OFFICE POLICIES
Patient agrees by initialing the following:
Crisis: In the event of an emergency, please call 911. If you are in crisis, please call 1-866-4CRISIS.
Appointment Times: Please see the website for Office Hours, as they are subject to change. Walk-in appointments are not available. However, an effort will be made to accommodate your scheduling needs if possible.
Appointment Reminders: An automated system is used to make reminder texts and emails prior to your scheduled appointments. These are a courtesy and we are not responsible for appointments missed due to incorrect information or non-receipt of a message. It is your responsibility to keep your scheduled appointments.
Cancellations/Rescheduling/No Shows: Please provide at least 24 hours’ notice of appointment cancellations or rescheduling. You will be financially responsible for appointments not cancelled or rescheduled with appropriate advanced notice. We generally will not offer to reschedule late cancellations or no-shows for the initial evaluation session. Patients who cancel less than 24 hours before an appointment, or fail to attend their visit, will be charged a $75 no-show or late cancellation fee.
Appointments That Begin Late: If our appointment begins late because you arrived late, the session will end at the time it normally would have ended. This is so that other patients may stay on schedule. If you arrive after the scheduled session has ended, we can sometimes accommodate you, if an already scheduled appointment cancels or no-shows, but this cannot be guaranteed. Otherwise, the visit will count as a no-show.
Referrals: Many insurance companies may require a referral for your visit to our office. Please make sure to contact your insurance company and/or your primary care physician to ensure that you do get a referral if it is required. Failure to obtain a referral when necessary may cause your insurance company to deny your claim.
Fees for Services Provided Outside of Scheduled Appointments: Please let us know at the beginning of the session if we need to devote some of our time to discussing forms, filling out forms, or writing notes or letters. Please fill out forms to the best of your ability prior to the session so that we may use our time most efficiently.
Prior Authorizations: Some insurance plans require prior authorization for medications. If your plan requires a prior authorization, please ask the pharmacy to fax the information to our office. It is ultimately up to your insurance carrier to determine coverage for medications. It may take up to 72 hours to process. There is a $15 charge for completing the paperwork.
Medical Records: A Release of Medical Records must be signed in order to have your patient records sent to another health care provider.
Insurance & Billing: We may participate individually in various health insurance plans. Please contact your insurance company to determine if a particular provider is contracted with your plan. In addition, it is necessary for you to bring your insurance card and driver’s license or other government issued identification card to your first appointment. These documents are needed to verify your identity and protect you from insurance and identity fraud.
Payment: Payment is required at the time that services are provided. We accept cash and major credit cards. If we are contracted providers with your insurance company and have confirmed your coverage, you will only be responsible for your co-payment, co-insurance, and/or deductible at the time of your visit. Please be aware that verification of coverage by the insurance company is not a guarantee of coverage or payment for services. You will be personally responsible for all non-covered services.
Disability Forms: Your provider may or may not complete disability forms at his or her discretion. These forms are distinct from the treatment you receive. Independent Medical Examiners provide this service, if desired.
Email: If you choose to use email, please be aware that email is not a secure means of communicating sensitive mental health information. It is never an appropriate means of communication, if there is an emergency.
Fees
Initial Psychiatric Evaluation: $250.
Follow-up Medication Management: $75-$150.
Refill Request outside of appointment: $25 (Not covered by insurance).
No-show or Late-Cancellation: $75 (Not covered by insurance).
Completion of Forms: $100/hour (Not covered by insurance).
Phone Calls: $25 (Not covered by insurance).
Returned Check: $25 (Not covered by insurance)
Prior Authorization for Medication: $25 (Not covered by insurance).
Termination of Care: If you have not received treatment from your provider or otherwise contacted the office in 180 days, your chart will be changed to Inactive and the provider-patient relationship will be terminated.