Mietus NP Mental Health, LLC dba Mental Wellbeing NP
New Client Information
My name is Stacey Mietus, and I am a certified nurse practitioner (CNP), an advanced practice registered nurse (APRN), and a board-certified psychiatric-mental health nurse practitioner (PMHNP-BC). I have been a psychiatric NP since 2014 and have been working in private practice since 2019. I am committed to providing evidence-based, holistic care for mental health, helping you seek and treat root causes using medication, supplements, psychotherapy, and/or other healing modalities.
Welcome and thank you for considering Mietus NP Mental Health, LLC dba Mental Wellbeing NP (“Company”, “us”, “mental health professional,” “NP”) for your medication management and mental health needs. This document contains important information about our professional services and business policies.
Medication Management - Mental Health Services
The Company owner is a licensed healthcare professional. The mental health professional is engaged in private practice providing medication management and mental health care services to clients through the Company or via licensed agents of the Company. As an agent of the Company, your mental health professional provides all medication management and mental health services through the Company and not personally.
While it may not be easy to seek help from a mental health professional, it is hoped that you will be better able to understand your situation and feelings and move toward resolving your difficulties. The mental health professional, using their knowledge of neurobiology, psychopharmacology, and human development and behavior, will make observations about situations as well as suggestions for new ways to approach them. It will be important for you to explore your own feelings and thoughts and to try new approaches for change to occur.
Medication expectations
You may or may not be started on a medication the first time you meet with NP. If you are already on medication, there may or may not be changes made to medication(s) at the first visit. NP does not prescribe any controlled substance medications. (In mental health, this primarily means stimulants (ADHD meds) and benzodiazepines (i.e. Klonopin, Valium, Ativan, Xanax, etc.).) If you take a controlled substance on a regular basis (more than once weekly), NP will not be able to work with you and will provide a referral to another prescriber.
Medications and refills
There are no guarantees to the outcomes of medications. You will be involved in the choice of your prescribed medications and provided with rationale regarding treatment approaches. You have the right to refuse recommended medications, seek a second opinion, or terminate treatment at any time. All medications may produce side effects, and some can cause undesired outcomes. NP will discuss the most common side-effects and you will be provided resources and a discussion concerning each medication. Please request medication refills 7 days before the medication is needed; otherwise, NP cannot guarantee your medication will be filled before you run out.
Appointments
Appointments are made by calling (612) 662-9604 during the normal business hours listed below, or by visiting www.MentalWellbeingNP.org. Please call to cancel or reschedule at least 24 hours in advance, or you may be charged for the missed appointment. If the mental health professional has to cancel the appointment, you will be entitled to a refund. You will receive a link to join the appointment before the appointment starts. You will get a reminder email the day before the appointment. The Company allows you to only be up to 10 minutes late to the scheduled appointment time, before calling the appointment a no-show, at which point you will be unable to join the appointment. The Company office hours are Monday, Tuesday, Thursday, Friday 8a-4p (off Wednesdays and weekends). We do not offer appointments outside these hours, no exceptions.
No show/late cancellation fees
A no show is defined as a missed appointment w/o prior notification; a late cancellation is a cancellation less than 24 hours before the scheduled appointment time.
No shows and late cancellations may be billed $180.
Most insurance companies do not cover missed or canceled appointments, so the responsibility for the session fee will be on you.
After the 3rd no show and/or late cancellation within a 12-month period, you may be terminated from the practice and provided a referral to another prescriber.
Number of Visits
The number and frequency of sessions needed depends on many factors and will be discussed by the mental health professional. Your initial session will involve an evaluation of your needs and depending on your circumstances further evaluative sessions may be required. At the end of the evaluation process the assigned mental health professional will be able to provide you with some first impressions of what medication management and mental health services may include and a treatment plan to follow if both you and the mental health professional agree to work together. You should evaluate this information along with your own opinions of whether you feel comfortable working with the mental health professional. Medication management and mental health services involve a large commitment of time, money, and energy, so you should be very careful about the mental health professional you select. If you have questions about procedures feel free to discuss them with the mental health professional at any time. If you have doubts your mental health professional will be happy to refer you to another mental health professional for a second opinion.
