--- title: Does a Higher Premium Let You See Any Psychiatrist You Choose? description: Does a higher premium let you see any psychiatrist? See how HMO, PPO, EPO, and POS plans shape your choice, and what private pay means for families in Texas. image: https://www.healthandharmonypsychiatry.com/hubfs/does-a-higher-premium-let-you-see-any-psychiatrist-social.jpg --- [Skip to content](https://www.healthandharmonypsychiatry.com/blog/does-a-higher-premium-let-you-see-any-psychiatrist#main-content) [![TB-Decorative-Horizontal-H&H-P-Logo](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/TB-Decorative-Horizontal-H%26H-P-Logo.webp?width=1709&height=962&name=TB-Decorative-Horizontal-H%26H-P-Logo.webp)Homepage](https://www.healthandharmonypsychiatry.com/) - [Care for You](https://www.healthandharmonypsychiatry.com/conditions) - [Women’s Mental Health](https://www.healthandharmonypsychiatry.com/conditions/womens-mental-health) - [Anxiety](https://www.healthandharmonypsychiatry.com/conditions/anxiety) - [Burnout](https://www.healthandharmonypsychiatry.com/conditions/burnout) - [Depression](https://www.healthandharmonypsychiatry.com/conditions/depression) - 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[Care for Your Child](https://www.healthandharmonypsychiatry.com/services/child-adolescent-psychiatry) - [Child and Adolescent Psychiatry](https://www.healthandharmonypsychiatry.com/services/child-adolescent-psychiatry) - [Children, Ages 6 to 10](https://www.healthandharmonypsychiatry.com/services/child-psychiatry) - [Teens, Ages 11 to 17](https://www.healthandharmonypsychiatry.com/services/teen-psychiatry) - [ADHD in Children](https://www.healthandharmonypsychiatry.com/conditions/adhd-in-children) - [Meet Dr. McDade](https://www.healthandharmonypsychiatry.com/about) - [How Care Works](https://www.healthandharmonypsychiatry.com/services) - [Your First Evaluation](https://www.healthandharmonypsychiatry.com/services/psychiatric-evaluation) - [Medication Management](https://www.healthandharmonypsychiatry.com/services/medication-management) - [Telepsychiatry](https://www.healthandharmonypsychiatry.com/telepsychiatry) - [Services and Fees](https://www.healthandharmonypsychiatry.com/services) - [Learn](https://www.healthandharmonypsychiatry.com/blog) - [Learn with Dr. McDade](https://www.healthandharmonypsychiatry.com/blog) - [Psychiatry Glossary](https://www.healthandharmonypsychiatry.com/glossary) - [Refer a Patient](https://www.healthandharmonypsychiatry.com/refer-a-patient) - [How Referrals Work](https://www.healthandharmonypsychiatry.com/refer-a-patient) - [For Therapists](https://www.healthandharmonypsychiatry.com/refer-a-patient/therapists) - [For Physicians](https://www.healthandharmonypsychiatry.com/refer-a-patient/physicians) - [For Pediatricians](https://www.healthandharmonypsychiatry.com/refer-a-patient/pediatricians) - [For OB-GYN and Menopause Clinicians](https://www.healthandharmonypsychiatry.com/refer-a-patient/ob-gyn-and-menopause) [Schedule My Visit](https://www.healthandharmonypsychiatry.com/book-an-appointment) ![](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/does-a-higher-premium-let-you-see-any-psychiatrist-social.jpg?width=1200&height=630&name=does-a-higher-premium-let-you-see-any-psychiatrist-social.jpg) # Does a Higher Premium Let You See Any Psychiatrist You Choose? ![Dr. Allison J. McDade, MD](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/dr-allison-mcdade-author.webp?width=48&height=48&name=dr-allison-mcdade-author.webp) Dr. Allison J. McDade, MD November 3, 2026 - Medically reviewed November 2, 2026 - Updated November 2, 2026 Maybe you've sat with your benefits guide at open enrollment, choosing the plan that costs more and hoping it opens more doors. Or maybe you've found a psychiatrist you wanted to see, then learned she wasn't in your plan's network. And maybe you've done all of this for your whole family, with your own care still waiting its turn. You deserve to know what your premium buys before you choose, and a physician who stays with your story. This guide shows how plans and networks shape your choice, so the decision stays yours. The answer **A higher premium buys a plan, and each plan's network and rules decide which psychiatrists it covers and what you pay to see them.** Some plans cover care outside their networks only in an emergency, and others cover it for an additional cost, HealthCare.gov explains. Some plans also require a referral first. At Health & Harmony, you choose Dr. McDade, and every visit is with her, at two posted rates. **Check the network first, then choose what fits your family.