Insurance and Fee Information

Mental Health Fee Schedule

The price per hour will be billed to your insurance, when applicable. Each insurance carrier allows a different amount per service. Client responsibility will depend on personal insurance benefits. For further benefits questions, please contact your insurance carrier.

Insurance and Payment

Our clinicians are in-network providers for most major insurance companies. We work directly with your insurance company and will make all reasonable efforts to bill your insurance company. We will make reasonable efforts to verify your insurance benefit coverage and to obtain any required authorizations. FBTA is credentialed by most health plans and EAP’s including:

• AllOne EAP
• Beacon Health
• Blue Cross and Blue Shield
• Health Partners
• Medica/United Behavioral Health
• Medical Assistance
• Medicare
• Minnesota Care
• OPTUM
• Preferred One
• South Country Health Alliance
• ThedaCare EAP
• Ucare Minnesota
• Village EAP
• Vital EAP Solutions

Client Account Policy as of 01/01/2020

FBTA requires a credit card on file for all clients with commercial insurance plans or paying fee for service. Your credit card information will be tokenized and encrypted in order to maintain the security of your information.

All account balances must be paid in full each month. Credit cards will be run on the 5^th of each month for the statement balance and a receipt will be sent to email on file. A detailed statement will be available to review and download in the client portal. If you have not yet signed up for the client portal, please call (763) 780-1520 in order to be sent an emailed invitation.

Fee for Service and co-payments are due at the time of the service and can be paid in the form of cash, check, flex spending/HSA/HRA cards and all major credit cards. If your insurance charges a co-insurance or deductible, this amount will be due once the claim is processed. You will have the opportunity to pay your bill in several ways. Credit card payments can be made over the phone or online through the client portal. Cash or check payments can be sent by mail or in person. To ensure proper credit, please make checks payable to FBTA. There will be a $40 fee for returned checks. Thereafter, payment will only be accepted in the form of cash, credit card, or money order.

It will be important for you to understand your benefit coverage. For benefit and coverage questions, please call the customer/member service number on the back of your insurance card. Ultimately it is your responsibility to know and understand your health insurance coverage. Verification of benefit coverage is not a guarantee of claim payment. All benefits are subject to the terms and conditions (e.g. authorizations, network requirements) outlined in the member contract with your insurance company.

The provision of professional psychological services may be interrupted by FBTA if the client is more than 30 days past due. Service may resume once a mutually acceptable arrangement for payment has been made with FBTA.

FBTA reserves the right to send past due accounts to our collections agency. Accounts which are 120 days past due will be subject to collection procedures.

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

A “Good Faith Estimate” is part of the No Surprises Act which went into effect on January 1, 2022. Under the Act, health care providers are required to give patients who do not have health insurance or who have health insurance and decide not to use it, a Good Faith Estimate.  The Good Faith Estimate must include an estimate of the services to be provided, including their frequency, duration and cost.

• We will provide you with a Good Faith Estimate upon request or when scheduling an appointment for services.
• If you schedule an appointment in at least 3 days in advance, you will be provided a Good Faith Estimate in writing within 1 business day upon making the appointment. For persons who schedule an appointment at least 10 days in advance, we will provide you with a written Good Faith Estimate within 3 business days of scheduling the appointment.
• Should you receive a bill that is $400 or more over your Good Faith Estimate, there is patient-provider dispute resolution process which can be implemented through the Department of Health and Human Services to dispute your bill.
• We encourage you to save a digital or hard copy of your Good Faith Estimate.
• It may be that the clinical picture relative to your care may change the nature and/or scope of the services being provided to you. If this occurs, we are required to clearly convey this to you and to provide an amended Good Faith Estimate to reflect such changes.

For questions or more information about your right to a Good Faith Estimate, call Family Based Therapy Associates at (763) 780-1520.

Professional Consultations

Time spent with you on the telephone by your mental health professional other than for appointment information will be charged at a prorated hourly charge of $200 per hour.

Managing Your Account Balance

If mailing, please remit payment to Family Based Therapy Associates, 199 Coon Rapids Boulevard, Suite 306, Coon Rapids, MN 55433.

Preparation of Forms and Reports

These require chart review and often, discussion with the client. There will be a minimum charge of $25 up to a maximum of $200 per hour.

Court & Legal Proceedings

• FBTA clinicians do not provide disability determination evaluations or custody studies. FBTA clinicians will do their best to refer you to practitioners in the area who perform disability or custody evaluations, or other related evaluations for which they do not believe they are qualified to provide.
• FBTA clinicians do not perform court evaluations nor do they appear in court on behalf of clients. FBTA clinicians do provide psychological evaluation and psychotherapy to assist in alleviating psychological and emotional problems. FBTA clinicians are not typically trained for and do not maintain records with the intended purpose of court involvement.
• However, the legal process is such that we may be compelled to reveal information about you that could affect you negatively or undermine the relationship you have with your therapist. This can occur because the client-therapist relationship is built on trust with the foundation of that trust being confidentiality. Subsequently, it may be damaging to the client-therapist relationship if the therapist is asked to present client records to the court or testify as a fact or expert witness in any type of court proceeding.
• In the event that an FBTA clinician is called to court or our client records are requested through subpoena or court order, FBTA will charge the full amount applicable under state law or the usual and customary for our services.

This includes:

• Copies of records will be made available for a $19.42 processing fee, plus $1.46 per page for copying. (MN Statute 144.292, Subdivision 6).
• If a FBTA clinician testifies in any court or legal proceeding, voluntarily or by subpoena or court order, regardless if the testimony is factual or expert, or to present any or all records pertaining to the therapy relationship to a court official, the client agrees to pay FBTA for these testimony related services (including but not limited to: travel, necessary expenditures such as copies, parking, meals, and the like, time spent speaking with attorneys, reviewing records and preparation or reports) at the rate of $200 per hour.
• The client further agrees to pay a retainer fee of $2000 two weeks prior to the appearance, presentation of records, or testimony requested. A personal check will not be considered an acceptable form of payment for these services.

Insurance Company Links

• Blue Cross Blue Shield of MN
• HealthPartners
• Medica
• Preferred One
• BHP (Behavioral Health Providers)
• UCare
• Medical Assistance
• Cigna

These links are provided as sources of information for your convenience. The websites listed are operated by third parties and we do not control or accept responsibility for content, services or products provided to you by them.