First and foremost, if you have any questions about insurances we accept - please call or text Kylie our intake coordinator. (405)437-0205

We do not accept United Health Care Dual Complete and United Health Care Advantage plans.

 

Please note we do not accept Aetna Better Health, but we do take Humana Healthy Horizons and Oklahoma Complete Health.

*The open enrollment period to change this insurance is May 1, 2025 to June 13th, 2025.

 

Because Spravato treatment is strictly regulated by FDA REMs guidelines there are certain rules that patients must follow to ensure our clinic remains compliant:

1. You must be monitored for the full two hours of your treatment sessions. This means you may not leave the monitoring room without asking for staff assistance and you must wait for them to come to you after pushing your call light versus getting up and leaving the room on your own. If you do not follow this rule you WILL NOT BE ALLOW TO CONTINUE TREATMENT with Spravato at our facility.

2. You must be on time for your treatments. If you are more than 15 minutes late you will be asked to reschedule your session and charged the late cancellation fee per clinic policy.

Because the treatment room is shared with other clients please be respectful of others.

1. Please refrain from talking or making unnecessary noise during your treatments. To get the most out of your treatment, we recommend using headphones or earbuds and listening to relaxing music. Please ask us if you would like suggestions for Spravato playlists. If you are consistently disruptive in the treatment room you will not be allowed to continue Spravato treatment at our clinic.

2. There is no smoking or vaping in the treatment room.

3. Please refrain from any strong odors in the treatment room. This means one must be bathed and free of strong body odors, fragrances or smoke smells.

Thank you so much for your understanding and cooperation with helping to keep our clinic in compliance and making the treatment setting pleasant for everyone.

FREQUENTLY ASKED QUESTIONS ABOUT SPRAVATO (SPRAVATO FAQs)

IS SPRAVATO SAFE?

Spravato is a very safe depression medication in the hands of properly trained healthcare professionals. Its use as a treatment for depression, including treatment resistant depression, and other mental health conditions. The appropriate dosage is determined by your physician, below those necessary to induce general anesthesia. Spravato is also frequently used to treat patients with treatment resistant depression.

 

IS SPRAVATO A RECREATIONAL DRUG?

Spravato is esketamine, however ketamine has been abused as a recreational drug. Street drug use is in doses vastly higher than the sub-anesthetic doses used for the treatment of depression and other mental health conditions. As mentioned above, Spravato is used legally and safely and is a very safe medication in experienced hands. Incidentally, many of the drugs used in anesthesia practice have the potential for abuse, so Spravato is not unique in this respect. The key is administering the right dose to the right patient in the right setting.

 

IS INTRANASAL SPRAVATO THE ONLY WAY TO DELIVER SPRAVATO FOR TREATMENT RESISTANT DEPRESSION?

Spravato is only administered intranasally. Unfortunately, the effectiveness and predictability of response and the overwhelming majority of scientific studies of Spravato for depression and mental health conditions have been performed using intranasal Spravato. In short, intranasal Spravato is the gold standard route for Spravato administration.

 

CAN SPRAVATO HELP ME?

Research over the last 5-10 years has shown that intranasal administration of Spravato in sub- anesthetic doses remarkably benefits 70% of people suffering from severe depression. While the benefits can truly be remarkable, they often occur in ways that differ from some patients' expectations. That is, the changes produced by Spravato can be subtle, and while they occur quickly, they do not always manifest themselves immediately. This phenomenon stands in contrast to some patients' expectations of a benevolent "thunderbolt" response from Spravato treatment. With this in mind, we will work closely with you to identify and evaluate the benefits of Spravato as a depression medication.

 

WHAT SHOULD I EXPECT DURING MY FIRST INITIAL SPRAVATO VISIT?