** Her story explains [why Dr. McDade built a different model of care](https://www.healthandharmonypsychiatry.com/why-a-different-model). ## What does your premium pay for? Your premium keeps your coverage in place. It buys a plan with its own network, the doctors and other providers the plan has contracted with, HealthCare.gov explains. When you get care, you usually pay part of the cost too, like a deductible, copayments, and coinsurance. HealthCare.gov calls this cost sharing. With a plan through a job, you and your employer usually share the premium. A preferred provider organization (PPO) is the most common kind of plan through a job, and in 2026 its family premium cost a little more than the average, KFF's survey found. Some plans pair with a health savings account (HSA), and KFF counts these HSA-qualified plans on their own. What a family plan through a job cost in 2026, by plan type - A PPO$29,522 - Every plan type, on average$28,303 - An HSA-qualified plan$26,450 From KFF's 2026 national survey of employers with 10 or more workers, the average yearly premium for family coverage, you and your employer together. **Your premium buys coverage, and the network shapes your choices.** ## How do HMO, EPO, POS, and PPO plans differ when you want a psychiatrist? Two rules matter most when you want a psychiatrist, care outside the network and referrals. A psychiatrist is a medical doctor who specializes in mental health, the American Psychiatric Association explains, so your plan may treat a visit with one as specialist care. Plan typeCare outside its networkTo see a psychiatrist 1. 01Health maintenance organization (HMO) Care outside its networkGenerally covered only in an emergency To see a psychiatristMany HMOs require a referral from your primary care doctor first 2. 02Exclusive provider organization (EPO) Care outside its networkCovered only in an emergency To see a psychiatristChoose one in the plan's network 3. 03Point of service (POS) Care outside its networkCosts more than care inside it To see a psychiatristA referral from your primary care doctor comes first 4. 04Preferred provider organization (PPO) Care outside its networkCovered, for an additional cost To see a psychiatristOutside the network, no referral is needed An HMO may also require you to live or work in its service area. And if you skip a referral your plan requires, it may not pay for the visit, HealthCare.gov notes. Kinds of plans workers had through a job, 2026 - A PPO50% - An HSA-qualified plan29% - An HMO or EPO12% - A POS plan8% From KFF's 2026 Employer Health Benefits Survey, for workers with a plan through a job. KFF counts EPO plans with HMOs. **Know your plan's rules before you need them.** ## How broad are mental health networks? In KFF's 2026 survey, 22% of firms that offer health benefits called the network in their largest plan very broad for mental health and substance use care, and 42% called it somewhat broad. For the network overall, 51% said very broad. How firms rated their largest plan's network for mental health and substance use care, 2026 - Very broad22% - Somewhat broad42% - Somewhat or very narrow15% From KFF's 2026 national survey of employers with 10 or more workers, employers' own ratings, the three answers KFF reports. What matters for you is whether the psychiatrist you want is in your plan's network, and the next section shows how to check. **Look for the one name that fits you.** ## How do you check that a psychiatrist is in your network? Ask your plan, then confirm with the psychiatrist's practice. Your plan's directory lists the providers in its network. Some plans use tiered networks, where you pay extra to see some providers, HealthCare.gov notes. Questions to ask your plan first - Which psychiatrists in your network are taking new patients? - Is this psychiatrist in the network for my plan, and in which tier? - Do I need a referral first? - What would I pay to see this psychiatrist, inside the network and outside it? Most plans through a job, and most plans you buy on your own, must answer a question about a provider's network status within one business day. If the plan's directory or its answer listed a provider as in network by mistake, the plan can charge you only its in-network cost sharing for a covered visit. Federal No Surprises Act guidance explains both rules. Have your member ID ready when you call, and write down the date and the name of the person you spoke with. Ask for the plan's answer in writing too. Then call the practice to confirm the psychiatrist is in your plan's network, before you book. **Ask your plan first, and keep a note of its answer.