Insurance + pricing
We accept insurance for a growing set of plans including Medicaid. Select your state of residence to see if your treatment may be covered by insurance. Then, call us to confirm if you’re eligible.
Need help with insurance?
Our enrollment team can help you understand your coverage and costs, and whether your visits will be covered.GET IN TOUCH
Self-pay monthly plan
If you don’t have insurance, or you don’t want to use your coverage, we offer a transparent cash option.
- All clinician video calls
- Suboxone medication management, if eligible
- 7 day a week support from Ophelia care team
- Access to comfort medication to ease withdrawal symptoms
- Diagnosis and treatment of depressive, anxiety, and insomnia disorders
Insurance + pricing FAQ
The subscription-based service costs $195 a month without insurance. It includes: all Ophelia clinician visits via video calls, Suboxone management, and ongoing support from the dedicated Ophelia care team.
In order to respect our clinician’s time, and to respect the time of other patients who are waiting to be seen, Ophelia does charge no-show fees on visits. For initial visits (the very first appointment with your clinician), we charge $20 if the visit is no-showed or canceled within 12 hours of the start time. For Follow-Up Visits, because these are scheduled weeks in advance, we charge a $20 fee if the visit is no-showed or canceled within 24 hours of the start time.
Ophelia does not charge any late fees for payment. We want to be as flexible as possible with our patients, so as long as there is open and honest communication we can accept late payment without fee. If payments are consistently late or missing, however, this may lead to discussions of discharge.
Unfortunately, if a patient can no longer pay for treatment, we will have to initiate discharge. This does not mean that the patient will be abruptly kicked out of treatment without any support though. If we know discharge is coming, our care team will begin working with the patient on a discharge plan, including a list of referrals for other opioid use disorder clinics and programs. Our clinicians will also prescribe a discharge script of medication, meaning that patients will not be without any medication as they enroll in new treatment.
Our monthly fee of $195 covers all of your care for that month. This covers all visits, care coordination, peer support services, and optional support groups! We do not charge extra for each visit or additional services.
As you sign up for your initial visit with a clinician, you will be asked to put in your payment information to confirm the appointment. We need this information to schedule the visit, but you will not be charged yet! The first visit is risk free, meaning that we will not charge you unless you decide to enter treatment. If you talk with the clinician for 45 minutes, and then decide Ophelia isn’t the right fit for you, you won’t be charged anything! If you do join treatment, then we will charge the first $195 right after your visit. If you are unable to pay at that time, we can delay your first payment up to one week after your initial visit.
Zoom is completely free to download and use.
Most insurance plans will cover the price of medication with only small copays to be paid by the patients.
If you do not have insurance, the price of the medication will have to be paid for out of pocket. The price can vary depending on how much you are prescribed, the type of medication, and the dosage. We have some tools we use that can help lower the cost of the medication, so please ask about these if you are interested!
We are in network with a number of insurance plans, including medicaid and medicare options. By scrolling up and choosing your state, you can find the plans we accept or give us a call and we can help you navigate your insurance coverage.
Unfortunately, there’s not a clear answer to this question. The cost of copays depends on your insurance plan, your deductible, and a few other factors. As a result, we won’t know the copay amount until we submit the first claim. If you would like to know this information sooner, we recommend calling the member services number on the back of your insurance card and inquiring with your insurance provider directly.
For most of our patients, insurance does cover the full cost of the medication, or requires small copays of less than $10. Depending on the details of the prescription and your insurance plan, sometimes we need to file prior authorizations for the insurance company to cover the cost. Ophelia will happily complete and submit these documents for our patients.
In order to book an initial visit with Ophelia, we do require a card for payment on file, even if we accept a patient's insurance. We still need the card for a few reasons. The first is copays – as we bill insurance for our services, we are legally required to collect copays from our patients, so we must have a payment method on file to do so. Additionally, there are cases where a patient's insurance expires or is no longer acceptable, so we need to have a payment method on file to revert these patients back to out-of-pocket payment.