Three ways to pay
Most of the confusion about paying for mental health care comes from finding out too late which category you fall into. So here it is up front. There are three pathways, and a short phone call tells you which one is yours.
Pathway one
Using an accepted commercial plan
Some commercial plans are accepted for general psychiatric care and ADHD care. When your plan is one of them, you pay only what your plan requires, such as a copay or the part of your deductible that still applies.
- Applies to general psychiatric care and ADHD care
- Your specific plan and product are verified before your first visit
- Not all products from the same insurance company are treated the same way
Plan participation changes and varies by product, so we confirm it with you directly rather than publishing a list that could be out of date by the time you read it.
Pathway two
Using out of network benefits
If your plan is not one we accept directly, you can still be seen. You pay the published fee at your visit and receive an itemized superbill at no charge, which you submit to your plan yourself.
- You pay the published fee on the date of service
- You receive an itemized superbill at no charge
- You submit it to your plan and any reimbursement is paid to you
- Reimbursement is never guaranteed and depends on your plan
Aura Integra Behavioral Health, PLLC does not submit out of network claims on your behalf.
Pathway three
Paying directly
Some people choose to leave insurance out of it entirely, whether for privacy, because they are uninsured, or because their plan would not cover the care they want. Published fees apply and payment is due on the date of service.
- Published fees with nothing added afterward
- No diagnosis is reported to an insurance company
- A written Good Faith Estimate before you are seen
- A limited number of income based sliding scale spots are available on request
If cost is a barrier, ask about the sliding scale before you book. Details, tiers, and how to apply are on this page.
Using your out of network benefits
Out of network benefits are one of the least understood parts of health insurance, and plans are not especially motivated to explain them. Here is the short version, in the order it actually happens.
- You check your benefits first. Call the member services number on the back of your card, or call or text us and we will go through the questions with you. This costs nothing and does not commit you to anything.
- You are seen and you pay the published fee. Payment is due on the date of service.
- You receive an itemized superbill at no charge. It contains every piece of information your plan needs in order to process it.
- You submit the superbill to your plan. Most plans accept it through a member portal, by mobile app, or by mail.
- Your plan decides what, if anything, it reimburses. Any payment goes from your plan directly to you, not to the practice.
The four words that decide what you get back
- Plan type
- PPO and POS plans usually include some out of network coverage. Most HMO and EPO plans include none at all, which means the fee you pay is the cost of the care. This is the single biggest factor, so it is worth confirming before anything else.
- Out of network deductible
- A separate deductible from your in network one, and often a much larger one. Until you have met it, your plan typically reimburses nothing, though the amounts you pay usually count toward meeting it.
- Allowed amount
- The figure your plan decides a service is worth, which is frequently lower than what any clinician actually charges. Your reimbursement is calculated from that number rather than from the fee you paid, and the difference is yours to cover.
- Coinsurance
- The share of the allowed amount your plan pays once the deductible is met, often described as something like sixty or seventy percent. The rest stays with you.
Why we will not promise you a reimbursement figure
Put those four together and two people holding cards from the same insurance company can get completely different results from identical visits. That is why no honest practice can tell you in advance what you will be reimbursed, and why any practice that does quote you a number is guessing.
What we can do is tell you exactly what the care costs, give you a superbill that will not be rejected on a technicality, and help you ask your plan the right questions before you spend anything.
What a superbill is
A superbill is an itemized receipt for care you have already paid for. It is not a bill and it is not an insurance claim. It exists so that you can ask your plan to reimburse you.
Yours will include the date of service, how long the visit was, the service codes describing what was done, the diagnosis code, the amount you paid, and the practice and clinician identification numbers your plan requires. There is no charge for it.
Two limits worth knowing. Any reimbursement goes from your plan to you, never to the practice. And a superbill necessarily carries a diagnosis code, which means your insurance company will see a diagnosis. If keeping that entirely out of your insurance record matters to you, paying directly without a superbill is the pathway that does that.
