PPG Clinic Policies

Thank you for choosing Plymouth Psych Group as your health care provider. Please understand that payment of your bill is considered a part of your treatment for services. Please see below for details regarding our Financial Policy. For a printable copy of our Clinic Policies and Informed Consent form, click here Informed Consent Packet

Payments:

  • All copays are due at the time of your appointment
    – Adult Patients: All patients are responsible for full payment of any co-pays at time of service
    – Minor Patients: Parents or guardians accompanying minors are responsible for payment of co-pays at the time of service. If a minor is accompanied by an adult other than a parent or guardian, payment is still expected at the time of service. For accompanied minors, charges may be pre-authorized to an approved credit plan, credit card, or debit card at the time of service.
  • We accept checks, credit cards, or debit cards as forms of payment. We do not accept cash.

Regarding Insurance:

  • We may accept assignment of insurance benefits. The balance is your responsibility whether your insurance company pays, does not pay, or rescinds payment. We cannot bill your insurance company unless you provide us with your insurance information. Your insurance policy is a contract between you and your insurance company. We are not a third party to that contract. In the event, we do not accept assignment of benefits and your insurance has not paid your account in full within sixty days, the balance will automatically be transferred to your responsibility. Please be aware that some, and perhaps all, of the services provided may be non-covered services, and not considered reasonable and necessary under your medical insurance. Contact your employer or insurer if you have questions. All co-pays are due at the time of your session when you use an insurance plan for which your therapist is a provider. In the event, your insurance coverage changes, it is your responsibility to notify us. If your plan is one for which we are not participating providers, you are responsible for your account balance. Any follow up, or reporting to third parties that becomes necessary due to unpaid balances on your account shall not be considered a breach of confidentiality.
  • While Plymouth Psych Group may be listed as a network provider for your insurance, this is not a guarantee of coverage. Should your insurance company reject a claim, your will be held responsible for the balance due.

Fee Schedule:

  • A 15% discount off our posted rates is available to clients choosing not to use insurance and who pay in full at the time of service.

The following are the most commonly billed services:

Diagnostic Interview:

  • More than one diagnostic interview may be needed; in this case each session is billed at the rate indicated below.

Performed by a:

  • Medical Doctor (MD) or Nurse Practitioner: $360
  • Psychologist or Therapist: $300

Medication Management:

  • 25-30 minute medication management performed by a MD or NP: $200
  • 40 minute medication management performed by a MD or NP: $275

Psychotherapeutic Session:

  • 16-37 minute individual therapy: $150
  • 38-52 minute individual therapy: $200
  • 52+ minutes of individual therapy: $300
  • 60 minute Group Therapy: $100
  • 38-52 minute Family Therapy: $250

Phone Calls:

  • All phone calls with a provider are charged at $30 after the first 10 minutes, and $40 per 10 minute increment thereafter.
  • If you would like to speak with your providers nurse, please contact the front desk at 763-559-1640 and the nurse will be in contact with you free of charge within 24 business hours.

No Show & Cancellation Policy:

  • Plymouth Psych Group reserves the right to terminate patients from care when a patient misses two or more scheduled appointments without giving a 24-hour cancellation notice within a 6- month span.
  • Missed appointments or cancellations within 24 hours will result in a $75.00 charge after the 2nd offense. This charge is not covered by your insurance, and will be billed as your responsibility. Clients with two or more unpaid missed appointment fees are subject to termination of care.

If you need to cancel an appointment, please contact us at 763-559-1640 during regular clinic hours (note that this does NOT include Saturday), at least 24 hours before your scheduled appointment to reschedule to a better time. If there is something we can do to assist you in keeping scheduled appointments, please contact us.

Service/Finance Charges:

  • All Clients must complete our “Registration Form” before seeing a provider
  • Subject to service charge of up to %1.5 after 60 days of non-payment
  • Past due accounts may be reported to a collection agency
  • There is a $25 service charge for insufficient funds on debit cards and returned checks

Balance Policy:

A balance is considered “overdue” when the client has not made a payment on the amount not covered by insurance within 2 billing cycles (60 days) since the appointment.

  • Clients with overdue balances exceeding $300 will be required to comply with one of the three options listed below:
    a.) Pay down their balance before being seen for an appointment with a provider
    b.) Pay upfront for their appointment before being seen by a provider
    c.) Reschedule the appointment until their balance is reduced to under $300.
  • If a client has a balance that has been outstanding for 90+ days, regardless of the amount, they must pay for any appointment going forward upfront and in full.
  • Clients who are seen for psychological testing are required to fill out a separate financial statement regarding insurance and payment responsibility, and are billed according to that agreement.

Subpoena Policy:

  • For subpoenas requiring in-person testimony or appearance by an employee or contractor, Plymouth Psych Group reserves the right to charge the $250 hourly provider rate for time spent preparing for, commuting to, appearing and testifying in response to a subpoena. A $2000 advance will be charged for appearance in court.
  • For subpoenas requiring production of medical records and/or documentation, Plymouth Psych Group reserves the right to charge the current hourly provider rate for time spent production and copying of these records and/or documentation. As permissible under applicable law, additional fees may be charged. As permissible under applicable law, Plymouth Psych Group reserves the right to demand payment of these fees in advance of in-person appearance and record and/or document production. Plymouth Psych Group will comply with all applicable HIPAA, Minnesota Privacy Act and other regulations in responding to all subpoenas.

Thank you for understanding our financial policy. For questions or concerns please contact us at 763-559-1640, or by calling our billing department directly at 763-238-8388.

Services

Contact Us

Please fill in the required fields below.