After we have received your medical and psychiatric history and completed acknowledgement of ongoing care by a mental health professional or primary care doctor, we will schedule an initial consultation. At the initial consultation, we will discuss all your options regarding treatment for depression and assess if you are a good candidate for Spravato intranasal administrations, you are welcome to receive your first Spravato treatment once all insurance benefits and authorizations have been completed. You would also need to be enrolled in the Spravato REMS program. The logistics are as follows: we will apply monitors to enable us to record your heart rate and rhythm, blood pressure, and oxygen level continuously throughout the treatment, then we begin the intranasal administration while you are seated with your head at 45-degree incline. Afterwards, we will monitor you for approximately 120 minutes (2 hours) before you are released with a friend or relative who can drive you safely home. During the treatment, occasionally people experience nausea, mild non-threatening hallucinations, or dizziness. If you experience nausea, we are equipped to treat it with an anti-nausea medication. You will be awake during the treatment and able to interact with those around you. It is best to relax quietly or listen to relaxing music during the session. The effects of Spravato wear off quickly, although we ask that you refrain from driving until the day after the treatment.Please do not eat solid foods, milk, pulp-filled juices or soup for 4-hours prior to your appointment. Youmay have clear liquids such as water, Gatorade, apple juice, black coffee or tea up to two hours prior to your appointment.

 

HOW MANY INTRANASAL ADMINISTRATIONS DO I NEED?

The standard Spravato protocol for depression that has resulted from scientific trials and clinical experience around the U.S. is about 2 times per week for the first 4 weeks, and then weekly for 2 - 4 weeks and then maintenance. It has been shown that serial intranasal administrations are more effective than single intranasal administrations, and many patients who respond to Spravato treatment require maintenance intranasal administrations on an ongoing basis following the initial series. The frequency of these maintenance intranasal administrations varies greatly from person to person. It is important to note that Spravato intranasal administrations should not be viewed as a cure for depression, but rather a depression treatment that is a piece of a multi-modal approach that may include ongoing mental health therapy or other depression medication.

 

CAN I CONTINUE TO TAKE MY REGULAR MEDICATIONS?

Yes, you should not stop your antidepressant medications in order to receive Spravato. It is essential that we review your current medication list prior to beginning Spravato treatments.IS SPRAVATO ADDICTING?Spravato is not physically addicting but it could be psychologically addicting in those using it recreationally at much higher doses and in far greater frequencies than we will use. There is potential for abuse and misuse. Consider the risks and benefits of using Spravato prior to use in patients at higher risk of abuse. All patients will be monitored for signs and symptoms of abuse and misuse.

OTHER SPRAVATO FAQs

Is there a difference between Spravato Nasal Spray and Ketamine Infusions?
Spravato (esketamine) is the s-enantiomer of racemic ketamine. There are no head-to-head studies comparing esketamine and ketamine infusion. Spravato (esketamine) is delivered in a nasal spray form and ketamine is delivered intravenously.

Are there Samples of Spravato?
There are no samples of Spravato available—in accordance with federal guidelines, which prohibit the distribution of samples of class III medications.

How much does Spravato Cost?
The cost of Spravato is dependent on your insurance plan.

Can Spravato be taken with other medications for depression?
Spravato should be administered in conjunction with an oral antidepressant (AD). The new open-label oral AD initiated during Study 1 (short-term) was an SSRI in 32% of patients and an SNRI in 68% of patients.

What if a patient misses a dose of Spravato?
If a patient misses treatment session, and depression symptoms worsen, consider returning your patient to previous dosing schedule (i.e., every 2 weeks to once weekly, once or twice per week), per clinical judgment.

Can I pick up Spravato and self-administer at home?
No, under the REMS, Spravato must be administered in a certified healthcare setting. Due to the possibility of delayed or prolonged sedation or dissociation in some cases, patients should be monitored by a healthcare professional for at least 2 hours following each treatment session, or until the clinician determines the patient is safe to leave.

Ethical Responsibility in Service Delivery

• Counselors and other health care providers respect diversity and must not discriminate against consumers for any reason.

• Counselors and other health care providers must make every effort to avoid dual relationships with consumers.

• Counselors and other health care providers must not engage in any type of sexual intimacy with consumers.

• Counselors and other providers must take steps to protect consumers from trauma resulting from interactions during group work.