Self pay fees
These are the published fees. Payment is due on the date of service and nothing is added after the fact.
Self pay fees at Aura Integra Behavioral Health, PLLC
| Service | Length | Fee |
|---|
| Initial psychiatric evaluation | 60 minutes | $300 |
| Standard medication management follow up | 25 to 30 minutes | $150 |
| Extended medication management follow up | 50 to 60 minutes | $250 |
| ADHD diagnostic evaluation | Two part evaluation | $350 total |
| Adult buprenorphine initial evaluation and induction planning | 60 to 75 minutes | $300 |
| Adult buprenorphine follow up | 25 to 30 minutes | $150 |
| Oral naltrexone management follow up | 25 to 30 minutes | $150 |
| Clinician letters, forms, or record review outside ordinary treatment documentation | Per 30 minutes | $50 |
The complete policy version of this schedule, including cancellation and no show terms, lives on the fees and office policies page.
Income based sliding scale
A limited number of sliding scale spots are set aside for patients whose household income makes the published fee genuinely out of reach. It is an application, not an automatic discount, and it is offered so that cost is not the reason someone goes without care.
How it works
- Tell us before you book that you would like to be considered.
- You share proof of household size and household income. Acceptable documents are the most recent federal tax return, two consecutive recent pay stubs, a current benefits letter, or an equivalent record. We do not keep copies beyond what is needed to verify eligibility.
- Your adjusted fee is confirmed in writing before your first visit and appears on your Good Faith Estimate.
- Eligibility is reviewed once per calendar year, and any time your income or household changes materially.
Adjusted fee tiers
Tiers are based on the current federal poverty guidelines for your household size, published each year by the U.S. Department of Health and Human Services.
Sliding scale tiers based on household income as a percentage of the federal poverty level
| Household income | Your fee |
|---|
| At or below 200 percent of the federal poverty level | 50 percent of the published fee |
| 201 to 400 percent of the federal poverty level | 75 percent of the published fee |
| Above 400 percent of the federal poverty level | Published fee |
Payment is still due on the date of service at the adjusted rate. Cancellation and no show terms are unchanged. Slots are limited and reviewed on a rolling basis, so an approval offer is time bound.
What the sliding scale does not cover
- Medication for opioid use disorder is offered on a self pay basis at the published fee. The confidentiality rules under 42 CFR Part 2 make that a separate conversation, not a checkbox on a scale.
- Missed appointment and late cancellation fees are not adjusted by the sliding scale.
- Outside laboratory, pharmacy, and third party charges are set by those providers, not by this practice.
To ask about a spot, call or text 508-978-6455 or email billing@auraintegra.com. If none are available at the moment, we will tell you honestly and point you toward options that will be.
Your right to a Good Faith Estimate
Under the federal No Surprises Act, if you are uninsured or you are choosing not to use insurance for your care, you have the right to a written estimate of what that care is expected to cost before you receive it.
You will receive one automatically when it applies. You can also request one at any point without booking an appointment. If your final bill comes in at least $400 above your estimate, you have the right to dispute it.
Read about Good Faith Estimates
Medicare and MassHealth
Please talk to us before you book
Medicare and MassHealth are not accepted at this time, and the rules around both mean we cannot simply treat you as a self pay patient instead.
That is not a brush off. Call or text 508-978-6455 and we will talk through what is available to you and point you toward care that will actually be covered. We would much rather have that conversation with you now than have you book, pay, and find out afterward.
Medication for opioid use disorder
Buprenorphine and naltrexone treatment is offered on a self pay basis at this time. We do not advertise insurance coverage for this care, because coverage is inconsistent and because the confidentiality questions deserve more than a line on a website.
Substance use treatment records carry federal protections beyond ordinary medical privacy under 42 CFR Part 2. Whether anything is submitted to an insurance company, and what it would contain, is a decision you make with full information rather than something that happens by default.
Call or text 508-978-6455 and we will go through both the cost and the privacy side before you commit to anything.