Length of Visits
The initial intake and evaluative session is normally scheduled for ninety (90) minutes and may run longer depending on the testing or assessments a client is asked to complete. Further evaluative sessions may be scheduled as needed for the mental health professional to accurately assess your needs. Once the evaluation process is completed sessions are 30-45 minutes in length.
After-Hours Emergencies
Please know that your mental health professional and Company do not provide twenty-four (24) hour crisis or emergency medication management and mental health services. This practice does not have an on-call prescriber. Should you experience an emergency necessitating immediate mental health attention, immediately call 911 or if you are able to safely transport yourself, go to the nearest hospital emergency room for assistance. A crisis resource list will be provided to you. Your signature below indicates your understanding of the above, and your receipt of the resource list.
Parent-guardian expectation
If applicable, it is expected that a parent or guardian will be present for at least a portion of the minor’s or ward’s appointment at every visit, not just at the initial appointment. There will be a time during the appointment when we will talk one-on-one with the minor or ward, and also a time we will need to speak with the parent or guardian.
Relationship
Your relationship with the mental health professional is a professional and therapeutic relationship. In order to preserve this relationship, it is imperative that the mental health professional not have any other type of relationship with you. Personal and/or business relationships undermine the effectiveness of the therapeutic relationship. The mental health professional cares about helping you but is not in a position to be your friend or to have a social or personal relationship with you.
If the mental health professional encounters you in a public setting, in order not to reveal your identity the mental health professional will not acknowledge your presence unless addressed by you first.
Gifts, bartering, and trading services are not appropriate and should not be shared between you and the mental health professional.
Codes for Services
Mental Wellbeing NP strives to provide clients with an above-average psychiatric experience. The mental health professional conducts medication follow-ups beyond the 15-minute industry standard. The mental health professional believes that the therapeutic alliance is vital to this work and is proud to incorporate supportive therapeutic interventions into appointments. As a result, more than one billing code may be listed on an invoice. Common codes:
99204, 99205, 90792: Evaluation and Management (E&M) codes for psychiatric intake appointments and/or diagnostic assessments and updates.
99213, 99214, 99215: E&M codes for the medication management portion of the visit. The numbers increase based on level of complexity or visit duration.
99417: E&M add-on code for prolonged service time spent the same day in- or outside the visit.
90833, 90836: E&M add-on codes for supportive psychotherapy
Payment for Services
The fees for our services are listed below:
Fee schedule:
Psychiatric Intake - 90792 $425 Add-on Psychotherapy - 90836 (38-52 min) $165
Psychiatric Intake - 99205 $425 Add-on Psychotherapy - 90833 (18-36 min) $145
Psychiatric Intake - 99204 - $375 Add-On Extended Time Code - 99417 $120
Psychiatric Follow Up - 99215 $300 Family Therapy without Client Present - 90846 $185
Psychiatric Follow Up - 99214 $250
Phone calls may be billed. Exceptions: you will not be billed for phone calls less than 5 minutes, calls to schedule appointments, or if the NP has asked you to call or scheduled the call.
Letter writing, form completion, care coordination, school consultations, and additional services may be billed.
These fees are subject to change upon thirty (30) days' prior notice to you. If you are unable to pay, or are not willing to pay, the higher fee after receipt of notice, services may be terminated, and you may be given referrals to other competent providers. The Company will look to you for full payment of your account, and you will be responsible for payment of all charges.
All payments will be auto charged with a credit card authorization kept on file in BlueFin. Payment processing dates will not coincide with the date of service due to insurance processing delays, however the date of service should be listed on the invoice receipt.