• Counselors and other providers must terminate any counseling relationship if it is determined that they are unable to be of assistance.

• Counselors and other providers must keep information related to counseling services confidential, except in very specific circumstances as outlined in Rights of Persons Served.

• Counselors and other providers must not disclose information about one family member in counseling to another family member without prior consent.

• Counselors, other providers and staff must maintain confidentiality with all records at all times.

• Counselors  and other providers must obtain permission before recording sessions or transferring records.

• Counselors and other providers must not engage in sexual harassment or receive any personal gains, goods, gifts, or services.

• Counselors and other providers must communicate to group members that confidentiality cannot be guaranteed in group work.

CLINICAL POLICIES CONSENT

APPOINTMENTS
Appointments for medication sessions are required at least every three months for continuity of care and for patient monitoring. If medication adjustments are needed, appointments are dictated at the discretion of the provider. NEW medications are not prescribed without being seen due to the potential complexity of the medication, need for consent and thorough discussion and understanding of the risks and benefits of use. If prescribed a new medication, please know that you will follow-up at two weeks and at one month after starting the new medication or sooner at the discretion of the provider.

 

*Please note - a no show is considered being more than 15 minutes late for an appointment.

MEDICATION REFILLS
All prescription requests should be handled during scheduled office appointments. In extreme cases, refills will be handled within 3-5 business days (not including weekends or holidays) by email at officemanager@psychiatricwellness.org. Please keep up with your supply of medication to avoid running out. We are not equipped to handle emergent needs, so please plan accordingly.

CONTROLLED SUBSTANCES
Our clinic does not prescribe any benzodiazepines or other controlled substances. It is the patient’s responsibility to seek care at the nearest Emergency Room if experiencing symptoms of withdrawal.

MEDICAL LETTERS
Extended documentation including FMLA/disability paperwork are billed at $50.00-$150.00. If you require simple school/work letters for absences there is no a charge. Payments for documentation should be done at our office at time of request. Once the payment is complete, the document will be released. Please note that a Release of Information (ROI) is also required. ROIs are available at the time of your appointment or from our website.

TELEPHONE CALLS AND EMAILS
**PLEASE RECOGNIZE THAT WE ARE NOT AN EMERGENT OR CRISIS CARE FACILITY**
We typically return calls or emails within 24-48 hours during business hours. Please do not email with questions about treatment as these must be addressed during appointments.

DISCHARGE FROM THE CLINIC
Psychiatric Wellness APRN-CNP PLLC reserves the right to discharge any patient from treatment if concerns about the safety of the patient or provider occur. Examples include:
• Taking more or less medication than prescribed.
• Chronic lateness, no-shows, or cancellations without giving 24-hour advanced notice.
• Abuse of email or telephone calls (emails are only for brief communication). New medication(s) will NOT be filled via email or phone calls.
• Threatening behavior or harassing staff in any way (argumentative, verbally, physically, etc.).
• Not completing labs, recommended outpatient therapy, or other modalities and treatments as ordered.
• Abuse of the controlled substance policy. If you are discharged from our care, you will be provided with appropriate referrals upon request as well as a 30-day refill to give you enough time to find a new provider.
I have read through Psychiatric Wellness APRN-CNP PLLCs Clinic Policy forms and have been given a copy. I agree to follow the policies as set forth in the policy. I understand that if I do not follow certain guidelines as instructed in the policy that I may risk being removed from the care of Psychiatric Wellness APRN-CNP PLLC.

Please note threatening behavior such as yelling or cussing at providers or staff at Psychiatric Wellness is grounds for *immediate* discharge.

CONSENT FOR TREATMENT FORM

The undersigned patient or responsible party (parent, legal guardian or conservator), consents to, and authorizes services by Psychiatric Wellness APRN-CNP PLLC. These services may include psychotherapy, medications, laboratory tests, diagnostic procedures, and other appropriate alternative therapies.

The undersigned understands that he/she has the right to:
1. Be informed of and participate in the selection of treatment modalities.

