In-Network
Your provider has a contract with your insurance company at a pre-negotiated rate. Insurance pays their share directly to the provider, and you pay your copay or coinsurance at the time of service. No paperwork required on your end.
Out-of-Network (OON)
Your provider doesn't have a contract with your insurer. You pay the provider directly, then submit a claim to your insurance company to be reimbursed for their portion. Most commercial plans include OON benefits — often meaningful ones.
The key insight: Out-of-network does not mean uncovered. Most commercial insurance plans — including many employer-sponsored plans — include out-of-network benefits that allow you to see any licensed provider and get reimbursed. The process requires one extra step (submitting a claim), but the financial outcome can be surprisingly similar to in-network care, especially for plans with low deductibles.
| Insurance Plan |
Status at Modern Mentality |
Your Path Forward |
| Blue Cross Blue Shield (BCBS) |
In-Network |
Bill directly — no extra steps |
| Cigna |
In-Network |
Bill directly — no extra steps |
| United Healthcare (UHC) |
In-Network |
Bill directly — no extra steps |
| Aetna |
In-Network |
Bill directly — no extra steps |
| Harvard Pilgrim |
In-Network |
Bill directly — no extra steps |
| Tufts Health Plan / Point32Health |
In-Network |
Bill directly — no extra steps |
| Wellpoint / UniCare (GIC) |
Out-of-Network |
Use OON benefits + Reimbursify (guide below) |
| WellSense / BMC HealthNet |
Out-of-Network |
Self-pay rate available — contact us |
| Other commercial plans |
Verify with us |
May have OON benefits — call to confirm |
Not sure what you have? Call your insurer's member services number (on the back of your insurance card) and ask: "Do I have out-of-network mental health benefits? What is my OON deductible and coinsurance?" You can also use Reimbursify's free VeriFAST tool to check instantly.
1
Verify Your Benefits Before Your First Visit
Call your insurer or use the free Reimbursify app to confirm your OON deductible, coinsurance percentage, and whether behavioral health is covered out-of-network. Knowing your numbers upfront eliminates surprises. For Wellpoint (GIC) members, the individual deductible is typically just $500 — one of the lowest available.
2
Attend Your Appointment & Pay at the Time of Service
You pay Modern Mentality's session fee at the time of your visit. Our standard rate for medication management (psychiatric follow-up, CPT 99214) is $249 per session. We accept all major credit cards, HSA, and FSA cards.
3
Receive Your Superbill & Submit Your Claim
After each visit, we provide you with a detailed superbill — an itemized receipt containing everything your insurer needs to process your claim: CPT procedure codes, ICD-10 diagnosis codes, our NPI, tax ID, and the date and cost of service. You then submit this to your insurer, either directly or through Reimbursify (takes under 5 minutes).
4
Get Reimbursed Directly by Your Insurer
Your insurer reviews the claim and sends reimbursement directly to you — typically by check or direct deposit within 2 to 6 weeks. The amount is based on your plan's allowed rate for the service, minus your deductible (if not yet met) and coinsurance. You can also file claims for visits up to 12 months old, so nothing is lost if you're catching up.
Submit OON Claims from Your Phone in Minutes
Reimbursify is a free, HIPAA-compliant app that digitizes and streamlines the entire out-of-network claims process. Instead of mailing forms or navigating complex insurer portals, you submit through the app in minutes — and Reimbursify follows up with your insurer on your behalf.
✓
VeriFAST Benefit Check
Confirm your exact OON benefits before your first visit — no surprises.
✓
Submit in Under 5 Minutes
Enter your superbill details and submit entirely from your phone.
✓
Real-Time Claim Tracking
Monitor your claim status from the app dashboard at any time.
✓
Clone Recurring Visits
Repeat visits with the same details can be cloned in seconds.
✓
File Up to 12 Months Back
Catch up on older claims — most plans allow up to a year from date of service.
✓
Dedicated Support Team
If a claim runs into issues, their team works directly with your insurer to resolve it.
Download Reimbursify Free →
Available on iOS & Android. First claim free; subsequent claims $3.99 each or discounted in bundles.
If you have coverage through Wellpoint (formerly UniCare) via the Massachusetts Group Insurance Commission — common for state employees, municipal workers, teachers, and their families — your out-of-network behavioral health benefits are among the most patient-friendly available. Both the Total Choice and PLUS plans feature a low $500 individual deductible and 20% coinsurance after that.
Total Choice Plan
Individual deductible$500
OON coinsurance20% after deductible
In-network BH copay$20/visit
OON out-of-pocket capNo OON cap
Telehealth (in-network)First 3 visits free
PLUS Plan ★ Best OON Value
Individual deductible$500
OON coinsurance20% after deductible
In-network BH copay$10/visit
OON out-of-pocket cap$5,000 individual
Telehealth (in-network)First 3 visits free
Massachusetts law protects you from balance billing (MGL Ch. 32A, §20). As a GIC member receiving covered, medically necessary care in Massachusetts, providers may only collect your deductible, copay, and coinsurance — never the difference between our fee and what Wellpoint pays. Your out-of-pocket exposure is exactly what your plan document says it is, nothing more.
