Welcome to Integrative Psychiatry

We are pleased that you have selected Integrative Psychiatry as your mental health provider and look forward to getting to know you and providing the highest quality of care. Integrative Psychiatry is a private outpatient practice, dedicated to providing holistic and integrated treatment for each individual patient. We strive to identify and treat the underlying cause(s) and contributor factors to mental health symptoms, by evaluating and treating the whole person. Integrative psychiatry provides practical guidance for incorporating complementary and alternative medicine and therapeutic modalities with an understanding that the mind, body, and spirit are all interconnected. By providing cutting-edge psychiatric care, including advanced psychopharmacology, pharmacogenetic testing, nutrition coaching, spiritual guidance, and mindfulness-based therapy; Integrative Psychiatry creates a nurturing, yet comprehensive environment for all. In this packet you will find many important details about our clinic and its procedures. Please review in its entirety and if you have any questions, please call the office. We are here to help and look forward to assisting with your mental health needs.

Office Hours and Emergency Services

Integrative Psychiatry is open Monday through Friday. Our hours of operation are as follows:

Monday – Thursday: 9 am to 5 pm

Friday: 9 am to 4 pm

Saturday – Sunday: closed

Integrative Psychiatry does not offer after hours services or on-call crisis response. In case of an emergency, please call 911, or go to the nearest emergency room for further evaluation.

About Integrative Psychiatry

Vision Statement: Our vision is to provide all encompassing services by treating the mind, body, and spirit; with a passion in eliminating mental health stigma within the community.

Mission Statement: Integrative Psychiatry’s mission is to create a sustainable healing space where practitioners focus on treating the whole person by using the modalities and elements of integrative practice.

Appointments and Scheduling

The recommended length of treatment and frequency of sessions varies for each individual patient and their unique set of circumstances.

Please arrive on time. If you are late, your provider may not be able to meet with you, and you will be asked to re-schedule. You will be charged a late cancelation fee of $25 if you arrive more than 10 minutes past your scheduled appointment time, unless an appointment is rescheduled within the same week with your current provider.

Weather Policy

In the event of inclement weather, please watch the local news for the list of local business closings. Appointment cancellations or appointment rescheduling may also be done at the discretion of each individual provider. Your provider will notify you via phone call if your appointment will be cancelled or transferred to Telehealth. A sign will be posted in the office notifying patients of any other scheduled clinic closings.

Confidentiality

Integrative Psychiatry will follow state and federal law regarding the confidentiality of private and protected health information. To permit proper coordination of care, we ask you to sign an Authorization to Release Information when the law requires a patient's authorization to disclose information to a third party. There are exceptions to the requirement of patient authorization. The following are examples of situations when disclosures are permitted without patient authorization:

• If you are sent by the court for evaluation or treatment; the court typically requires a report.
• If the records are subject to a subpoena or court ordered.
• If you make a threat to harm yourself or others , or there is any concern about someone’s safety ; ethical standards of practice require s every effort to protect our patients and the public from harm ; therefore, reporting safety concerns to author ities, including police or DHHS, is mandated by the law .

Medical Records, Forms & Letters

There is a minimum of $20.00 for medical records and an additional .20 cents per page for records exceeding 100 pages. All fees are collected prior to records being collected – please note, there are no fees for faxing records from provider to provider. A two-week duration is expected to gather appropriate records.

There is a $20.00 fee for the completion of forms or letters. Additional charges may be applied depending on the nature and complexity of the form and/or letter. The minimum fee will be collected prior to the provider initiating work on the requested forms. Please allow 7-10 business days to complete all forms or letters. A signed Authorization to release or request information may be required to process your request.

Communication and Social Media

At Integrative Psychiatry, we want to make communication with you as convenient as possible. Unless you instruct us otherwise, we will communicate with you about scheduling via phone and voice messaging using the preferred contact information you provided. By signing this form, you understand the risks in receiving protected health information via unencrypted (unsecured) phone messages and that such messages could be heard by a third party. You can always update your preferences with the front desk staff if applicable.

I understand that I, having warranted authority to do so, hereby grant to Integrative Psychiatry and its agents and independent contractors’ consent to call for billing and debt collection purposes any wireless/cell phone numbers that I provide to Integrative Psychiatry, and if I discontinue use of any phone number provided, I shall promptly notify Integrative Psychiatry and hereby indemnify Integrative Psychiatry and its agents and independent contractors from any expenses or other loss arising from any failure to notify.

When communicating with your provider, please call the office and leave a detailed message with your provider and/or medical assistant. This allows all patient phone calls to be documented in the patient’s chart for records and treatment purposes.

Social media should not be used to communicate with us about your care, schedule appointments, or refills. WE WILL NOT RESPOND to social media conversations.

Discharge from the Practice

There are times when professional relationships do not work and an alternative provider is recommended. When certain situations arise, it may be necessary for Integrative Psychiatry or an individual provider to terminate the patient provider relationship. In this event, you will receive a written notice to allow you time to locate another provider. At the end of the notice period, you can no longer schedule appointments, obtain medication refills, or consider us to be your provider. You will have to find another practice for your services.

