Are you tired of not getting a straight answer when asking about medical costs? Are you annoyed by the fact that you can “shop around” for the best value for other services but the prices for physical and mental health services are often elusive? Wellness Matters is committed to transparency and fair pricing for services. Wellness Matters caters to busy people who value privacy, recognizing that some people may prefer not to have their insurance companies notified when they are receiving services. Whether you prefer to bill insurance or pay cash, Wellness Matters is committed to providing transparent prices and affordable services. Please see the “Rates” sections below for our rates and discounts that are available for self-pay clients.
Insurance
Wellness Matters is in the process of contracting with public and private insurances. If your insurance company is not listed below, please contact us and we will pursue contracting with them.
We are currently contracted with the following insurance companies:
- Aetna
- Blue Cross Blue Shield
- Blue Plus
- Medica
- Medical Assistance
- Optum
- Preferred One
- Prime West
- Sanford Health
- South Country Health Alliance
- TriCare
- UCare
- United Health
We are in the process of contracting with the following:
- Health Partners
- Humana
- Medicare
Wellness Matters recognizes that many people have very high deductibles. Unfortunately, many insurance companies prohibit discounting patient’s out-of-pocket expenses. For this reason, we set our rates as low as possible. If you anticipate difficulty in paying your bill due to a high deductible, Wellness Matters will work with you to set up a payment plan that works for you. (Due to bureaucratic barriers, we are unable to contract with Medicare; unfortunately, if Medicare is your primary insurance plan and they deny the claim, your secondary insurance will deny as well. As discussed below in the “Sliding Fee Scale” section, Wellness Matters offers deep discounts to qualifying self-pay clients. Additional discounts for seniors may be available, based on need and circumstances.)
Transparency is Important to Us!
At Wellness Matters, we are committed to “up-front pricing.” Unlike other health care providers, we post our fee schedule for any and all to see.
Discounts, Discounts, Discounts!
- Wellness Matters pricing structure is generally based on 50% above the amount the Medicaid reimburses for most services. Rather than matching the highest prices charged by other clinics in the area, we utilize the Medicaid reimbursement level, which is often the lowest, and go up from there. As a result, Wellness Matters rates are much more affordable.
- Furthermore, Wellness Matters recognizes that many people are uninsured. To help make our services accessible and affordable to “self-pay” folks, our pricing structure reflects an approximate 33% discount on most services.
- Wellness Matters strives to provide affordable services to all and has a liberal Sliding Fee Discount option for those who prefer not to bill their insurance companies or who do not have insurance. The Sliding Fee Discount offers reduced rates for household income less than or equal to 300% of the Federal Poverty Guidelines (FPG). For example, a family of four whose household income is $50,200 (which is at 200% of the FPG), qualifies for a reduction of approximately 33% off the already lowered Self-Pay Rate.
Tap here to text Rita at (218) 255-3321 for more information
Legal Tender
Wellness Matters accepts cash and all major debit/credit cards for co-pays and services. Our HIPPA-compliant health record system also securely stores card information for conveniently billing at midnight on the night that the service is provided.
Self-Pay Clients
Since there are significant administrative savings to Wellness Matters if we don’t have to bill your insurance company, we pass a significant cost savings on to you with an approximate 33% reduction off our regular rate. Self-pay clients are also encouraged to refer to the Sliding Fee Discount below to see if you are eligible for an additional discount. Self-pay clients will normally be required to have a debit or credit card on file that will be automatically be charged the same day of service. Cash payment at the time of service is also accepted.
2019 – 2020 Rates:
|
SERVICE |
CPT CODE |
Essentia |
Sanford |
Wellness
Matters Regular Rate |
Wellness Matters Self Pay
Rate |
2019
Medicaid Reimbursement Rate |
| Mental Health (MH) Diagnostic Assessment |
90791 |
$328 |
Requested on 11/4/19 – declined to share |
$180 |
$120 |
$120.64 |
| 53 – 60 Minute
MH Therapy Session |
90837 |
$324 |
Requested on 11/4/19 – declined to share |
$180 |
$120 |
$118.10 |
| 38 – 52 Minute MH Therapy Session |
90834 |
$216 |
Requested on 11/4/19 – declined to share |
$120 |
$80 |
$78.69 |
| 16 – 37 Minute MH Therapy Session |
90832 |
$162 |
Requested on 11/4/19 – declined to share |
$95 |
$60 |
$59.13 |
| Group Therapy | 90853 | $63 | Requested on 11/4/19 – declined to share | $35 | $20 | $23.61 |
| Family/Couples MH Therapy (Patient not present) |
90846 |
$230 |
Requested on 11/4/19 – declined to share |
$145 |
$120 |
$95.01 |
| Family/Couples MH Therapy (Patient present) |
90847 |
$232 |
Requested on 11/4/19 – declined to share |
$150 |
$120 |
$98.82 |
| *Rule 25 or Substance Use Assessment |
H0001 |
Does
not provide |
Requested on 11/4/19 – declined to share |
$175 |
$175 |
Provided
for free by the County |
*Rule 25s, Substance Use Assessments, and treatment will be paid for at the time of service via cash or debit/credit card. A receipt will be provided for insurance reimbursement purposes. Wellness Matters neither implies nor guarantees that such reimbursement requests will be honored by the insurance company.
Sliding Fee Scale for Uninsured or Self-Pay Clients
Wellness Matters recognizes that employment benefits often do not include health insurance and purchasing it on the open market can be cost prohibitive. To make Wellness Matters services affordable, we provide significant discounts when household income is verified to be less than or equal to 300% of the Federal Poverty Guidelines (FPG). Eligibility is based on a properly completed Sliding Fee Discount application and verification of household income and family size. The Sliding Fee Discount application can be obtained from Wellness Matters staff.