2. Receive a copy of this consent.

3. Withdraw this consent at any time.

Financial Policy

Thank you for choosing Psychiatric Wellness APRN-CNP PLLC for your mental health care. This policy has been put in place to ensure that financial payments are recovered to allow us to continue to provide our patients with quality care. It is important that we work together to assure that payment for service is simple and straightforward. We will be happy to discuss these policies with you. Please carefully read each statement and sign below.

1. I understand that there is a $50 deposit *required* to secure your appointment. This $50 will be put towards the initial evaluation fee of $200. Exceptions are Medicaid/SoonerSelect programs and patients that are on the financial hardship program. *Please call/text Kylie 405-437-0205 intake coordinator with any question in regards to the financial hardship program.

2. I understand that if I do not have my insurance card, referral, co-payment, deductible, and/or coinsurance, that my appointment may be rescheduled until such time that I can provide the required documents or payments.

3. I understand I am financially responsible for any copayments, deductibles, coinsurance and all charges, which are not covered by my insurance. I understand that verification of coverage is not a guarantee of payment of benefits. My insurance company determines benefit payments. I understand I will be responsible for the portion not covered by my insurance. I understand I am responsible for knowing my financial responsibility for all tests and procedures.

4. I understand that copays are due the day before or the day of service. *NO EXCEPTIONS* If unable to pay copay, or card is declined - please reschedule within 24 hours to avoid $150 fee. *IF your card is declined, Psychiatric Wellness reserves the right to reprocess the payment during the subsequent 5 business days.*

5. I understand that if I am unable to make a scheduled appointment I need to contact the office at least 24 hours prior to my scheduled appointment. A $150 FEE WILL BE ASSESSED FOR ALL MISSED APPOINTMENTS CANCELLED OR RESCHEDULED WITH LESS THAN 24-HOUR ADVANCED NOTICE, EXCLUDING WEEKENDS AND FEDERAL HOLIDAYS. (Fee is subject to inflation and cost of treatment at the time fee is incurred)

6. I understand that missed appointments will NOT be rescheduled until the $150 fee is paid.

7. I understand Psychiatric Wellness will suspend all future services in the event where 15 days pass by without payment made toward an overdue balance.

8. I understand that if the card on file declines payment after my account is more than 30 days overdue, AND I neglect to contact the office to establish a payment arrangement, a collection-processing fee will be added to the outstanding balance and sent to a collection agency. The collection agency will also add additional processing fees to the total due.

PATIENT/PROVIDER EMAIL CONSENT FORM

Psychiatric Wellness APRN-CNP PLLC offers patients, parents or guardians the opportunity to communicate by email. Using email to discuss patient information, however, is different than phone messaging.

E-mail communication has several possible risks that patients, parents or guardians should consider before using. If the patient, parent or guardian is concerned about information being seen by other people, an alternative form(s) of communication such as telephone communication should be used, and the method choice should be chosen below.
Please recognize that we are not a Crisis or Emergent clinic. Any questions that arise are usually answered within 24-48 business hours, Monday through Friday only.
We also ask that you follow the policy and refrain from asking for medication adjustments or for information that can be utilized during a follow-up medication session. Email should strictly be used for difficulties obtaining medications at the pharmacy, appointment requests, or for rescheduling. You may call us at 405-437-2240 and leave us a message.

PATIENT ACKNOWLEDGEMENT AND AGREEMENT
I acknowledge that I have read and fully understand the information the Provider/Practice has provided me regarding the risks of using e-mail. I understand the risks associated with the communication of email between Provider/Practice and I and consent to the conditions outlined. In addition, I agree to the above instructions, as well as any other instructions that the Provider/Practice may impose regarding email communications. By signing below, I am agreeing to use email communication and have been informed of the risk.

