The following has been prepared in order to facilitate our work together. Please read this document carefully and communicate any concerns so they may be addressed immediately.
Confidentiality
The law, professional ethics, and common sense require that information disclosed within sessions is confidential and may not be revealed to anyone without your written permission. There are, however, some exceptions to the rule where disclosure is required by law: where there is a reasonable suspicion of child, dependent or elder, abuse or neglect; where a patient presents a threat to safety or danger to self, to others, to property, or is gravely disabled, or when required by a court of law. When applicable, insurance Providers, other healthcare providers, and other third-party payers may be given information related to services rendered. More details are available upon request of our Notice of Privacy Practices.
Patient Portal: Registration and Online Scheduling
All scheduling is completed online using our portal “Patient Ally”, which can be accessed through our website or at www.PatientAlly.com, in lieu of contacting us by phone. Your cooperation leaves us more available to tend to more important aspects of your care.
When registering, you will receive an email from Patient Ally with a link to the portal. Once you create an account, complete any paperwork under the “Documents tab”. Call us if you have difficulty using Patient Ally.
Follow-up appointments will be confirmed within about 1 business day in the portal. Request to reschedule or cancel appointments through the messaging feature of the portal. For your convenience, you may receive optional appointment reminders through our automated system via text, email, or phone call. Note that visits scheduled through Patient Ally are visible in the Patient Ally portal, visits scheduled by phone or in-person are not visible in the portal. Therefore, you are responsible for marking your appointment times on your personal calendar. Please use Patient Ally to keep your information up to date, such as by messaging us changes to your home address, phone number, insurance, and emergency contact information as needed.
Contact Procedures
Phone/Patient Portal: For non-emergency matters, contact us by phone at (760) 650-2290 during business hours or through the online portal. We typically respond within 1-2 business days during normal business hours. Messages left after 5 pm on Fridays will be returned at the beginning of the next week. Please use the portal for routine scheduling in lieu of contacting us by phone if possible. If there is limited unscheduled telephone consultation of an urgent matter between normal sessions, and it is 10 minutes or less, then there will be no charge. However, please bring any concerns related to your treatment to your face-to-face appointments, which are not always ideal to address by phone or portal messaging. If you need to send us documents but are not using the portal, there is an alternative, secure file uploader on our website.
Telehealth/Virtual Appointments: Instructions for attending virtual appointments are listed on our website under the Telehealth FAQ. Please note the messaging feature of the telehealth application is only for communication with your doctor during your visit or exchanging documents. Scheduling staff do not have access to this feature. If you need to cancel or reschedule, you must contact us through our ordinary phone/portal contact procedures.
Email/Text/Social Media: We primarily communicate with patients through our secure patient portal and by phone. We do not use standard email for patient care. Social media contact is discouraged. We may use text messaging for limited administrative purposes such as appointment scheduling and coordination. Text messaging is not a secure or encrypted form of communication and should not be used for clinical concerns or urgent matters. We will never sell your information. Always reserve issues of a clinical nature for your face-to-face sessions with your providers.
By providing us your mobile number, you agree to receive messages related to routine scheduling communications. Message frequency varies, and standard message and data rates may apply. You have the right to OPT-OUT receiving messages at any time. To OPT-OUT, reply "STOP" to any text message you receive from us. Reply HELP for assistance.
Emergency procedures: In case of an emergency, call 9-1-1 or go to the nearest emergency room. The San Diego County Access and Crisis line is available 24/7 by calling 1(888)724-7240.
Medication refills: Please request medication refills at a minimum of 5 business days in advance. Dr. Arora may require an in-office visit for medication refills, so please plan accordingly.
Payment for Services
Payments for services are due at the time the service is rendered or a charge is incurred. Charges may include co-insurance costs, balances not covered by insurance, and late cancellation or no-show fees. We accept check, cash, or credit/debit card. Our fees are periodically raised with reasonable advance notice. Please notify us if any problem arises during the course of our work together regarding your ability to make timely payments. If you have not remit payment for outstanding balances or set up a fee payment plan within 90 days of charges, your account may be sent, with reasonable notice to you, to a collection agency.
A holder of this medical debt contract is prohibited by Section 1785.27 of the Civil Code from furnishing any information related to this debt to a consumer credit reporting agency. In addition to any other penalties allowed by law, if a person knowingly violates that section by furnishing information regarding this debt to a consumer credit reporting agency, the debt shall be void and unenforceable.
All patients are required to keep a credit card on file in case you choose not to arrange for an alternative means of payment at the time a charge is incurred or in case you do not update us with your residential address for invoicing. Your cooperation with this matter leaves us more available to tend to more important aspects of your care. You may request a detailed statement of charges or payments at any time.
Your bank statement may include a charge that states luciditysleeppsych.com. If you mistakenly initiate an unauthorized chargeback request through your bank or the card processor, you will be charged the fee again, plus any fees acquired for the error, plus an additional $25 administrative fee. You are responsible for keeping your credit card up to date. We will inform you immediately if you miss a payment for a service. You then have 10 business days to re-submit payment for that service. Otherwise a late payment fee of $25 for each unpaid charge will be incurred. Checks returned for insufficient funds will be billed to you in addition to bank fees incurred, plus an extra $25 fee. If you use a personal check, please fill it out prior to session rather than during or after your appointment. Checks may be made out to Lucidity Sleep Psychiatry.
By initialing below and signing this form, I, the patient (or the patient’s representative), acknowledge that payment is due at the time a service is rendered or a charge is incurred. I authorize that my credit card on file may be charged if I do not arrange for alternative means of payment prior to incurring a charge. I acknowledge these charges may include fees for missed appointments or late cancellations.