Frequently Asked Questions

My practice utilizes Functional and Integrative Medicine along with Traditional Psychiatry to optimize patients progress and outcomes. Functional Psychiatry treats root causes and underlying triggers of mental illness, not just psychiatric symptoms. It implements evidence-based practices to assess key biomarkers, biochemical imbalances, inflammation, and infections that may cause or contribute to mental illness.

In addition, Functional Psychiatry incorporates nutritional and metabolic interventions to restore mental and physical health and well-being.  

Integrative psychiatry is an approach to mental health care that combines traditional psychiatric treatment methods with complementary and alternative therapies. It emphasizes treating the whole person—mind, body, and spirit—while integrating evidence-based practices from conventional psychiatry with holistic approaches such as nutrition, exercise, mindfulness, and supplements.

At Brain Garden Psychiatry, we believe in moving beyond symptom management and addressing the root causes of mental health conditions and promoting overall well-being through integrative psychiatry. This approach allows us to tailor treatment plans to each individual's unique needs, incorporating a variety of modalities to support mental health and emotional balance.

There are significant similarities between psychiatrists and psychiatric nurse practitioners. Both are highly-trained mental health experts who are qualified to:

• Assess and diagnose mental health disorders
• Create and monitor treatment plans
• Offer psychotherapy
• Prescribe medication
• Collaborate with therapists, physicians  and other clinicians if appropriate for a patient’s needs
• Refer patients out to other types of providers (like therapists) 

Both psychiatrists and psychiatric nurse practitioners undergo training to diagnose and treat a wide range of mental and behavioral health conditions, including:

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorder
• Bipolar disorder
• Depression
• Dissociative disorders
• Eating disorders
• Mood disorders eg: Depression
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Personality disorders
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Sleep disorders
• Substance use disorders

Psychiatrists and psychiatric nurse practitioners are both highly trained medical providers who are qualified to prescribe medication and provide psychotherapy.

• The primary difference between psychiatrists and psychiatric nurse practitioners is their education. Training typically takes 12 years for psychiatrists and  7 years for psychiatric nurse practitioners.
• Due to an increased demand for mental health services and a shortage of psychiatrists, more and more patients are working with psychiatric nurse practitioners (PMHNP). 

Yes—with a collaborative, whole-body approach.

At Brain Garden Psychiatry, I provide functional and integrative psychiatric support for children, adolescents, and teens—specifically those who are under the care of a pediatrician or child/adolescent psychiatrist. While I do not serve as the primary psychiatric provider, I work closely with your child’s medical and mental health team to offer complementary, root-cause-focused care.

My services include:

• Comprehensive psychiatric and developmental evaluations
   
• Functional lab and nutritional assessments
   
• Personalized supplement and lifestyle recommendations
   
• Trauma-informed, neurodiversity-affirming care
   

This approach is especially beneficial for autistic youth, children and teens with ADHD, or those navigating co-occurring anxiety, depression, OCD, trauma, sensory processing issues or emotional regulation difficulties. I help families move beyond surface-level symptom management to uncover the deeper imbalances affecting their child’s mental health and development.

At the heart of my work is a comprehensive, integrative approach to psychiatry. I believe mental health cannot be separated from physical health. That’s why I assess and address the many interconnected factors that may contribute to psychiatric symptoms, including:

• Underlying medical conditions
   
• Genetic and biological vulnerabilities
   
• Inflammation and metabolic imbalances
   
• Nutritional deficiencies and gut-brain dysfunction
   
• Environmental toxins and infectious contributors
   
• Medication side effects and drug-nutrient interactions
   
• Sleep disruption, chronic stress, trauma, and grief
   

By exploring these multidimensional contributors to mental health, we create a personalized, compassionate treatment plan—one that supports not only symptom relief, but long-term resilience and healing.