Risks of Mental Health Services and Assumption of Risk
There are no guarantees in mental health services and medication management services and the mental health professional does not make any guarantees with this agreement. You assume the risk of mental health services by signing this form. The mental health professional is not liable for any adverse reactions to mental health services or medications. The mental health professional may take any reasonable action necessary during mental health services when there is a dangerous circumstance, as determined by the mental health professional. We do NOT prescribe controlled substances. The Company may discharge you at its sole discretion based on the amount of controlled substances you have been prescribed by another provider and the frequency of use.
Contacting Your Mental health professional
The Company uses a secure electronic portal to maintain your records and communicate with you; the Company may also communicate via Spruce, which is also HIPAA-compliant and secure. The best way to reach the Company is through the secure portal or Spruce. You will receive instructions on how to access your portal. Your mental health professional is often not immediately available. There is no guarantee of a response time or a response at all, but the Company strives for a 2 to 3 business day response time. In most circumstances, the appropriate time to discuss any topic outside of rescheduling is at the next session.
The undersigned mental health professional and Company may use and respond to email only to arrange or modify appointments. Please do not send emails related to your treatment or mental health services as electronic communications are not completely secure and confidential. Any medication management and mental health services related questions or issues will not be addressed by the mental health professional in any electronic communication but will be dealt with during your next appointment. Any electronic transmissions of information by you are retained in the logs of your service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the service providers. You should know that any e-mails, online communications and specifically the website www.MentalWellbeingNP.org are not secure and you assume the risks of the insecure transmission.
Social Media
Your mental health professional does not accept friend or contact requests from current or former clients on any social networking sites. Adding clients as friends or contacts on these sites can compromise confidentiality and privacy of both the mental health professional and the client. It can blur the boundaries of the professional relationship and are not permitted. Any attempt by a client to surreptitiously gain access to the mental health professional's personal site(s) will be cause for termination of the mental health services.
Audio and Video Recordings
You acknowledge and, by signing this information and consent form below, agree that neither you nor the undersigned mental health professional will record any part of your sessions unless you and the mental health professional mutually agree in writing that the session may be recorded. You further acknowledge that the undersigned mental health professional objects to you recording any portion of your sessions without the mental health professional's written consent. You expressly agree that audio and video recordings used for security purposes are not part of mental health services, and are therefore not protected by confidentiality or any other provisions under this agreement.
Duty to Warn
In the event that the undersigned mental health professional reasonably believes that you are a danger, physically or emotionally, to yourself or another person, by signing this information and consent form below, you specifically consent for the mental health professional to warn the person in danger and to contact any person in position to prevent harm to yourself or another person, in addition to medical and law enforcement personnel.
This information is to be provided at your request for use by said persons only to prevent harm to yourself or another person. This authorization shall expire upon the termination of your mental health services with the undersigned mental health professional.
You acknowledge that you have the right to revoke this authorization in writing at any time to the extent the undersigned mental health professional has not taken action in reliance on this authorization. You further acknowledge that even if you revoke this authorization, the use and disclosure of your protected health information could possibly still be permitted by law as indicated in the copy of the Notice of Privacy Practices of the undersigned mental health professional that you have received and reviewed.
You acknowledge that you have been advised by the undersigned mental health professional of the potential of the redisclosure of your protected health information by the authorized recipients and that it may not be protected from unauthorized disclosures as required by the federal Privacy Rule.
You further acknowledge that the treatment provided to you by the undersigned mental health professional was not conditioned on you providing this authorization.
Mandated Reporting
Under certain State Law, persons in designated professional occupations are mandated to report suspected child or vulnerable adult abuse or neglect. Persons who work with children and families and vulnerable adults are in a position to help protect them from harm. These persons may be required by law to report to child protection or local authorities if they know or have a reason to believe that a child or vulnerable adult is being abused or neglected or that a person has been neglected or abused within a certain timeframe. As a mandated reporter, the mental health professional may be required to break confidentiality and report certain information to the appropriate authorities.
