IN NETWORK FOR THE FOLLOWING INSURANCES:
MN MA, Blue Cross Blue Shield, United Healthcare, Medicare,
UCARE
MosaicSelf uses: Resource Medical Billing
Billing@resourcemedicalbilling.com
1-877-452-2009
IF YOU HAVE QUESTIONS ABOUT YOUR BILL, PLEASE CALL: 1-877-452-2009
Please check with your Insurance Company customer service number on the back of your insurance card, to verify mental health coverage for therapy or counseling services. Ask specifically about telehealth coverage. Also verify that MosaicSelf is in network ,and ask about your deductible and or copayment. Co-Pays are due at time of service with credit card / or HSA card.
Do check with your Insurance customer
service to inquire about your out-of-network deductible.
Cancellation & No Show Policy
MosaicSelf must be notified at least 24 hours in advance (48 hrs is preferred to be available for others) if you need to cancel your appointment.
- For cancellations, messages can be left 24 hours a day on MosaicSelf Voicemail.
- MosaicSelf will charge $50 for NO SHOW insurance based appointments. Your Health insurance will not cover NO SHOW cost. You will be financially responsible for the NO SHOW charge. This is a time I have reserved for you. If you are private pay or Out of Network you will be billed the entire session fee.
- If you do not show or cancel with short notice MosaicSelf will cancel any remaining reoccurring appointments until we get in touch. MosaicSelf will contact you and discuss with you if continuing the relationship would be beneficial, if not a referral can be made to another provider.
- FEE SCHEDULE AND CONTRACT Effective January 2023
- Please note that this fee schedule is subject to change with a written notice
- Initial Intake and Diagnosis Evaluation: $220
- Individual Counseling:
- 38-53 min= $165.00
- 53min + = $180.00
Copy of Records - $35.00 Request for records may be made through your client portal by secure messaging through the client portal or email in writing.
A discount is available for clients paying strictly with cash/check throughout on the same day as session. (Part of the above fees cover administrative time such as telephone calls to insurance companies and related paperwork.)
Court Appearances: $350.00/hr. portal to portal
You are fully responsible for all services rendered. Payment is expected through Resource Medical Billing. You will receive a bill directly from them. Please make checks payable to MosaicSelf Counseling. There will be a $30 charge for returned checks as non-sufficient funds or non-payable. Credit cards are accepted through IVY Pay.Payment in full is expected. Please talk to me if you are having an exceptional hardship to discuss monthly payments as an alternative. If you become delinquent on a payment, your name, address, and telephone number will be given to a collection agency along with the amount owed plus 10% interest by Fairview Billing. By signing the last page you agree to waive your right to confidentiality in the instance of collection of fees owed whereby a collection agency needs to become involved due to your lack of payment.