I am a Nurse Practitioner that is Dual Board Certified by ANCC in Family Medicine and Psychiatry.  I have over 25 years of experience as a nurse and over 10 as a nurse practitioner in Primary Care, Functional Medicine, Addiction Medicine and Psychiatry. My education consists of a Bachelor's of Science in Nursing (RN) and two Master's Degrees  (MSN) (Family Medicine and Psychiatry/Mental Health) consisting of  over 10 years of post graduate education.

I have extensive training in Integrative and Functional Medicine (including a year long Fellowship in Functional and Integrative Psychiatry) and continue to engage in ongoing continue education in Psychiatry, Functional Medicine, Integrative Medicine, Psychiatry, Internal Medicine, Autism Therapies, Psychotherapy and Psychedelic Medicine. 

Yes, coordinating care with your primary care physician and other specialists, and providers is a fundamental aspect of my practice. Collaboration ensures comprehensive and integrated treatment, addressing your mental health within the broader context of your overall well-being. I believe in a team approach to healthcare and will work closely with your other healthcare providers to ensure we are all aligned in supporting your best interests.

Yes, absolutely. You are welcome to continue seeing your current therapist. My role can complement your existing therapy by providing specialized services such as medication management and functional and integrative psychiatry. Additionally, if you prefer, we can incorporate supportive therapy into our sessions to address specific aspects of your care, such as lifestyle changes, that may differ from what you're focusing on with your primary therapist. I also offer the option to coordinate closely with your therapist to ensure we are aligned in supporting your overall well-being and treatment goals.

No, I do not accept insurance. I operate on a fee-for-service basis, which allows me the flexibility to dedicate more time to each patient, provide personalized care, and offer comprehensive services beyond medication management without the constraints imposed by insurance companies. While I have opted out of working directly with insurance providers for my Functional and Integrative practice , many health insurance plans offer out-of-network benefits that may cover part or all of the cost of my services. I have opted out of Medicare which means Medicare recipients will not be able to seek reimbursement for their services from me. 

I provide superbills for all visits, which you can submit to your insurance company for potential reimbursement. Additionally, you can utilize  Reimbursify,(https://reimbursify.com/individual-page/)  a service that helps verify your out-of-network benefits, submit claims online and streamline the reimbursement process. 

Out-of-Network Insurance Benefits

Brain Garden Psychiatry is an out-of-network practice for most insurance plans. Many patients choose to use their out-of-network benefits, which means you pay at the time of service and submit a superbill to your insurance for partial reimbursement. The amount reimbursed depends on your plan, deductible, and out-of-network coverage.

If you’re unsure what your plan offers, call the number on the back of your card and ask:

“What are my out-of-network mental health benefits for outpatient psychiatry?”
 

1. What to Ask Your Insurance About Out-of-Network Coverage

When you call your insurance company, these questions help clarify your benefits and avoid surprises:

1. Do I have out-of-network benefits for outpatient mental health services (psychiatry)?
    
2. What is my out-of-network deductible and how much of it have I met?
    
3. After the deductible, what percentage of the visit is reimbursed?
    
4. Is reimbursement based on the billed amount or the plan’s “allowed amount”?
    
5. Do I need preauthorization for out-of-network psychiatry visits?
    
6. What is the process for submitting a superbill, and how long do reimbursements take?
    
7. Are telemedicine visits covered the same as in-person visits?
8. Billing Codes Used in My Practice

For patients using out-of-network benefits or submitting superbills, you may see the following CPT codes listed. These codes are standard in medical billing and help insurance companies determine reimbursement.

Medical assessment, diagnosis, medication management, and treatment planning.

• 99205 — New Patient Visit
  Comprehensive psychiatric evaluation.
  Typical time: 60–74 minutes.
   
• 99215 — Established Patient Visit (High Complexity)
  Used when managing multiple conditions, making significant medication changes, or reviewing complex data.
  Typical time: 40–54 minutes.
   
• 99214 — Established Patient Visit (Moderate Complexity)
  Ongoing medication management, review of symptoms, labs, and treatment response.
  Typical time: 30–39 minutes.
   