** ## How do you compare plans for psychiatric care at open enrollment? Start with the care you want, then look at the premium. A plan's price tells you what coverage costs, and its network and rules tell you who you can see. Before you choose a plan - Write down the psychiatrist you want, or the kind of care you need - Look up that name in each plan's directory, and note its tier - Note whether each plan asks for a referral - Ask what a visit costs inside each network and outside it - Then set each plan's premium beside those answers If the psychiatrist you want is in none of the plans, read on for three common paths. **Choose the care first, then the plan.** You've chosen plans for everyone. Now choose a physician who stays with your story. [Find Care That Understands Me](https://www.healthandharmonypsychiatry.com/book-an-appointment) ## What if the psychiatrist you want is outside your network? You have three common paths, and each fits a different family. Choose a psychiatrist in your network, use your plan's out-of-network benefits if it has them, or pay the practice directly. Your pathWhat it costsGood to know 1. 01Stay in your network What it costsYour plan's cost sharing, such as a deductible, copay, or coinsurance Good to knowCheck the directory and ask your plan first 2. 02Use out-of-network benefits What it costsAn additional cost, with the plan paying from its own allowed amount Good to knowHMO and EPO plans generally cover it only in an emergency 3. 03Pay the practice directly What it costsTwo posted rates, with a good faith estimate before your first visit Good to knowEvery visit is with Dr. McDade. Ask about a superbill if your plan has out-of-network benefits. With out-of-network benefits, your plan pays from its own allowed amount. If a fee is more than that amount, you may have to pay the difference, HealthCare.gov explains. The right path depends on what matters most to your family. **Three paths, each with its own costs and rules.** ## What stays the same with private pay here? Your physician. Private pay, also called self-pay or cash pay, means you pay the practice directly for each visit. Every visit is with Dr. McDade, from your first evaluation on, so your care builds on trust and continuity. She sees every patient herself, because that is the work she trained for, and care here centers on you and your relationship with her. You can book your first visit without a referral, and every visit is a [telepsychiatry](https://www.healthandharmonypsychiatry.com/telepsychiatry) visit by secure video, for patients in Houston and across Texas. You can keep your plan for the rest of your family's care. If you fill a prescription through your health plan, the plan's rules still apply, and some prescriptions need its approval first. When one does, Dr. McDade calls and helps however she can, as part of her standard fees. **The same physician, at every visit.** If you need help now If you are in crisis or thinking about suicide, call or text 988 or chat at [988lifeline.org](https://988lifeline.org/) to reach the 988 Suicide and Crisis Lifeline. If you are Deaf or hard of hearing, use your preferred relay service or dial 711, then 988. In an emergency, call 911 or go to the nearest emergency room. This practice does not provide emergency services. ## What happens after you reach out? Here is each step, from the first call to your first follow-up. 1. 01 ### You reach out Book on the [booking page](https://www.healthandharmonypsychiatry.com/book-an-appointment), or call [832.387.6088](tel:+18323876088). Online or phone 2. 02 ### A brief screening A brief screening first confirms that telepsychiatry fits your needs. Before the visit 3. 03 ### Intake in the portal You'll complete a few intake forms in the patient portal, then meet with Dr. McDade for a full evaluation. Patient portal 4. 04 ### Your first evaluation Dr. McDade hears your story and reviews your history and your health, over 60 to 90 minutes. Understanding relies on context, and some stories need more time. Unhurried 5. 05 ### A plan built with you You and Dr. McDade discuss each option in depth. When therapy is the better starting point, she refers to therapists she knows well. Collaborative 6. 06 ### Follow-up with Dr. McDade Follow-up visits run 15 to 30 minutes by secure video. Steady The [psychiatric evaluation page](https://www.healthandharmonypsychiatry.com/services/psychiatric-evaluation) explains what the first visit covers, and the [telepsychiatry page](https://www.healthandharmonypsychiatry.com/telepsychiatry) explains how video visits work. **Your story comes first.** ## Questions about networks and private pay How much does care cost? Care is private pay. A new evaluation with Dr. McDade is $465, and follow-up visits with Dr. McDade are $275. You receive a good faith estimate before your first visit. Does Dr. McDade take insurance? No. Care is private pay, with rates set in advance and shared up front. You have the right to receive a [Good Faith Estimate](https://www.healthandharmonypsychiatry.com/good-faith-estimate) explaining how much your medical care will cost. Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. Do I need a referral to see a psychiatrist? No referral is needed to book with Dr. McDade, so you can book your first visit directly. With a plan, it depends on the plan. Many HMOs require a referral from your primary care doctor before other care, and a POS plan requires one to see a specialist, HealthCare.gov explains. What is an out-of-network provider? A provider who doesn't have a contract with your health insurer or plan. HealthCare.gov calls this a non-preferred provider, and you'll pay more to see one. Care here is private pay, and Dr. McDade has no contract with any health plan. Can I use out-of-network benefits for visits here? If your plan offers them, it may pay part of the cost. Ask your plan first whether it needs a referral or its approval before it pays. The practice can give you a superbill to send to your plan if it offers out-of-network mental health benefits. It lists the visit, its billing codes, and what you paid. Your plan then decides what it pays back, from its own allowed amount. Will I see the same doctor at every visit? Yes. Health & Harmony Psychiatry is a physician-only practice, and every visit, from your first evaluation through every follow-up, is with Dr. McDade. Sources for the facts on this page. - [2026 Employer Health Benefits Survey](https://www.kff.org/health-costs/2026-employer-health-benefits-survey/), KFF, October 22, 2026 - [Premium](https://www.healthcare.gov/glossary/premium/), HealthCare.gov - [Network](https://www.healthcare.gov/glossary/network/), HealthCare.gov - [Cost sharing](https://www.healthcare.gov/glossary/cost-sharing/), HealthCare.gov - [Health insurance plan and network types](https://www.healthcare.gov/choose-a-plan/plan-types/), HealthCare.gov - [What is Psychiatry?](https://www.psychiatry.org/patients-families/what-is-psychiatry), American Psychiatric Association - [Referral](https://www.healthcare.gov/glossary/referral/), HealthCare.gov - [Non-preferred provider](https://www.healthcare.gov/glossary/non-preferred-provider/), HealthCare.gov - [Allowed amount](https://www.healthcare.gov/glossary/allowed-amount/), HealthCare.gov - [Key Responsibilities for Group Health Plans and Health Insurance Issuers Under the No Surprises Act](https://www.cms.gov/files/document/nsa-key-responsibilities-plans.pdf), CMS.gov, revised January 2025 This guide explains plans and networks in general terms and is not insurance advice. The information on this website is for general education and does not constitute medical advice or create a physician-patient relationship. For care, please schedule an appointment. ## Keep reading - Her story[Why Dr. McDade chose a different model](https://www.healthandharmonypsychiatry.com/why-a-different-model) Her story, and what one physician with time makes possible. - Service[Telepsychiatry](https://www.healthandharmonypsychiatry.com/telepsychiatry) How video visits work with this practice. - Service[Psychiatric evaluation](https://www.healthandharmonypsychiatry.com/services/psychiatric-evaluation) What the first evaluation with Dr. McDade covers. - About[About Dr. McDade](https://www.healthandharmonypsychiatry.com/about) Her training, her credentials, and how she works. ## Care Through Connection The physician you choose, with time for your whole story. Book the first visit online, or call [832.387.6088](tel:+18323876088) with questions. A parent or guardian books for anyone under 18, and a brief screening confirms fit before your first visit. [Find Care That Understands Me](https://www.healthandharmonypsychiatry.com/book-an-appointment) Health & Harmony Psychiatry does not provide emergency care. If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Ages 6 to 70. Health & Harmony Psychiatry provides care by secure video to patients physically located in Texas at the time of their appointment. ## Share this post [mailto:https%3A%2F%2Fwww.healthandharmonypsychiatry.com%2Fblog%2Fdoes-a-higher-premium-let-you-see-any-psychiatrist](mailto:https%3A%2F%2Fwww.healthandharmonypsychiatry.com%2Fblog%2Fdoes-a-higher-premium-let-you-see-any-psychiatrist) ## Keep reading ### [![](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/what-to-expect-from-a-private-pay-psychiatrist-social.jpg?width=1200&height=630&name=what-to-expect-from-a-private-pay-psychiatrist-social.jpg) What Should You Expect From a Private-Pay