Common questions
Do you take insurance?
Some commercial plans are accepted for general psychiatric care and ADHD care. Everything else is seen as out of network or self pay.
Because participation depends on your specific plan and product rather than just the insurance company name, we confirm your coverage with you before your first visit instead of publishing a list.
Which plans are accepted?
Plan participation varies by product and changes over time, so we verify it individually rather than posting a list that could go out of date.
Call or text 508-978-6455 with the name of your plan and we will tell you which pathway applies to you. There is no charge for that conversation and you do not need to book an appointment first.
What happens if my plan is not one you take?
You can still be seen. You pay the published fee at the time of your visit and receive an itemized superbill at no charge.
You may then submit that superbill to your insurance company yourself and ask them to reimburse you under your out of network benefits.
What is a superbill?
A superbill is an itemized receipt for care you have already paid for. It lists the date of service, the service codes, the diagnosis code, the amount you paid, and the practice and clinician identification numbers your plan needs.
It is not a bill and it is not an insurance claim. You send it to your insurance company yourself, and any reimbursement goes from your plan to you.
Will my insurance reimburse me for out of network care?
That depends entirely on your plan and we cannot guarantee it.
Reimbursement depends on whether your plan includes out of network outpatient behavioral health benefits at all, whether your out of network deductible has been met, the allowed amount your plan assigns to the service, and your coinsurance percentage. Some plans reimburse a meaningful share of the fee and some reimburse nothing.
Do you submit out of network claims for me?
Not at this time. Aura Integra Behavioral Health, PLLC does not submit out of network claims on your behalf, and we do not accept assignment of out of network benefits.
You submit the superbill to your plan yourself. If that changes, this page will be updated before the option is offered.
How do I find out what my out of network benefits actually are?
Call the member services number on the back of your insurance card and ask four questions. Does my plan include out of network outpatient behavioral health benefits. What is my out of network deductible and how much of it have I met this year. What percentage does the plan pay after the deductible is met. Is prior authorization required.
You are also welcome to call or text us at 508-978-6455 and we will walk through those questions with you at no charge.
What does care cost if I pay directly?
An initial psychiatric evaluation is $300. A standard medication management follow up is $150. An extended follow up is $250. A two part ADHD diagnostic evaluation is $350 in total.
The complete fee schedule, including buprenorphine and naltrexone visits and administrative charges, is published on the fees and office policies page.
When is payment due?
Payment is due on the date of service, at your published fee or your approved sliding scale fee, whichever applies.
If cost is a barrier, ask about the income based sliding scale before you book. Approved patients pay a reduced fee tied to household income and federal poverty level. Slots are limited and eligibility is reviewed once a year.
What is a Good Faith Estimate and do I get one?
Under the federal No Surprises Act, if you are uninsured or you are not using insurance to pay for your care, you have the right to a written estimate of what your care is expected to cost before you receive it.
You will receive one automatically when it applies, and you can also request one at any time without scheduling an appointment.
Do you accept Medicare or MassHealth?
Not at this time.
If you have Medicare or MassHealth, please call or text 508-978-6455 before booking anything so we can talk through your options and point you toward care that will actually be covered. Please do not book an appointment before speaking with us.
Can insurance cover medication treatment for opioid use disorder?
Medication treatment for opioid use disorder is offered on a self pay basis at this time, and we do not advertise insurance coverage for it.
Substance use treatment records carry additional federal confidentiality protections under 42 CFR Part 2, and how a claim or a superbill interacts with those protections deserves a real conversation rather than a checkbox. Call or text 508-978-6455 and we will go through both the cost and the privacy questions with you before you decide anything.
Ask before you book
If you take one thing from this page, take this. Call or text with the name of your plan before you schedule anything. It takes a few minutes, it costs nothing, and it is the difference between knowing what your care will cost and finding out later.
Please do not include diagnoses, medication lists, member ID numbers, or details about substance use in an ordinary text message. Bring those to the secure message thread or to your visit.