These codes are billed in addition to E/M codes when psychotherapy is provided during the same visit.

• 90833 — Add-On Psychotherapy (~30 minutes)
  Time range: 16–37 minutes.
   
• 90836 — Add-On Psychotherapy (~45 minutes)
  Time range: 38–52 minutes.
   
• 90838 — Add-On Psychotherapy (~60 minutes)
  Time range: 53+ minutes.
   

The combination of E/M and psychotherapy add-on codes reflects both the medical and therapeutic components of your care. The codes used for each visit depend on time spent, clinical complexity, and the type of service provided.

When asking about your out of network benefits, be sure to confirm whether your plan requires prior authorization or submission of patient chart notes for reimbursement, as some insurance companies request additional documentation before processing claims.
 

1. In-Network Exception (Gap Exception)

Some insurance plans offer a gap exception (also called an in-network exception). This allows you to see an out-of-network provider while receiving in-network level coverage when the plan does not have an appropriate in-network clinician available.

Gap exceptions are frequently approved for patients who require:

• Neurodivergent-informed care (autism, ADHD, AuDHD)
• Perinatal psychiatry (pregnancy, postpartum, fertility-related mental health)
• Complex trauma, OCD, dissociation, chronic illness, or POTS/dysautonomia-related psychiatric complexity
• Longer, more comprehensive evaluations than typical in-network providers offer
• Timely access when in-network waitlists are long or no one is accepting new patients

A gap exception may be appropriate if:

• The needed specialty is not available in-network
• In-network providers are not accepting new patients
• The wait time for in-network care is unreasonably long
• Your condition requires specialized evaluation or management not represented in-network

Gap exceptions are requested directly through your insurance company. Once you initiate the request, I am happy to provide supporting documentation (notes, diagnosis, medical necessity statements).

When calling your insurance, you can ask:

“Do you offer gap exceptions or in-network exceptions for out-of-network mental health providers? My condition requires specialty care that is not available in network. What is the process to apply?”
 

Patients with neurodevelopmental needs, perinatal mental health concerns, or complex medical-psychiatric overlap are commonly approved because these specialties are often not available in-network.

1. About Single Case Agreements and Insurance Platform Contracts

Some insurance companies offer Single Case Agreements (SCAs) or request that providers use the insurance company’s own telehealth platform. Both of these require the clinician to sign contracts with the insurance company.

I do not enter into Single Case Agreements or platform-based contracts, because they require formal legal agreements that place the practice under insurance company control, billing systems, or technology platforms. Maintaining an independent, private practice allows me to provide personalized, comprehensive, and uninterrupted care without administrative constraints.

Patients may still use out-of-network benefits and may still request gap exceptions, which do not require me to sign a contract with the insurance company.

Provider Information:

Carrie Wilson Friedman, Nurse Practitioner (FNP, PMHNP)

board certified in Family Medicine and Psychiatry

Out-of Network Provider

Address of Service:  Telehealth Online or 1198 Melody Lane #113 Roseville, CA 95678

Provider NPI: 1053712729

Yes, I accept HSA (Health Savings Account) and FSA (Flexible Spending Account) cards with the VISA or Mastercard logo. Using your HSA or FSA card with me is straightforward—it functions just like a credit or debit card for payment of services rendered. This offers you the convenience and flexibility to use your healthcare funds for your psychiatric care with ease.

No, Brain Garden Psychiatry does not offer a sliding fee scale. I believe in maintaining fairness and transparency in pricing for all patients. 

I do not offer free consultations. Instead, I provide a 15-minute Discovery Call for $100. This call is designed to answer your initial questions, share how I practice functional and integrative psychiatry, and ensure we are a good fit before moving forward. If you decide to book an initial evaluation, the $100 fee will be fully credited toward your first visit.

If you have quick questions about logistics or scheduling before booking, you’re always welcome to reach out by email at info@braingardenpsychiatry.com

I primarily see patients via telemedicine. For  patients requiring in person appointment or evaluations, I offer in-person appointments one day a week in Roseville. Initial Psychiatric Evaluations and Follow-up visits can also be scheduled in person in Roseville, depending on availability.