Common Reasons for Dismissal Include (but are not limited to):

• Failure to keep appointments, frequent no-shows
• Noncompliance or failure to follow provider instructions on treatment recommendations
• Abusive to staff
• Disrespectful / Destructive behavior of child or patient
• Failure to pay your bill

Financial Policies

Understanding your financial responsibilities is important to your financial health and an essential element of your care and treatment.

Benefits Verification

It is your responsibility to verify your insurance coverage, including obtaining pre-authorizations as required. We ask that you provide benefit information when scheduling your first appointment. When this information is provided, we will bill your insurance accordingly. If you do not have health insurance, out of pocket fees will be collected prior to each appointment.

Minors & Patients With Divorced Parents

Parent or guardian must submit custody decree to keep on file at Integrative Psychiatry. Integrative Psychiatry staff and providers will be expected to follow the court order. We will not follow verbal requests or declarations. Whoever (parent, grandparent, babysitter, etc accompanies a minor to his/her appointment is expected to bring payment at the time of service. It will not be billed. For separated or divorced parents, payment is expected from the parent bringing the child in for treatment. We will not bill another parent for payments due at time of service; regardless of which parent is responsible for the insurance.

Private Pay/Cash Discounts

Because there are fees associated with billing insurance companies and third-party payers, we offer a 10% discounted rate for insurance eligible services when you choose to pay privately. When using this option, it is expected that you pay at the time of service, which further reduces the cost of sending statements.

Insurance

Your insurance policy is a contract between you and your insurance company. It is your responsibility to know and understand the provisions, limits, and requirements of your benefit plan(s).

We will file your insurance claim for you; however, we cannot guarantee benefits or payments. You remain financially responsible for all services provided by this office.

If your insurance carrier denies payment for services, you remain financially responsible for payment regardless of any insurance company determination, quote, or misquote, except where prohibited by law or prior contractual agreement.

Please bring your current insurance card to each visit and notify our staff of any changes in your coverage, address, telephone or family status.

Co-Payments, Deductibles, and Fees

All co-payments, insurance deductibles, and fees for services not covered by insurance are DUE AT THE TIME OF SERVICE.

If your deductible has not been met, we will expect payment in full prior to each appointment. Following your deductible being met, we will expect that you pay your co-pay at the time of each visit.

We accept cash, checks and credit cards. Payments are accepted by phone. If checks do not clear, or are returned due to insufficient funds, a charge of $30 will be added to the bill.

Billing Statements

The balance on your statement is due and payable upon receipt. To avoid any financial stress, we ask that you pay your balance within 30 days. After this period, it is considered past due. If the balance is not paid in full or other arrangements are not made with our office, the front desk and/or providers will not be able to schedule any future appointments.

• Payments can be made in person, by mail, or by phone.
• If your account balance is overdue by sixty (60) days or more or you have a balance of $ 2 00 or  more, with no attempt to set up a payment plan; future appointments will be cancelled, and you  may not be given the opportunity to make a new non - emergency appointment until payment is made.
• If your account  is 120 days past due and a formal payment plan is not in place, your account will be sent to a collection agency and you will be responsible for all fees incurred from the collection agency and/or attorney.
• Financial noncompliance may result in termination from the practice.

Cancelled, Late and Missed Appointments

Missed appointments without proper notification of at least 24 hours, results in time being blocked from other patients. Please understand, this is a standard practice and policy to ensure that we can provide efficient services to all our patients; therefore, the following policies apply:

• Patients will be charged a late cancelation fee of $25 if you arrive more than 10 minutes past your scheduled appointment time, unless an appointment is rescheduled within the same week with your current provider.
• I agree to A MINIMUM OF 24 HOURS NOTICE OF CANCELLATION for appointments. I understand that I WILL BE CHARGED FOR THE SESSION FOR MISSED APPOINTMENTS without the minimum notification as outlined below. Insurance companies do not reimburse for missed appointments. Therefore, charges incurred for missed appointments are the responsibility of the patient.
  • First missed appointment (no show/canceled): $25 charge
  • Second missed appointment: $100 charge
  • Third missed appointment and discharged from care: $150 charge
  • Medicaid patients will not be charged. However, after 2 missed appointments you will be dismissed as a patient and will need to find other services. Appointments may be made during our walk-in clinic hours after two missed appointments, under the discretion of your provider, as not all providers offer this service.
  • Missed appointment fees must be paid before scheduling your next appointment.

Questions

It is important that you understand the expectations of your treatment at Integrative Psychiatry. Please let us know if there is anything in this document that you do not understand, or if you have any questions. We will be happy to assist you with any questions or concerns.

Acknowledgment

I have read and understood the attached policies of Integrative Psychiatry and its independent contractors.  I agree to be bound by these policies when accepting care at Integrative Psychiatry. 

I agree to assign insurance payments to be made directly to Integrative Psychiatry, for services rendered.

Visitor Confidentiality Statement

I agree to keep confidential any and all information I may have access to during my visit at Integrative Psychiatry.

I understand that this confidentiality statement extends to the use of any client’s first or last name, address, or any other information which could identify them when discussing general client information in any public meeting or place. In addition, information regarding a client’s diagnosis, prognosis, or treatment is confidential. I understand that this confidentiality statement also extends to any written materials that may be viewed by the general public.

In addition, I understand that if I recognize or think I know a client within the clinic, I may not discuss that I saw them or are aware that they are connected with our clinic now or at any point in the future.