Our Policies and Terms
Please read the following information carefully so you have a clear understanding of our policies concerning communication, fees, insurance, confidentiality, etc. This acknowledges that we have provided you the opportunity to review our Practice Policies and Procedures as is required by federal law. Please take your time to review and fully understand this document. Please download; sign and date at the end to indicate that you have understood and agree. Thank you for your cooperation.
If you require additional medication before your next appointment, please contact the clinic as soon as possible. Please allow up to 3 business days to process refill requests for non-controlled medications and 5 business days for controlled substances. Refills are not processed after business hours, on weekends, or holidays. A refill in advance of an appointment takes time to coordinate and requires documentation. During your appointment, you will be given enough medication to last until your next appointment. Before contacting the clinic, please call the pharmacy directly to ensure that you do not have any additional refills on file, possibly under a different prescription. ***We do not respond to pharmacy-generated automated refill requests. *** If you need a refill of your medication and there is not one on file at the pharmacy, please contact the clinic. If you fail to schedule and/or you have not been seen you for 90 days your file will be formally closed and the provider will no longer be able to be the provider on record unless plans have been made to the contrary. Once your chart is closed you will no longer be considered a patient, and no further care/refills will be provided.
Medication Information
At your appointment, you will be provided with enough medication until your next recommended follow-up visit. When medications are initially prescribed, patients are generally seen more frequently, and then less frequently as stability is achieved. The frequency is determined at the most recent visit with the provider. Medications are refilled only for patients who are active in treatment. Even if you are stable on your medication, an evaluation of your progress needs to take place. If you cancel or reschedule your appointment, it is your responsibility to contact your provider, if you need additional medication until your next visit. Medications may not be given if you cancel or no-show regardless of the dangers associated with abrupt discontinuation if the doctor feels a clinical evaluation is necessary prior to a refill. Medications may cause life-threatening withdrawal symptoms when not taken as prescribed, or if abruptly stopped. It is the responsibility of the patient to make follow-up appointments at the recommended interval. You must tell every doctor and pharmacist every medication you are taking so you do not harm yourself and do not break the law. This includes over-the-counter medications, vitamins, and supplements.
No Shows, Late Cancellation, Late Arrivals
We do not overbook appointments. Your appointment time is a reservation just for you. If you are not able to come to your appointment, please reschedule through the patient portal or leave a message on the office line during business hours to reschedule. If you contact the office within 24-48 business hours (excluding weekends and holidays) of your appointment you may reschedule with no additional cost, and the appointment will be offered to someone else. For example, if your appointment is on a Monday, the cancellation must be made by the same hour on the preceding Friday. Weekend appointments must be cancelled by the same hour on the Thursday before the appointment. If an appointment is not cancelled or rescheduled more than 24-48 business hours ahead, the standard appointment fee will be applied to your account. Stating that you did not receive a reminder does not exempt you from a no-show/late cancellation fee. Should you arrive more than 10 minutes late for any appointment, you will be asked to reschedule so that an appropriate amount of time and attention may be devoted to your care. You will still be responsible for payment for the missed session. This fee is not covered by insurance and cannot be submitted for insurance reimbursement. For initial evaluations, we may require full prepayment to schedule the appointment. This will be charged to the credit card on file. If you miss that appointment and do not give appropriate notice, that fee is nonrefundable. If you wish to book the initial appointment again, another full prepayment may be required to schedule the second appointment. Please ensure that you give us 24-48 hours’ notice to reschedule your appointment. An appointment cancelled without at least a 24–48-hour notice is considered a No Show/late cancellation and may not be rescheduled. Failure to show to your first appointment may also result in an inability to schedule further appointments. Failure to show for your follow up appointments (or violation of this cancellation policy) on two or more occasions may be grounds for discharge from the clinic. Note that the cancellation fee may be waived in special circumstances, determined on an individual basis (e.g.: medical emergency- patients may be asked to provide documentation for the same). For our part, we will make every effort to provide you with adequate notice if the provider will be unavailable for a scheduled appointment and will work to reschedule your appointment in a timely fashion.
Insurance Clients
We are in-network with Blue Cross Blue Shield (BCBS) PPO. UHC, Medicare, Medicaid. Tri-Care and Indemnity plans and considered an “out-of-network” provider for all other insurances. If you are a cash pay client, you pay the full amount at the time of service. Fees are collected on the same day as the appointment, including copays. If you are not able to pay for your appointment in full prior to the start time, you will need to reschedule. If someone else (parent, spouse, domestic partner, etc.) is financially responsible for your expenses or carries your insurance, please share this policy with them, as it explains our practices regarding insurance billing, copayments, and patient billing. Patients may request an invoice to submit to their insurance company for possible reimbursement upon request. Insurance reimbursement depends on an individual patient’s policy terms. We are not responsible for filing or ensuring insurance reimbursements for insurance plans we do not accept. Your insurance plan is a contract between you and the insurance company and does not directly involve the provider. Even if your insurance company reimburses you for your treatment, they may limit the number of treatments for which you may receive reimbursement. Please review your policy carefully and be aware of any limitations on your benefits. Please be aware of your copay, coinsurance, and deductible prior to your appointment.. You further understand your share of the cost of the services, e.g., copayments, co-insurance, and deductibles, will be collected on the same day or service, prior to or after the visit.
Self Pay and other Fees
Please note that you are ultimately responsible for all charges incurred for your treatment or the treatment of those for whom you are responsible. If for any reason your insurance company, or other third-party payer (such as a divorced spouse or lawyer), does not promptly reimburse for services rendered, you will be responsible for those charges. You may pay with cash or credit/debit/FSA/HSA card at the time of service. Checks may be accepted on an individual basis for established patients. If a check is returned by your financial institution for any reason, a fee of $25 will be charged and future payments must be made by cash or credit/debit card. If you choose to pay with cash, please have the exact amount. You will be required to leave a confidential credit card on file that may be billed for services provided outside the office, like clinical phone calls/messages through the portal. Your credit card is used to secure payment in the case that there is a no-show/late cancellation/returned check fee. A test transaction may occur to verify the card on file is active prior to your appointment. If for any reason the card is rejected, your appointment may be cancelled and may not be rescheduled. You are responsible for fees from credit card companies, collection agencies or banks due to non-sufficient funds, payment disputes, or non-payment of fees. Please notify us if there is any change in your payment information or if any problem arises in your ability to make payments. Overdue accounts may be referred to collection agencies as a last resort. Fees are subject to change and reflect the complexity and type of service(s) provided. You will be notified thirty days in advance of any changes in our fees.
Basic Fees:
Phone calls: $50 per 15 minutes (phone calls under 5 minutes are not charged)
Straightforward letter: $10
Straightforward FMLA: $25
**Please contact us if you have questions about which types of services are billed. Some examples include letter preparation, clinical phone calls, clinical emails, etc. Services will be billed at $50 per 15-minute increment. This amount is not covered by insurance and cannot be billed to insurance. Please note that you will not be billed for phone calls/messages related to scheduling, billing, or other non clinical questions