is the same structure, applied to psychiatry specifically. Retainer for access, small panel, direct contact. The difference from primary-care concierge is that psychiatric care benefits more from continuity, because the clinician who has known you for two years catches things a new one cannot.

Can I switch to standard care later?
Yes, at any renewal. Many people use a retainer through a difficult period and step down once things stabilise. That is a good outcome, not a lost customer.

Does this guarantee I get better?
No. Nothing does, and any clinician promising outcomes is telling you something untrue. This guarantees access and time. What we do with them is clinical work, and clinical work has uncertainty in it.

What is not included

Emergency and crisis services. A retainer is not emergency care. If you are in crisis, call or text 988 or go to your nearest emergency department. Hospitalisation, intensive outpatient programmes, and inpatient care are referred and billed separately by those providers.

The retainer also does not purchase a particular diagnosis, a particular medication, or a particular outcome. Clinical judgement is not for sale at any price, and you should be wary of anyone selling it.

Terms

• Billed annually in advance. Quarterly available.
• Twelve-month term, renewable by mutual agreement.
• Cash-pay only. No insurance billing. A superbill is provided for your own out-of-network submission.
• Sixty-day refund of the unused portion if the fit is wrong.

Most people should start here instead

If you are unsure, you probably do not need this. A standard initial evaluation at $400 gives you the same diagnostic thinking and the same treatment planning. Follow-up visits at $200 serve most people well for years.

Start there. If access turns out to be your real constraint, the retainer will still be here.

A superbill is available if you choose to seek out-of-network reimbursement yourself. That is entirely your decision, and it does put a diagnosis code into your insurer’s hands — which is worth knowing before you submit one.

What it does remove is the automatic transmission of your diagnosis to an insurance company as a condition of receiving care. For the people who ask me about this, that is the part that was actually worrying them.

It is worth being precise, because overstating this would be its own kind of dishonesty. A clinical record still exists — I am required to keep one. That record remains subject to subpoena or court order, and mandatory reporting obligations apply regardless of how care is paid for. Cash-pay is not anonymity, and no clinician can offer you that.

What cash-pay does not do

No prior authorisation. No visit limits. No utilisation review deciding that six sessions should have been enough. How often we meet and for how long is a clinical decision made between us.

No one outside the room decides how much care you get

Without a payer in the room, the diagnosis in your record is the one I actually believe is correct. Sometimes that is a formal diagnosis. Sometimes it is an honest statement that the picture is not yet clear. Neither has to satisfy anyone but the clinical facts.

Insurance reimbursement requires a billable diagnosis, and it has to be one the payer accepts for the service provided. That creates quiet pressure toward codes that justify reimbursement rather than codes that best describe what is actually happening.

Your diagnosis reflects clinical judgement, not billing requirements

For a physician thinking about credentialing, an attorney thinking about the bar, or anyone who has ever wondered what a life or disability insurance underwriter might one day request, that distinction is not abstract.

When care is billed to insurance, a diagnosis code is submitted with the claim and becomes part of that insurer’s records. When there is no claim, there is no code to submit. Nothing about your care is transmitted to a third-party payer at all.

No claim means no diagnosis code sent to a payer

This practice does not bill insurance. For most people that is simply a cost consideration. For the people this practice is built for, it changes three things that matter more than the fee.

What cash-pay actually changes