Upon receipt of the completed Sliding Fee Discount application and required income documentation, Wellness Matters staff will review the information to determine where your household income falls on the Federal Poverty Guideline chart. If it is determined that your household income is less than or equal to 300% of the FPG, you will be eligible for discounts on most services (excluding Diagnostic Assessments, groups, and Rule 25/Substance Use Assessments):
- 0 – 100% of the FPG may pay 20% of the Self Pay Rate.
- 101% – 138% of the FPG may pay 40% of the Self Pay Rate.
- 139% – 150% of the FPG may pay 50% the Self Pay Rate.
- 151%- 200% of the FPG may pay 70% the Self Pay Rate.
- 201% – 250% of the FPG may pay 80% the Self Pay Rate.
- 251% – 300% of the FPG may pay 90% the Self Pay Rate.
- 301%= of the FPG will pay the Self Pay Rate
Sliding Fee Discount:
|
SERVICE |
0 to 100% of FPG |
101% to 138% of FPG |
139% to 150% of FPG |
151% to 200% of FPG |
201% TO 250% of FPG |
251% to 300% of FPG |
Wellness Matters Self Pay Rate |
| Mental Health (MH) Diagnostic Assessment |
$50 |
$120 |
$120 |
$120 |
$120 |
$120 |
$120 |
| 53 – 60 Minute
MH Therapy Session |
$24 |
$48 |
$60 |
$84 |
$96 |
$108 |
$120 |
| 38 – 52 Minute MH Therapy Session |
$16 |
$32 |
$40 |
$56 |
$64 |
$72 |
$80 |
| 16 – 37 Minute MH Therapy Session |
$12 |
$24 |
$30 |
$42 |
$48 |
$54 |
$60 |
| Group Therapy | $5 | $20 | $20 | $20 | $20 | $20 | $20 |
| Family/Couples MH Therapy |
$24 |
$48 |
$60 |
$84 |
$96 |
$108 |
$120 |
| Rule 25 or Substance Use Assessment |
$175 |
$175 |
$175 |
$175 |
$175 |
$175 |
$ 175 |
Wellness Matters rates and the Sliding Fee Discount rates will normally be reviewed and adjusted when the federal Medicaid reimbursement rates are updated.
https://medicaid.ms.gov/wp-content/uploads/2014/03/CommunityMentalHealthCenter.pdf
Self-pay patients will have a debit or credit card on file that will be automatically charged the same day of service. Cash payment at the time of service is also accepted.
How do I determine if I might be eligible for the Sliding Fee Discount?
To qualify for the Sliding Fee Discount, you must show proof of gross income for all immediate family members in your household. Gross income is all income from all sources before taxes. Please contact Wellness Matters staff for a Sliding Fee Discount Application if you believe that you will qualify AND you do not have insurance or are choosing not to bill insurance.
Federal Poverty Guideline Chart
| # in Household |
100% FPG |
138% of FPG | 150% of
FPG |
200% of
FPG |
250% of
FPG |
300% of FPG |
| 1 | $12,140 | $16,753 | $18,210 | $24,280 | $30,350 | $36,420 |
| 2 | $16,460 | $22,715 | $24,690 | $32,920 | $41,150 | $49,380 |
| 3 | $20,780 | $28,676 | $31,170 | $41,650 | $51,950 | $62,340 |
| 4 | $25,100 | $34,638 | $37,650 | $50,200 | $62,750 | $75,300 |
| 5 | $29,420 | $40,600 | $44,130 | $58,840 | $73,550 | $88,260 |
| 6 | $33,740 | $46,561 | $50,610 | $67,840 | $84,350 | $101,220 |
| 7 | $38,060 | $52,523 | $57,090 | $76,120 | $95,150 | $114,180 |
| 8 | $42,380 | $58,484 | $63,570 | $84,760 | $105,950 | $127,140 |
For households with more than 8 individuals, add $4,320 for each additional person.
The information above is drawn from the “Yearly Guidelines and Thresholds” for Coverage Year 2019
Substance Use Disorder and Co-Occurring Treatment Rates
Self-pay Substance Use Disorder treatment session rates are $120 per 55-minute session.
Wellness Matters provides “co-occurring treatment” for people who have both active mental health and substance use disorder diagnoses. When both diagnoses are active, the mental health diagnosis will be billed to the insurance company. In those instances where clients do not have a mental health diagnosis and are not able/willing to self-pay for substance use disorder treatment, Wellness Matters staff will assist in coordinating care with a clinic that bills insurance for substance use treatment. Substance Use Disorder patients will have a debit or credit card on file that will be automatically charged the same day of service. Cash payment at the time of service is also accepted.
Coaching
Wellness Matters offers coaching as an option for those instances where people want more support or coaching but do not want or need mental health treatment. Coaching services are available in such areas as career development, parenting, co-parenting, spirituality and health/wellness. The rates for coaching services are the same as the “Wellness Matters self-pay” rate of $120 per 55-minute session. Coaching patients will have a debit or credit card on file that will be automatically charged the same day of service. Cash payment at the time of service is also accepted.
Wellness Matters provides services without regard to a person’s race, color, sex, national origin, disability, religion, sexual orientation, or gender identity.
Tap here to text Rita at (218) 255-3321 for more information
For more information about Wellness Matters, please see About Us – Wellness Matters.