Phone: (651) 454-0114
Send Us An Email:
contactus@mnmentalhealth.com
APPLE VALLEY
Central Intake
CHASKA
County, Contract Hours ONLY
EAGAN
EDINA
LAKEVILLE
MAPLEWOOD
MINNEAPOLIS
PLYMOUTH
ST LOUIS PARK
STILLWATER
TELEHEALTH Therapy
WOODBURY
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In-person
Virtual or in-person
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Client Details
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Middle Name
Last Name
Date of Birth
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Email Address
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Relationship to Client
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First Name
Middle Name
Last Name
Date of Birth
Phone Number
Email Address
Insurance or Payment
Insurance
Cash Pay
Name of Insurer
AARP HealthCare Options
AARP Medicare Complete
Aetna
Aetna Allina Health Medicare
Aetna American Continental
Aetna Medicare
Aetna Senior Supplemental Insurance
All Savers Insurance /United Healthcare
Alliance Health
Allied Benefits Systems
Allstate supplement
America's PPO
American Trust
Avera Health Plans
BCBS Commercial (MN Plans ONLY)
BCBS Federal Plans
BCBS Medicare
BCBS Out State Plans
BCBS PMAP
BCBS Secondary
Beacon Health EAP
Beacon Health Solutions
Bind Benefits Inc
Careguard
Carelon Behavioral Health
Central State Indemnity
Champ VA
Cigna Behavioral Health
Cigna Behavioral Health Medicare
Cigna Behavioral Health Secondary
Colonial Penn/Bankers Life
Comprehensive Care Services
Continental Benefits
Cox Health Plans
Crime Victims
Dakota County TCM
Dakota Cty Social Services
EBMS
EMPLOYEE BENEFITS SERVICES INC EBSI
Golden Rule Ins Company
GPA Ins
Gravie Administrative Services
Health EZ
Health Partners Commercial
Health Partners Medicare
Health Partners PMAP
Health Partners Secondary
Health Scope
Health Smart
Hennepin Health
HMA LLC
HMC HealthWorks
Humana Commercial
Humana Medicare
Inova Care
Magellan Behavioral Health
Managed Health Network
Medica Commercial
Medica IFB
Medica Mayo
Medica Medicare
Medica PMAP
Medica Secondary
Medicare Part B
Meritain Health
Minnesota Care
Mutual of Omaha EAP
National Association of Letter Carriers
Omaha Insurance Company
Optum EAP
Oxford Health
Palmetto GBA
Piedmont Community Health
PO - PCH Group
PO - PKA Group
Preferred One PPO
Preferred One Secondary
Prime West Health
Priority Health Claims
Sanford Health Plan
Security Health Plan
Select Care
Select Health
South Country Health PMAP
Surest
Tricare
Trustmark Healthcare
UCare Individual and Family Plans
UCare Individual and Family Plans w/Fairview
UCare Medicare
UCare PMAP 2022
UMR
UMR Secondary
United American Insurance Co
United Health Care Commercial
United Health Care Medicare
United Health Care Secondary
United Healthcare PMAP
United Healthcare Shared Services
United Healthcare Student Resouces
United Shared Services & GEHA
UPMC Insurance
USAA
Valenz
Washington County
WEA Insurance
Web TPA
WPS Commercial
Policy Number
Group Number
Provide at time of service
Please note that payment will be due prior to or at your appointment date.
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Send Us An Email: contactus@mnmentalhealth.com
Send Us An Email: contactus@mnmentalhealth.com
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