The frequency of follow-up appointments varies based on individual needs and treatment progress. When initiating a new medication, I typically schedule a follow-up appointment at two weeks to assess its effectiveness and address any initial concerns. Subsequent visits of 50 mins are then scheduled every 2-4 weeks as needed, depending on the patient's specific response and circumstances. Once stabilized, most patients transition to monthly 50 minute follow-up appointments to monitor ongoing progress and make any necessary adjustments to their treatment plan.

If you need to reach me between appointments, I can be contacted during office hours via our office phone number or email at info@braingardenpsychiatry.com. For medical or psychiatric emergencies, please call 911 or go to your nearest emergency room.

I generally handle prescription refills during regularly scheduled appointments to ensure comprehensive and personalized care. I do not refill prescriptions after hours, on weekends, or holidays. It's important to maintain regular appointments to discuss your ongoing medication needs and any adjustments necessary for your treatment plan.

In general, I do not prescribe controlled substances in my practice, although there are occasional exceptions. Patients prescribed controlled medications will need to sign a controlled substances contract and may be subject to random urine toxicology screenings.

When treating ADHD, I do not prescribe stimulant medications. Instead, I utilize evidence-based non-stimulant medications, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), coaching, and lifestyle modifications. If you require stimulant medication for ADHD treatment, I can provide you with a referral to a provider who specializes in this area.

Yes, I treat Substance Use Disorders "SUD" (Alcohol Use Disorder, Stimulant Use Disorder, Opioid Use Disorder, and Poly-substance Use Disorder) using a comprehensive approach that includes medication-assisted treatment (MAT), psychotherapy, and addressing any co-morbid psychiatric illnesses. However, I do not utilize controlled MAT medications such as Buprenorphine or Methadone. Instead, I employ medications like Naltrexone and Vivitrol (monthly injection of Naltrexone), Campral (Acamprosate) as well as other pharmaceutical medications and non-pharmaceuricals. 

My treatment approach is personalized, integrating various modalities such as psychotherapy, lifestyle coaching, Dialectical Behavior Therapy (DBT), and integrative medicine and psychiatry. This holistic approach is evidence-based and aims to address the multiple facets of substance use disorders.

I specialize in treating adults ages 18 and older. While I do not treat children or adolescents with traditional Psychiatric Medication Management, I will treat as a collaborating provider for Functional /Integrative Medicine (non-prescribing)  if the patient has a primary treating Pediatrician or Psychiatrist. I have a special interest and training in Autism Spectrum Disorder (ASD). In addition,  as a mother of two children with ASD (one ASD and one AuDHD (Autism and ADHD). I have firsthand experience navigating the challenges of parenting and the special education system.

I offer consulting services to parents related to their child's Individualized Education Plan (IEP)  or 504 plan and navigating the special education system in California. This includes helping parents understand their rights, advocating effectively within the school system, and accessing services through Regional Center for special needs children.

Having 'walked the path' both as a parent and clinician, I understand the importance of asking the right questions and advocating for your child's needs. I am here to provide support, guidance, and empower parents with the knowledge to best advocate for their child.

I do not currently offer Ketamine therapy directly in my practice. However, I am affiliated with Propel Therapeutics in Sacramento, where IV Ketamine therapy is available under the guidance of a board-certified anesthesiologist, Dr. Sofia Peeva, and board-certified  Psychiatrist, Dr. Christopher Fischer. Propel Therapeutics also offers Ketamine Assisted Psychotherapy in Sacramento, California. 

Ketamine has shown to be an highly effective evidence-based treatment for Depression, PTSD, Anxiety Disorders, and Suicidality. If you are interested in exploring Ketamine therapy, I can provide you with more information about Propel Therapeutics and help facilitate a referral. You can also visit Propel Therapeutics online at https://www.propeltherapeutics.com/