Questions, answered straight

Both, from one clinician. Karel Winner is a psychiatric nurse practitioner who provides psychotherapy and medication management in the same course of care, so the person adjusting your prescription is the person who hears your whole story. If you want medication management only, without therapy, that care has its own dedicated home at PsychMed Care (psychmedcare.com), run by the same clinician.

Mostly, yes. Visits run on secure video across 35 states and DC, and your care continues if you move. This practice is telehealth by design. The one exception: for patients prescribed controlled substances, federal and DEA requirements call for one in-person visit each year in most states. I meet patients in person, in the state where they are, to satisfy those requirements, arranged together well in advance. The practice offices are not walk-in locations.

I'm in network with Aetna, Cigna, UnitedHealthcare and Optum, the Blue Cross Blue Shield family across more than a dozen states, Oscar, Oxford, Carelon, Providence, and many more, plus Medicare in Arizona, California, Colorado, Texas, and Utah, and Medicaid in Oregon and Wyoming. Every plan is verified before your first visit; copays for the majority of plans land between $0 and $40, and you'll know your exact number up front.

I'm licensed in 35 states and Washington DC, and care runs on secure video in all of them. The homepage coverage section has a one-tap checker that confirms your state instantly. If you move to another covered state, your care continues with the same clinician.

Sometimes, when it's clearly right. Often I'd rather understand the whole picture first, because rushing that step is how people end up on the wrong medication, or the wrong dose, and lose months to it. You will leave the first visit knowing what I think is going on, what the options are, and exactly what happens next.

Yes. GeneSight pharmacogenomic testing shows how your genes may affect the way you process common psychiatric medications, and targeted labs check thyroid function, B12, folate, vitamin D, iron, and metabolic and inflammatory markers. Testing is ordered when it would change a decision, not by routine.

The Comprehensive Initial Appointment runs 60 minutes and Follow-up Appointments run 30 minutes, whether the visit centers on therapy, medication, or both. The first visit is a real conversation: what brought you in, your history, your physical health, your sleep, what you have tried, and what a good outcome would actually look like for you.

The 60 minute Comprehensive Initial Appointment is $350 and 30 minute Follow-up Appointments are $250, the same whether the visit centers on therapy, medication, or both. If your plan is out of network, you may still have benefits worth using; the homepage fees section explains how to check them through Mentaya before you book.

When one is clinically appropriate, yes, inside a careful evaluation and an ongoing treatment relationship, never as a standalone refill service. Federal and state rules apply: in most states a controlled-substance prescription requires one in-person visit a year, which we arrange together well in advance. What fits your situation is a first-visit conversation.

Adults and older teens, 17 and up. Care is individual; this practice does not currently offer couples or family therapy.

Book in the booking section or through the practice site. Three quick steps come first: sign the short treatment intention agreement, share your preferred days and times, then complete the intake forms and consents, about ten minutes. Your insurance is verified before the visit, so your cost is known up front and there are no billing surprises. Then the first visit itself is a real conversation, not an interrogation.

Existing patients can message through the patient portal or Spruce for prescription questions, scheduling, and brief check-ins. Messages are answered on practice days; they are not monitored around the clock, and anything urgent belongs on the crisis lines, not in a message thread.

Yes, and it happens often. Because one clinician provides both, moving from therapy alone to combined care, or stepping down to medication-only Follow-up Appointments, needs no referral and no new Comprehensive Initial Appointment. The plan follows your needs, not a program track.

This practice is not an emergency service, and email and portal messages are not monitored around the clock. If you might act on thoughts of harming yourself or someone else, call 911. You can call or text 988 any time for the 988 Suicide and Crisis Lifeline, or text HOME to 741741 for Crisis Text Line. The full list is on the crisis resources page.