Billing Policy

Guarantee of Account

I agree to pay Minnesota Mental Health Clinics for all charges and services not covered by any third-party payer. I understand that I am responsible to comply with the rules and regulations of my insurance company regarding pre-certification and prior authorization requirements. I agree if a pre-authorization of service is required, unauthorized visits are my responsibility for payment. We will assist you in keeping a count of the number of sessions used.

Insurance Consent

I request that payment of authorized benefits be made directly to Minnesota Mental Health Clinics, and the facility’s participating physicians and therapists, for any services furnished to me. I authorize this facility to release to Medicare, and other accident or health insurer, medical or financial information as needed for claims processing, fraud investigation, or quality of care review and studies.

There is no guarantee your insurance company will provide payment for services, and you agree that you are fully responsible for any charges not covered by insurance.

If you plan to submit your own claims to your insurance company, full payment is due at the time of service.