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

Holiday Closings will be listed in the clinic; however, each provider determines their own schedule, and it is best to make sure what hours your provider is working during these times, as each provider may vary.

Integrative Psychiatry does not offer after-hour 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 closings. The clinic will generally follow the Elkhorn School District weather/snow day cancellation policy. A sign will be posted in the office, notifying patients of any other clinic scheduled closings.

Please remember that each provider is contracted and creates their own schedule. If a provider feels it is safe to travel and wants to continue seeing patients during inclement weather, they will notify their patients accordingly.

 

PRESCRTIPTIONS AND REFILLS

Please call your pharmacy or call the office to request refills.

Each provider will provide you a prescription during your appointment with enough refills to sustain you until your next appointment. If for some reason you miss your follow up appointment or are running low on medications, please contact your pharmacy or call the office to request a refill.

The purpose of this policy is to make sure you are taking the correct medications and the correct doses of the medications. In addition, many prescriptions will require periodic blood work, vital signs and/or a follow-up visit with your nurse practitioner prior to receiving a refill. Therefore, it is very important to keep your regularly scheduled appointments.

To serve you best, please allow a 72-hour notice on all medication refills. ALL MEDICATIONS, even refills, must be reviewed and approved by your nurse practitioner prior to approval. Please note that requests received over the weekend will not be reviewed until the next business day.

It is standard practice to require regular follow-up appointments when certain controlled substances are prescribed. These include stimulants, anti-anxiety medications, and sleep aids. Please be aware of this standard and understand that your prescriptions may not be refilled (at the discretion of your provider) if you do not schedule and attend regular appointments. The general standards for follow-up are as follows:

o Psychostimulants every 1-3 months

o Benzodiazepines every 3-4 months

o Sleep medications every 6 months

Medications must be taken exactly as prescribed, or you will run short prior to the next refill. It is our office policy and standard of care to NOT refill prescriptions early. We will NOT replace lost or stolen medications SO please manage your medications appropriately.

NDMP - The Federal National Drug Monitoring Program was established in Nebraska in January 2017. Integrative Psychiatry complies with all aspects of this program. We are required by law to submit information about the medications prescribed to our patients to the DEA. We also receive information from NDMP about medications prescribed to our patients from other providers to make sure medications are being prescribed appropriately.

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 requires every effort to protect our patients and the public from harm; therefore, reporting safety concerns to authorities, 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 in 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.

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

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 will pay at the time of service, which further reduces the cost of sending statements.

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 as noted in our payment policy 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.

PAYMENT POLICY 

 

Please understand that your insurance benefits information has been verified by your insurance carrier(s). Integrative Psychiatry will establish your payment plan in accordance with the information they have been provided. The information provided by your insurance carrier(s) is not a guarantee of payment by your insurance carrier(s). The monetary responsibility for services rendered is the responsibility of the patient.

All copays must be paid at the time of service, and we also ask that an estimated amount be paid towards your deductible and/or co-insurance at each visit, until met. If you have chosen to be seen via Telehealth, we will collect any outstanding payments and/or copays prior to the visit via the check-in process. This is put in place to keep patient balances low and manageable for all parties.

BILLING STATEMENTS

Upon receiving your monthly statement, we expect that you will remit payment in full for your account balance. In the event that you are unable to pay in full, please understand that balances of $200 or greater must be paid prior to scheduling an additional appointment.

Providers at Integrative Psychiatry are all contracted, meaning their pay is dependent on patient payments. It is vital for our practice to continue managing financial obligations of the patient for our providers to be reimbursed for their time and efforts.

1. The balance in 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.

2. 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.

3. Payments can be made in person, by mail, or by phone.

4. If your account balance is overdue by sixty (60) days or more or you have a balance of $200 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.

5. 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.

6. Financial noncompliance may result in termination from the practice.

7. All payment plans must be made to complete the total bill below $200 within a three- month period or less to continue scheduling appointments with your provider. If you are making minimum payments that will not allow the bill to be brought down below $200 within a three-month time period, all appointments will be placed on hold until financial responsibility can be re-established.

