Practice Policies | Self-Pay Telehealth Psychiatry Minnesota & Arizona

Scope of Services & Location

Contrast Mental Health, PLLC provides psychiatric assessment and medication management via telehealth.

Geographic Requirement: I am licensed to provide services in Minnesota and Arizona. Due to telehealth regulations, you must be physically located within the borders of MN or AZ at the time of our appointment. If you are traveling outside these states, we must reschedule.
Telehealth Platform: We utilize a HIPAA-compliant video platform. You agree to secure a private space free from distractions. Sessions cannot be conducted if you are driving or in a public area.

Minors (Children & Adolescents)

Parent or legal guardian consent is required for evaluation and treatment.
Documentation of legal guardianship/custody may be requested prior to initiating care.
Age-appropriate confidentiality is respected in accordance with applicable laws.

Financial Policy (Self-Pay Only)

Contrast Mental Health, PLLC is a private pay practice and does not participate in any health insurance plans (including Medicare/Medicaid).

Payment Due: Full payment is due at the time of service.
Card on File: A valid credit, debit, or HSA/FSA card must be kept on file in our secure system (SimplePractice).
Out-of-Network Reimbursement: Upon request, we can provide a "Superbill" (a detailed receipt) that you may submit to your insurance company for potential out-of-network reimbursement. We cannot guarantee your insurance will reimburse you.

Lab Testing

When clinically indicated, lab orders may be provided. You may choose your preferred laboratory for blood draw.
Patients pay laboratory fees directly to the lab (e.g., Quest, Labcorp, hospital/clinic lab). The practice does not bill or collect lab fees.

Supplements

The practice does not dispense or sell supplements. If supplements are discussed, they are optional and may be purchased from a vendor of your choice.

Appointments & Cancellation Policy

Your appointment time is reserved specifically for you. Consistency is key to effective treatment.

Cancellations: We require at least 24 hours notice if you need to cancel or reschedule.
No-Show/Late Cancellation Fees:
- 1st Occurrence: We understand that life happens. Your first late cancellation or no-show will be waived as a courtesy.
- Subsequent Occurrences: Any further late cancellations or no-shows will be charged a flat fee of $50.
Late Arrival: If you are more than 15 minutes late to the video session, it will be considered a no-show.
Discharge Policy: Three (3) no-shows or late cancellations will result in discharge from the practice to allow us to serve clients who are able to commit to the treatment schedule.

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Good Faith Estimate

Under the No Surprises Act, as a self-pay client, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. A separate estimate will be provided to you before your first scheduled service.

Medication Protocols

Refills: Please request refills at least 3 business days before you run out. Refills are processed during business hours only.
Controlled Substances: Prescribing controlled substances via telehealth is subject to strict state and federal regulations.
- We strictly adhere to the Prescription Monitoring Program (PMP) in both MN and AZ.
- Lost or stolen prescriptions for controlled substances will not be replaced.

Emergency Situations

This practice is not an emergency service and I am not available 24/7.

In case of a life-threatening emergency, drug overdose, or immediate risk of harm to self or others, call 911 or go to the nearest Emergency Room immediately.
For mental health crises, you may also call or text the 988 Suicide & Crisis Lifeline.

Confidentiality & Communication

Client Portal: All non-urgent communication should be sent via the secure SimplePractice Client Portal.
Privacy: Your information is protected by HIPAA. We will not release information without your written consent, except where required by law (e.g., risk of harm to self/others, child/elder abuse, court order).

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This page summarizes key policies and is not legal advice. Policies may be updated periodically.