Psychiatrist?](https://www.healthandharmonypsychiatry.com/blog/what-to-expect-from-a-private-pay-psychiatrist) ### [![](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/insurance-network-changes-and-your-psychiatrist-social.jpg?width=1200&height=630&name=insurance-network-changes-and-your-psychiatrist-social.jpg) When Your Insurance Network Changes, What Happens to Your Psychiatrist?](https://www.healthandharmonypsychiatry.com/blog/insurance-network-changes-and-your-psychiatrist) [![Health & Harmony Psychiatry, home](https://www.healthandharmonypsychiatry.com/hs-fs/hubfs/TB-Gold-Decorative-icon-H%26H-P-Logo.webp?width=1254&height=1254&name=TB-Gold-Decorative-icon-H%26H-P-Logo.webp)](https://www.healthandharmonypsychiatry.com/) Private, evidence-based telepsychiatry for children, teens, and adults across Texas. [Book a private visit](https://www.healthandharmonypsychiatry.com/book-an-appointment) Opens the booking page. A brief screening confirms fit before your first visit. - [Call 832.387.6088](tel:+18323876088) - [Email Email us](mailto:Admin@healthandharmonypsychiatry.com) - Mailing address 800 Rockmead Dr., #113, Kingwood, TX 77339 ## Care near you - [Humble and Atascocita](https://www.healthandharmonypsychiatry.com/areas/humble-atascocita) - [Kingwood](https://www.healthandharmonypsychiatry.com/areas/kingwood) - [The Woodlands](https://www.healthandharmonypsychiatry.com/areas/the-woodlands) - [The Heights and Midtown](https://www.healthandharmonypsychiatry.com/areas/heights-midtown) - [Telepsychiatry in Texas](https://www.healthandharmonypsychiatry.com/areas/texas) Care by secure video reaches all of Houston and Greater Houston, and anywhere private in Texas. ## The practice - [About Dr. McDade](https://www.healthandharmonypsychiatry.com/about) - [Telepsychiatry](https://www.healthandharmonypsychiatry.com/telepsychiatry) - [Services](https://www.healthandharmonypsychiatry.com/services) - [Conditions treated](https://www.healthandharmonypsychiatry.com/conditions) - [Children and teens](https://www.healthandharmonypsychiatry.com/services/child-adolescent-psychiatry) - [Refer a patient](https://www.healthandharmonypsychiatry.com/refer-a-patient) ## Connect - [Contact us](https://www.healthandharmonypsychiatry.com/contact) - [Patient portal](https://phr.charmtracker.com/login.sas?FACILITY_ID=aad7261cfb8b45309218a1b28e8d04bb00b2727119a96f912e62fe42203ae47d7be1cfd797c1e554) - [LinkedIn](https://www.linkedin.com/in/allisonmcdademd/) - [Psychology Today](https://www.psychologytoday.com/us/psychiatrists/allison-mcdade-kingwood-tx/1680650) - [Instagram · Let’s Unpack That](https://www.instagram.com/letsunpackthat88) **Health & Harmony Psychiatry does not provide emergency care.** If you are in crisis or thinking about harming yourself, call or text 988, or call 911. ## NOTICE CONCERNING COMPLAINTS Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, surgical assistants, medical radiologic technologists, non-certified radiologic technicians, respiratory care practitioners, medical physicists, and perfusionists may be reported for investigation at the following address: Texas Medical Board Attention: Investigations 1801 Congress Avenue, Suite 9.200 P.O. Box 2018 Austin, Texas 78768-2018 Assistance in filing a complaint is available by calling the following telephone number: [1-800-201-9353](tel:+18002019353) For more information please visit our website at [www.tmb.state.tx.us](https://www.tmb.texas.gov/) Ver este aviso en español ## AVISO SOBRE LAS QUEJAS Quejas sobre médicos, así como sobre otros profesionales médicos de la Junta Médica de Texas, incluyendo asistentes médicos profesionales, acupunturistas, asistentes quirúrgicos, tecnólogos médicos en radiología, técnicos radiólogos no certificados, profesionales de cuidados respiratorios, físicos médicos, y perfusionistas se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board Attention: Investigations 1801 Congress Avenue, Suite 9.200 P.O. Box 2018 Austin, Texas 78768-2018 Si necesita ayuda para presentar una queja, llame al: [1-800-201-9353](tel:+18002019353) Para obtener más información, visite nuestro sitio web en [www.tmb.state.tx.us](https://www.tmb.texas.gov/) [Read the Texas Medical Board’s notice in English and Spanish (PDF) →](https://www.tmb.texas.gov/file/complaint-notice-poster) © 2026 Health & Harmony Psychiatry Dr. Allison J. McDade, MD - [Privacy](https://www.healthandharmonypsychiatry.com/privacy) - [Good Faith Estimate](https://www.healthandharmonypsychiatry.com/good-faith-estimate) - [Terms](https://www.healthandharmonypsychiatry.com/terms) - [Patient notices](https://www.healthandharmonypsychiatry.com/patient-notices) Privacy Policy · Legal · © 2026. All rights reserved. ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Dr. Allison J. 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