What does this look like in real dollars? At $249/session for medication management (CPT 99214), and assuming your deductible is already met: Wellpoint reimburses approximately 80% of their allowed rate. Depending on your plan's allowed amount for your ZIP code and service, many patients receive $140–200 back per visit — bringing the true net cost well below the sticker price. Use Reimbursify's VeriFAST tool to see your specific estimate before your first appointment.
Some patients prefer the simplicity of self-pay — no claims, no deductibles, no prior authorizations. We offer straightforward, transparent pricing for all self-pay patients, and we are always happy to provide a superbill so you can submit for reimbursement on your own if your plan allows it.
Standard Self-Pay Rates
All sessions are with our licensed clinicians (PMHNPs, LICSWs, and PsyDs). Rates reflect the complexity and specialization of our evidence-based care.
$249
Medication Management
CPT 99214 — psychiatric follow-up
$249
Psychotherapy Session
Individual — 45–60 minutes
Contact Us
ADHD Evaluation & Testing
Comprehensive diagnostic package
HSA and FSA accepted. If you have a Health Savings Account or Flexible Spending Account, psychiatric care is a qualified medical expense. Paying with pre-tax HSA or FSA dollars effectively reduces your out-of-pocket cost by your marginal tax rate — a meaningful savings on top of our self-pay rate.
What is a superbill and how do I get one?
A superbill is a detailed receipt that contains all of the information your insurance company needs to process an out-of-network claim: your provider's name, NPI, and tax ID; the date and location of service; CPT procedure codes; ICD-10 diagnosis codes; and the fee charged. At Modern Mentality, we provide superbills automatically after each visit for all self-pay and out-of-network patients. If you ever need a superbill reissued, just contact our billing team.
How do I know if my plan has out-of-network benefits?
The fastest way is to call the member services number on the back of your insurance card and ask: "Do I have out-of-network mental health benefits? What is my out-of-network deductible and coinsurance for outpatient behavioral health?" You can also log into your insurer's member portal or use the free VeriFAST tool inside the Reimbursify app to check instantly before your first visit.
Can I use my FSA or HSA to pay for sessions?
Yes. Psychiatric services are qualified medical expenses under both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). You can use your HSA or FSA debit card directly at Modern Mentality. Paying with pre-tax dollars effectively lowers your out-of-pocket cost by your marginal income tax rate, which is a meaningful benefit especially if you are also submitting for OON reimbursement.
How long does OON reimbursement take?
Most insurers process out-of-network claims within 2 to 6 weeks of receipt. Reimbursify delivers your claim to your insurer's processing hub electronically within hours, which is significantly faster than mailing a paper form. Reimbursement is sent directly to you by your insurer — either as a check by mail or, for some plans, via direct deposit.
What if my OON claim is denied?
Claim denials can happen, but they are often appealable. If you file through Reimbursify, their customer support team works directly with your insurer to troubleshoot and resolve denied claims on your behalf. Common reasons for denial include missing information or incorrect codes — issues that are almost always correctable. Our billing team is also available to help you understand your explanation of benefits (EOB) and determine whether an appeal is warranted.
Can I file claims for past visits I haven't submitted yet?
Yes, in most cases. The majority of health insurance plans allow OON claims to be filed for up to 12 months from the date of service. If you have unpaid superbills from previous Modern Mentality visits, you can file them now through Reimbursify or directly with your insurer. Don't leave money on the table — contact us if you need duplicate superbills for past visits.
Does Modern Mentality offer payment plans for self-pay patients?
Yes. We understand that psychiatric care is an ongoing commitment, and we are always willing to have a conversation about payment arrangements for patients facing financial hardship. Please reach out to our billing team directly to discuss your situation — we will do our best to find a workable path forward without interrupting your care.
I have Wellpoint (UniCare). Will my OON claims actually get paid?
Yes — Wellpoint GIC plans have a clear, well-documented out-of-network behavioral health benefit. After your $500 individual deductible is met, the plan reimburses approximately 80% of their allowed rate per visit. Massachusetts law (MGL Ch. 32A, §20) also protects GIC members from balance billing, meaning your total out-of-pocket exposure is limited to your deductible and coinsurance. Use Reimbursify's VeriFAST tool to confirm your specific allowed rate before your first visit.
Ready to Get Started?
Our team is here to help you navigate your benefits and find the most affordable path to care. Reach out today — we'll make it simple.
Get Started Today
Questions about your insurance? Call us at (781) 803-7757 or email us through the contact form.
Disclaimer: The information on this page is provided for general educational purposes only and does not constitute insurance, financial, or legal advice. Insurance benefits, deductibles, and reimbursement amounts vary by plan, employer, and individual circumstances and are subject to change. Wellpoint/UniCare benefit figures are based on publicly available Summary of Benefits and Coverage documents for the 2025–2026 GIC plan year. Modern Mentality is not affiliated with Wellpoint, the Massachusetts GIC, or Reimbursify, and does not receive compensation for referrals to any third-party service. Always verify your specific benefits with your insurer before receiving care. Reimbursify pricing and features are subject to change; visit reimbursify.com for current terms. Massachusetts balance billing protections under MGL Ch. 32A §20 apply to GIC non-Medicare members receiving covered, medically necessary services in Massachusetts; members should verify applicability to their specific plan and circumstances.