Notice of Privacy Practices Agreement

1. Your medical records are used to provide treatment, bill and receive payments, and
conduct healthcare operations. Examples of these activities include but not limited to
review of treatment records to ensure appropriate care, electronic or mail delivery of
billing for treatment to you or other authorized payers, appointment reminder telephone
calls, and records review to ensure completeness and quality of care. Use and
disclosure of medical records is limited to the internal used outlined above except
required by law or authorized by the patient or legal

2. Federal and State laws require abuse, neglect, domestic violence and threats to be
reported to social services or other protective agencies. If such reports are made, they
will be disclosed to you or your legal representative unless disclosure increases risk of
further

3. Disclosed information will be limited to the minimum necessary. You may request an
account for any uses or disclosures other than those described in Sections 1 and
Sections 2.

4. You, or your legal representative, may request your records to be disclosed to yourself
or any other entity. Your request must be made in writing, clearly identify the person
authorized to request the release, specify the information you want disclosed, the name
and address of the entity you want the information released to, purpose and the
expiration date of the authorization. Any authorization provided may be revoked in
writing at any time. Psychotherapy notes are part of your medical records. We have 30
days to respond to a disclosure request and 60 days if the records is stored off site.

5. You may request corrections to your records.

6. A request for disclosure may be denied under the following circumstances: disclosure
would likely endanger the life or physical safety of you or another person, requested
information references other persons, except another healthcare provider, or if released
to a legal representative would likely result in harm.

7. If a request for disclosure is denied for reasons outlined in Section 6, you or your legal
representative may request review of the denial. A review will be conducted by another
licensed healthcare provider appointed by the original reviewer, who was not involved in
the original decision to deny access. A review will be concluded within 30 days.

8. You may request that we restrict uses and disclosures outlined in Section 1. However,
we are not required to agree to the restrictions. If an agreement is made to restrict use or
disclosure, we will be bound by such restriction until revoked by you or your legal
representative orally or in writing except when disclosure is required by law or in an
emergency. We may also revoke such restrictions, but information gathered while
required by law or in an emergency. We may also revoke such restrictions, but
information gathered while the restriction was in place will remain restricted by such an
agreement.

9. If you wish to complain about privacy related issues you may contact the Secretary of
the Department of Health and Human Services, Hubert H. Humphrey Building, 200
Independence Avenue SW, Washington DC, 20201. In any case there will not be any
retaliation against you or your legal representative for filing a complaint.

10. This agreement may be modified or amended as required by law or in the course of
health care operations.

Payment Policy Consent Form

Please note that if you are using insurance to pay for part of your visit cost that YOU ARE RESPONSIBLE for verifying your insurance and being aware of any copays, co-insurances, deductibles and costs for any third party services that may be a part of your insurance plan.

Examples of third-party services include LABORATORY SERVICES and referrals to OTHER HEALTH CARE PROFESSIONALS. Staff at Psychiatric Wellness will attempt to verify these as well prior to your first visit but please know that it is ultimately your responsibility to verify directly with your insurance company.

Pricing for paperwork to be filled out is $2.50 per minute with a 15-minute minimum if paperwork is filled out by the provider outside of sessions.

Psychiatric Wellness collects copays, coinsurance and deductibles for follow up visits on the day the visit is scheduled versus after the visit has occurred. Please note that these charges will be made to the credit card that you have on file with us.

YOU ARE RESPONSIBLE for letting the office know as soon as you are aware of any UPCOMING INSURANCE CHANGES. If the office is not notified and insurance does not pay, you will be responsible for the full amount of services rendered.

If there are outstanding charges and you have not responded to messages from the office about this with a payment or payment plan within 30 days, the credit card you have on file will be automatically charged for your full outstanding balance.

Notice of Client Rights Form

Client’s rights shall include, but are not limited to the following:

A.   Each client shall retain all rights, benefits, and privileges guaranteed by law except those lost through due process of law.

B.   Each client has the right to receive services suited to his or her condition in a safe, sanitary and humane treatment environment regardless of race, religion, gender, ethnicity, and age, degree of disability, handicapping condition, legal status or sexual orientation.

