Spectrumbehavioralhealthny.com-Billing Policies And Procedures

SPECTRUM BEHAVIORAL HEALTH

New In-take Fax: 845-485-8780

Poughkeepsie Fax: 845-452-7546 / Fishkill Fax: 845-897-3376 / Kingston Fax: 845-331-1479

Click the check box on each line to indicate that you have read and accept these policies:*

Appointments must be cancelled 24 hours before the appointment(s) or patient will incur a missed appointment fee of $30 per appointment scheduled. Messages will not be accepted for cancellation. Please find the listing of the office phone numbers and hours at the bottom of this page.Personal checks returned for any reason will incur a $50.00 fee per time presented for payment. All checks returned for Non-Sufficient Funds (NSF) will be electronically debited for the face value of the checks, plus a returned processing fee as allowed by state law.Co-payments, co-insurance, and deductibles are payable at the time of service. If patient's account has a balance, patient or patient's guarantor will be required to settle balance before additional appointments may be made. We do not bill for co-payments are deductibles. They are due at the time of service.Prescription refill requests may take up to 72 business hours to complete. A $35 processing fee is required to refill prescriptions. Payment must be received before prescription refills are released. Patients who attend their visit to obtain prescription refills will not be charged this fee. We recommend that patients make medication management appointments at least two weeks before the patient will run out of medication to avoid any unnecessary crisis.Late arrival to appointments where Spectrum Behavioral Health scheduling is unable to accommodate flexibility will result in a $30 missed appointment fee per appointment.Spectrum Behavioral Health makes every effort to keep the patient's scheduled appointment time. However, in case of clinical emergencies, the patient may have to wait a few extra minutes.Billing cycle statements will be sent to the address you specify. If payment or balance has not been received after the bill is received, or if the mail is returned as undelivered, the patient's account may be transferred to an outside collection agency or legal firm to further collection efforts and a collection fee will be incurred on the account. Collection and/or legal fees are disputable and non-negotiable. Patients must verify and update their insurance, address, and contact information atPatient is responsible for notifying Spectrum Behavioral Health, promptly, of any changes in address, phone number and/or insurance to avoid incurring additional fees and collection activity.Patient with Medicare Part B and Medicaid of New Jersey as secondary, please be advised that Spectrum Behavioral Health DOES NOT accept Medicaid. Patient will be responsible for co-insurance after Medicare Part B payment in this situation.

Poughkeepsie Office: 514 Haight Avenue, Poughkeepsie, NY 12603. Phone: (845) 485-3506
Fishkill Office: 789 Route 9, Fishkill, NY 12524. Phone: (845) 897-2384
Kingston Office: 65 Albany Avenue, Suite B, Kingston, NY 12401. Phone: (845) 331-1079
New In-Take Appointments: (845) 485-9098
Billing Office: HealthQuist. Phone: 1(800) 403-2300

*** For medical records, there will be a $1 fee per page printed. Medical records will take approximately 14-28 business days.
Click box below and use the mouse or your finger to sign to acknowledge that you have read and understand our Billing Polices and Procedures

Signature*

Print Name*

First NameLast Name

Date*