Funding and Payment Options:

Insurance Types Accepted:

• Aetna
• Medica
• Medical Assistance
• Optum Plans
• Preferred One
• UCARE
• United Behavioral Health
• United Healthcare

NOTE: It is important for you to verify coverage with your insurance, and to make sure that you understand what your out of pocket expenses will be due to possible deductibles or copays. I will also verify insurance prior to our first full session.

Private Pay

Some people prefer to pay privately, without the use of insurance. The purpose of this option may be to use a provider not in network with your insurance agency. Another purpose may be in order to keep your diagnosis and therapy goals confidential and protect your privacy with your insurance company or employer. If this is your preference, I am happy to provide you with a billing statement which you may decide to submit to your insurance company at a later date if you would like to get reimbursed.

Sliding Scale

For people who may not have the financial means or stability to pay any out of pocket costs for their therapy, I am happy to offer a sliding scale payment plan. This scale is subject to income guidelines. Offering sliding scale is one way that I am able to practice my value of ensuring that any person in our community has access to mental health and chemical health care, regardless of financial status.

Co-Pays

If your insurance requires a co-pay, those fees are due at the time of service.

Deductibles

If you have an unmet deductible through your insurance plan, you will need to pay for the cost of therapy out of pocket, at each session, until your deductible is met. Those costs are due at the time of service.

Monthly Statements

Monthly statements will be generated for every person indicating services provided/received, balance and amount paid.

Rescheduling and Cancellation Policy

I understand that there are things that will come up that may prevent you from making it to your therapy session. I ask that you contact me within 24 hours to cancel or reschedule your appointment if you will be unable to make it. If you do not call to reschedule with the 24 hour time period, there is a $50 charge. I also understand that there are emergencies and things that may come up that do not allow you to reschedule in my requested timeframe. We will work something out given extenuating circumstances.

Payment Options

• Cash
• Credit/Debit Card
• HSA/FSA card
• Check

Good Faith Estimate Rights for Clients- Effective January 1, 2022
Dagaz Therapy wants to do our part to protect our patients from surprise bills. While we wait for many details regarding the compliance of the No Surprises Act, we assure you of our commitment to comply with all guidelines to protect our patient’s rights and will update this page as further information emerges.

Insured Clients Using Benefits to Cover Therapy
Your health plan can give you the most accurate price for medical services.

Minnesota law requires physicians, hospitals, and health plans to provide consumers with a good faith estimate of the cost of their care. Over 94 percent of Minnesotans have insurance, and that number is expected to increase as the Affordable Care Act is fully implemented. Because health insurers negotiate different payment rates for services with each health care provider, including hospitals, physicians, clinics, and individual providers, the best way to compare prices you will pay is to contact your own insurance company. Your final out-of-pocket costs can be higher or lower than your neighbor’s — even when you’ve received the same services because health insurance plan payments vary, and insurance plan benefit levels are unique to each plan. Your insurance plan can tell you what the hospital’s price will be for all your services as well as what your out-of-pocket, co-pay, and deductible will be.

Always independently verify insurance coverage, provider participation, and coverage terms. This may not reflect all insurance accepted by the provider and is for informational purposes only.

Here is a list of Minnesota frequently used commercial insurance companies and their main customer service phone numbers:

Insurance Providers:

Blue Cross Blue Shield of MN: 651-662-8000
HealthPartners: 952-883-5000
Medica/UnitedHealth Care/UMR: 952-945-8000
Preferred One: 763-847-4477
Aetna: 800-872-3862
UCARE: 612-676-3200
Tri-Care: 844-866-9378


NOTE: If you are insured, you should contact the phone number provided on your insurance card. The above is only a partial list of insurance companies. You should also know that clinics/providers are not permitted to assemble to set prices. That would be a violation of federal and state antitrust laws that protect you.

Uninsured and Self/Private-Pay Clients
Your patient rights by law as of January 1, 2022, seek to ensure that you have the right to a written estimate of your healthcare bill. It is called a “Good Faith Estimate”.
Dagaz Therapy clients have a right to this good faith estimate when:

• You schedule your appointment 3 or more days in advance AND
• You won’t be utilizing insurance to pay for the visit or if you do not have insurance coverage.
• If you schedule your appt in less than 3 days time, your Good Faith Estimate will be provided for any additional services/plans for care following your appointment.
• If you schedule a “free consult” your Good Faith Estimate will be provided after your consultation, along with any other needed intake information.

Notice to All Clients:
Save a copy of your Good Faith Estimate

Your rights extend to providers not affiliated with Dagaz Therapy. A good faith estimate will include expected charges, including but not limited to lab charges, imaging, procedures, and supplies. It is always helpful if you save a copy of your bill and Good Faith Estimate in a safe and easy to locate place. If you receive a bill from us that is more than $400 above your estimate, you may dispute your bill within 120 days of receiving it.

If you have questions regarding our internal billing processes you can contact our business office by calling (763) 445-9264 or by email: mvinton@dagaztherapy.com.

Additional information regarding your rights to a Good Faith Estimate is posted at:
• National CMS: www.cms.gov/nosurprises or call 800-985-3059.
• Minnesota state law protections: how much patients covered by fully insured commercial plans will pay for certain unauthorized, non-emergency services and unauthorized emergency services. For more information about your rights under Minnesota state law, please contact the Minnesota Department of Commerce.