C.   No client shall be neglected or sexually, physically, verbally, financially or otherwise abused or humiliated.

D.   Each client shall be provided with prompt, competent, and appropriate treatment and an individualized treatment plan. A client shall participate in his or her treatment programs and may consent or refuse to consent to the proposed treatment. The right to consent or refuse to consent may be abridged for those clients judged incompetent by a court of competent jurisdiction and in emergency situations as defined by law. Additionally, each client shall have the right to the following:

Allow other individuals of the client’s choice to participate in the client’s treatment and with the client’s consent; To be free from unnecessary, inappropriate, or excessive treatment; To participate in client’s own treatment planning; To receive treatment for co-occurring disorders if present; To not be subject to unnecessary, inappropriate, or unsafe termination from treatment; and to not be discharged for displaying symptoms of the client’s disorder.

E.   Every client’s record shall be treated in a confidential manner.

F.   No client shall be required to participate in any research project or medical experiment without his or her informed consent as defined by law. Refusal to participate shall not affect the services available to the client. Should a client choose to participate in a research project, PW will adhere to research guidelines.

G.   A client shall have the right to assert grievances with respect to an alleged infringement on his or her rights.

H.   Each client has the right to request the opinion of an outside medical, psychiatric, or legal consultant at his or her own expense or a right to an internal consultation upon request at no expense. Direction to self- help and advocacy support services is also provided.

I.   No client shall be retaliated against or subjected to any adverse change of conditions or treatment because the client asserted his or her rights.

J.   A client has the right to know why services were refused. In that event, PW will provide a written explanation of the reasons why services were not provided. 

K.   No client shall be subject to unnecessary, inappropriate or unsafe termination from treatment.

L.   Clients should expect an investigation of any infringement of rights. This process is outlined in the client Grievances policy.

M.   Each client has the right to receive services in an environment which provides privacy, promotes personal dignity, gives freedom from financial or other exploitation, and provides opportunity for the client to improve their functioning.

N.   Each client shall have a voice in the selection of their service provider. Client’s preferences will be taken into consideration and should it be necessary every effort will be made to find an alternate provider as determined by available resources. If resources are unavailable a referral will be made if the client so wishes.

O.   Each client shall be given the rights under the Americans with Disabilities Act of 1990. Clients will be referenced to "Americans With Disabilities Handbook" published in the U.S. Equal Employment Opportunities Commission and the U.S. Department of Justice.

 

Email & Text Communication Consent

I hereby consent and state my preference to have my provider and other staff at Psychiatric Wellness APRN-CNP PLLC communicate with me by email or standard SMS messaging regarding various aspects of my medical care, which may include, but shall not be limited to, test results, prescriptions, appointments, and billing. 

 

I understand that email and standard SMS messaging are not confidential methods of communication and may be insecure. I further understand that, because of this, there is a risk that email and standard SMS messaging regarding my medical care might be intercepted and read by a third party. 

 

Between-Visits Communication Policy Consent

Our providers often will communicate directly with clients after they have had their first visit via text or phone in between visits. This is mostly utilized for issues with prescription refills or short questions for which communication is free.

However, if a conversation about a more extensive such as a change to the treatment plan, ex: trying a new medication or wanting to discuss FMLA paperwork, then you will be charged for a phone visit. Sometimes insurance will pay for this and sometimes not but you will be ultimately responsible to make sure payment is received. Charges for these visits vary depending on the amount of time needed during the discussion and range from $40 to $100 (ex: a 7 minute discussion versus a 30 minute discussion). If longer than thirty minutes is needed, then an appointment needs to be scheduled.

 

Thanks,Elisabeth Mustachia, APRN, PMHNP-BC

For identification purposes, prior to scheduling we need the client's Driver License or State ID on file.

For verification of active insurance coverage and to obtain a benefits quote for outpatient psychiatric office, we need the insurance card(s) on file, both FRONT & BACK sides.

The second page of this MUST be filled out and sent in through the mail, text or email.

Our address is:
1491 S Sunnylane Rd,
Del City, ok 73115

You can text it to: 405-437-0205

You can email it to: kylie@psychiatricwellness.org

Please complete page 2 of Spravato Enrollment Form in the next step. Again, this MUST be filled out to continue. 

Spravato REMS  <--- FORM that MUST be filled out - PAGE 2 ONLY