FEES FOR REQUIRED COURT/LEGAL PROCEEDINGS

If a specific case in which a professional of Integrative Psychiatry is/was required to be involved in legal proceedings as an expert witness, the following guidelines will be followed:

If Integrative Psychiatry professionals were to receive a subpoena, the attorney or office staff needs to call Integrative Psychiatry and set up a time for the subpoena to be served during office hours. We request a minimum of 72-hour notice of any court appearance SO that schedule changes for the professional can be made within a reasonable time.

Please note: If a subpoena or notice to meet attorney(s) is received without a minimum of 72- hour notice, there will be an additional $500.00 express charge, which must be paid prior to the professional's involvement in the court or legal situation.

With respect to court and/or legal actions required, the following fees are in effect SO that our business is not harmed by the professional provider being pulled out of their regular duties:

1.Preparation time from the professional (including submission of records): $500.00/hr (billable in 15- minute increments)

2. Phone calls with attorneys or legal representatives: $500.00/hr (billable in 15-minute increments)

3. Depositions: $500.00/hour.

4.Time required in being available for a court appearance, needing to be present at the courthouse, or providing testimony: $500.00/hour

5. Mileage: Current Federal reimbursement rates.

6. All attorney fees and costs incurred by Integrative Psychiatry professionals due to the legal action. This includes paying Integrative Psychiatry's provider's legal representation to prepare for court responsibilities.

7. Paper copies of medical records: the fees allowed by the State of NE will be charged. If an Integrative Psychiatry professional is subpoenaed, and the case is continued with less than 24 hours' notice before the beginning of the day of the scheduled court appearance- and/or the testimony is not given, the attorney will be charged $1,000.00. In the event state or federal law dictate a different fee, Integrative Psychiatry will, or course, follow applicable law.

TELEHEALTH CONSENT

I hereby consent to participate in telehealth with Integrative Psychiatry as part of my treatment with my provider. I understand that telehealth is the practice of receiving clinical health care services via technology assisted media or other electronic means between the provider and the client via two differing locations.

I understand the following with respect to telehealth:

1. I have the right to withdraw consent at any time without affecting my right to future care, services, or program benefits to which I would otherwise be entitled.

2. There are risks, benefits, and consequences associated with telehealth, including but not limited to, disruption of transmission by technology failures, interruption, and/or breaches of confidentiality by unauthorized persona, and/or limited ability to respond to emergencies.

3. There will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.

4. Integrative Psychiatry follows the primary law that protects the confidentiality of my protected health information (PHI) when participating in any telehealth appointment.

5. If I am having suicidal or homicidal thoughts, actively experiencing psychotic symptoms, or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telehealth services are not appropriate, and a higher level of care is required.

6. During a telehealth session, we could encounter technical difficulties resulting in service interruptions. If this occurs, end and restart the session. If we are unable to reconnect within five minutes, please call our front desk at (402) 933-5700 to discuss options of completing your visit in full. Unfortunately, there may be times in which we may need to reschedule your appointment to a future time.

7. My provider may need to contact my emergency contact and/or appropriate authorities in case of an emergency

PROFESSIONAL FEE POLICY FOR TELEHEALTH

For all Telehealth appointments, you must check-in with our business administrators prior to your appointment with your provider. There is a check-in link on our website that you will use initially, and then our business team will let your provider know when you are ready to begin your appointment. Each provider has their specified Telehealth link on our website, which should be utilized for your designated appointment. Please check-in approximately five minutes prior to the start of your appointment, So the check-in process does not take away from the time with your provider.

All telehealth appointments will be billed to your insurance following the session. Once your insurance has processed your claims, they will send an Explanation of Benefits (EOB) to both you and our office showing what your total patient responsibility is and this will be collected in the check-in process at your next appointment.

 

CANCELED, LATE AND MISSED APPOINTMENTS

Missed appointments without proper notification of at least 24 hours, results in time being blocked from other patients. Insurance companies do not reimburse for missed appointments. Therefore, charges incurred for missed appointments are the responsibility of the patient.

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:

1. 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.

2. First missed appointment (no show/canceled): $25 charge

3. Second missed appointment: $100 charge

4. Third missed appointment and discharged from care: $150 charge

5. 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.

6. Missed appointment fees must be paid before scheduling your next appointment.

QUESTIONS

It is important that you understand the expectations of your treatment 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.

ACKNOWLEDGEMENT

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.