Substitute Professional
In the case that the healthcare provider(s) you usually see at the Company are temporarily absent for any reason, you authorize alternate professionals to work with you on your behalf and to review your file to determine reasonable next steps, as is appropriate for the circumstances.
Mental health professional's Incapacity or Death
You acknowledge that, in the event the undersigned mental health professional becomes incapacitated or dies, it will become necessary for another mental health professional to take possession of your file and records for administrative purposes, but not necessarily to become your mental health professional. By signing this information and consent form below, you give consent to allowing another licensed mental health professional selected by the undersigned mental health professional to take possession of your file and records and provide you with copies upon request, or to deliver them to a mental health professional of your choice and also to provide you with simple notifications of updates of the Company transition. The Company will select a successor mental health professional within a reasonable time and will notify the appointed licensed mental health professional.
Mental Health Professional Testimony
Although it is the goal of the Company to protect the confidentiality of your records, there may be times when disclosure of your records or testimony will be compelled by law. In the event disclosure of your records or the mental health professional's testimony are requested by you or required by law, regardless of who is responsible for compelling the production or testimony, you will be responsible for and shall pay the costs involved in producing the records and the hourly rate charged by the mental health professional at the time of the request or service of the subpoena (current rate is $550/hour) for the time involved in traveling to and from the testimony location, reviewing records and preparing to testify, waiting at the location, and giving testimony. Such payments are to be made at the time or prior to the time the services are rendered by the mental health professional. The mental health professional may require a deposit for anticipated court appearances and preparation. You will not be entitled to a pro-rated refund.
Termination of Relationship
The undersigned mental health professional may set boundaries including forms of client interactions and communication including ceasing to provide services to you for good cause, including without limitation: your refusal to comply with treatment recommendations, the undersigned mental health professional or staff is uncomfortable working with you, you no show or late cancel 3 times in a 12 month period, or your failure to timely pay fees or deposits in accordance with this Agreement, subject to the professional responsibility requirements to which the undersigned mental health professional is subject.
Conflicts of Interest
Mental health professionals avoid conflicts of interest in treating minors or adults involved in custody or visitation actions by NOT performing evaluations for custody, residence, or visitation of the minor. Mental health professionals who treat minors may provide the court or mental health professional performing the evaluation with information about the minor from the mental health professional’s perspective as a treating mental health professional, so long as the mental health professional obtains appropriate consents to release information. To avoid clinical conflict of interest, the Company will not see family members of current clients.
Pre-Licensed Mental Health Practitioner
The Company may make use of pre-licensed mental health professionals, which are individuals in the mental health field working toward their professional licensure in mental health services under an approved tract allowed by law. This means that the practitioner does not have a license. The practitioner is authorized to provide services while under supervision of a licensed professional. You understand this engagement and you consent to it by signing this Agreement. You have had the opportunity to ask questions about the engagement. You may continue to ask questions or voice concerns at any time. You may request to not have a pre-licensed mental health professional, but this may mean that services are unable to be rendered at the Company.
Legal
This Agreement shall be construed in accordance with, and governed by, the laws of the State of Minnesota as applied to contracts that are executed and performed entirely in the State of Minnesota. The exclusive venue for any court proceeding based on or arising out of this Agreement shall be the county of the business address of the Company. The parties agree to attempt to resolve any dispute, claim or controversy arising out of or relating to this Agreement by arbitration, which shall be conducted under the then current arbitration procedures of the American Arbitration Association any other procedure upon which the parties may agree. The parties further agree that their respective good faith participation in arbitration is a condition precedent to pursuing any other available legal or equitable remedy, including litigation, arbitration or other dispute resolution procedures. If any legal action or any arbitration or other proceeding is brought for the enforcement of this Agreement, or because of an alleged dispute, breach, default or misrepresentation in connection with any of the provisions of this Agreement, the successful or prevailing party or parties shall be entitled to recover reasonable attorneys’ fees and other costs incurred in that action or proceeding, in addition to any other relief to which it or they may be entitled.