From the blog
Telehealth psychiatric care expanded dramatically during the pandemic and has stayed widely available since. For many patients it is a practical option for medication management and follow-up visits, and for some initial evaluations. It isn't the right fit for every situation, and part of a psychiatrist's job is to say so.
But the rules around who can prescribe what, across which state lines, are genuinely complex and change periodically. This is a practical primer for Texas residents considering telehealth psychiatry.
Texas requires that the psychiatrist seeing you via telehealth be licensed in Texas at the time of the visit. State of residence of the psychiatrist doesn't matter. What matters is that they hold an active Texas medical license and you (the patient) are physically located in Texas during the visit.
This is why telehealth psychiatry hasn't fully unlocked the national psychiatrist supply for Texas patients. The license is state-specific. Many out-of-state telehealth platforms route Texas patients only to Texas-licensed psychiatrists, which means you're still drawing from the Texas psychiatrist pool, just with broader geographic flexibility within the state.
At MindMED, Dr. Fredes is licensed in Texas, New York, and Virginia, meaning we can see patients via telehealth in all three states.
Most major insurance plans in Texas (Aetna, BCBSTX, UnitedHealthcare and Optum, Oscar) cover telehealth psychiatric visits at the same rate as in-person visits. This was reinforced by Texas regulations during the pandemic and has remained the standard.
Self-funded employer plans (ERISA-governed) sometimes have different rules. If you have employer-sponsored coverage and aren't sure, the safest move is to call the number on the back of your insurance card and ask: "Does my plan cover telehealth psychiatric visits at the same rate as in-person?"
Medicare and Medicaid coverage for telehealth psychiatry has become more durable post-2020, though specific coverage rules continue to evolve at the federal level.
At MindMED, ADHD evaluations are done in person. If your care involves ADHD, plan on at least one visit at our Southlake office; follow-up visits may be telehealth when clinically appropriate.
More generally, Dr. Fredes may recommend an in-person visit at any point when it is clinically appropriate, and will say so upfront.
There are clinical situations where telehealth isn't appropriate. Active suicidality requiring in-person assessment, suspected psychosis where physical examination signs matter, patients in acute crisis needing same-day inpatient evaluation, and certain neurological presentations all warrant an in-person visit, sometimes urgently.
A good psychiatrist will tell you upfront if telehealth isn't the right fit for your situation, and will help you find the right level of care if you need something more acute than outpatient telehealth can provide. MindMED is an outpatient practice and does not provide emergency or inpatient care. If you are in crisis, call 911 or go to the nearest emergency room; for crisis support at any hour, call or text 988.
Telehealth visits use a secure video platform, at our practice, that's the SimplePractice telehealth integration with HIPAA-compliant encryption. You don't need to install anything; you click a link in your patient portal at the appointment time.
Practical advice: a private, well-lit space with reliable internet works best. Headphones improve audio. If you live with others, give them a heads-up that you'll be unavailable. Some patients take their telehealth visits from their car in the office parking lot. That works fine when home isn't private enough.
We accept telehealth visits for new patients, follow-ups, medication adjustments, and routine care across most conditions we treat: anxiety, depression, OCD, bipolar disorder, perinatal psychiatric care, insomnia, and women's mental health. Dr. Fredes may recommend an in-person visit when clinically appropriate, and ADHD evaluations are in person.
Schedule a consultation with Dr. Fredes to discuss your situation in detail.