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Clinic Policies


 

Thank you for choosing Plymouth Psych Group!

It is our goal to avoid any miscommunication or concerns regarding clinic policies in order to focus our energy on providing excellent and compassionate mental health care to our patients.

If you have any questions or require clarification on the policies outlined below, please contact us and our office staff would be happy to assist.

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 20% 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: $425
  • Psychologist or Therapist: $300

Medication Management:

  • 25-30 minute medication management performed by a MD or NP: $285
  • 40 minute medication management performed by a MD or NP: $385

Psychotherapy Session:

  • 38-52 minute individual therapy: $215
  • 52+ minutes of individual therapy: $277.50
  • 60 minute Group Therapy: $250
  • 38-52 minute Family Therapy: $225

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 $70.00 charge. 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.
  • Cancelations due to a Winter Weather Advisory will not result in a cancellation/No Show charge if the client calls to cancel. No show, no call may still result in a cancellation charge.

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

Refunds

  • Any credits accrued throughout the year will be used toward future sessions
  • All refunds will be processed at the end of the fiscal year

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 or with a balance outstanding for more than 90+ days 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.
  • If you are unable to comply with Plymouth Psych Group’s financial policy due to financial hardship, we may recommend alternative mental health clinics that would fit your needs.
  • 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.

External Transfer of Care

When an external transfer of Care is deemed necessary, a written Notice of Transfer must be given to the patient, stating the reason for the transfer of care, treatment plan, prescription accommodation at the provider’s discretion, records coordination, followed with at least three appropriate referrals. This Transfer of Care period should conclude within 90 days, or once the patient has established alternative care.

  1. If a patient is unable to comply with Plymouth Psych Group’s financial policy, referral to an alternative mental health provider may be suggested to ensure consistency of care and reasonable financial assistance for the patient.
  2. If a patient requests a transfer of care, they must clear any unpaid balance before records will be released, unless the reason for transfer is due to financial hardship. This status must be confirmed by the Office Manager.

Internal Transfer of Care

An Internal Transfer of Care can be requested by the client or referred by the provider.

  • If a patient requests an internal transfer of care, they must complete a Transfer of Provider form, found at the front desk. This completed form will be given to both providers, current and prospective for their knowledge. Both providers can review the reason for, and if they agree to the transfer and inform the front desk staff for future scheduling of the client
  • If a Provider refers a client to an alternative provider, they must inform the prospective provider formally by direct or email notification and are responsible to discuss the continuity of care for the patient. An exit session may take place as needed.

Records Requested

An Internal Transfer of Care can be requested by the client or referred by the provider.

  • Records requested that result in more than 20 pages will be charged a $5 processing fee, as well as, $0.25 per sheet printed
  • This charge will be applied to the account of the person whose records are requested

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, narrative reports, and/or any official documentation, Plymouth Psych Group, reserves the right to charge $500.00 in advance to process the requested documents. Any time spent over two hours in production and copying of these records and/or documentation will result in a charge of $250 per hour. 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 Office Manager at 763-559-1613.

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Location
Plymouth Psych Group
3021 Harbor Lane N., Suite #206
Plymouth, MN 55447
Phone: 763-220-4439
Fax: 763-559-1617
Office Hours

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763-220-4439