Policies and Procedures

Clinical services
If there is a potential of any physical danger to you, or others, you will call 911 immediately or go to the closest emergency room. To reach me outside of standard business hours, kindly send a message through your patient portal for non-urgent/non-emergent needs and I will respond to you in 24-48 hours.
If you are seeing me for medication management only:

• You will contact your therapist first for any emergency or crisis, unless it may be medication related

• You will inform me if you are considering stopping therapy, or have actually stopped

 

Confidentiality
There is no guarantee of confidentiality under the following conditions:

• If I suspect you are in imminent danger of harm to self or others, or a child or elderly person is being abused or neglected (as I am a mandated reporter)

• If a court orders a release of information

• If you initiate a malpractice lawsuit, or a billing dispute with a financial institution

• If your insurance company requests to review your case

• If you pay by credit card, my name will appear on your credit card statement

• If you do not pay your bill, your balance due statement (including diagnostic and procedural codes) may be sent to a collections agency or other responsible party

• Between me and my administrative staff, or colleagues with whom I consult professionally 

Payment
For out-of-network services:
- New patient consultation (60 mins): $250
- Follow up consultation (30 mins): 125
For in-network services:
I will submit claims on your behalf as a courtesy, but there is no guarantee that your insurance will pay. You are responsible for full payment, whether your insurance company ends up paying partially, or not at all, for services rendered.

Medication refill policy
You are responsible for scheduling a follow-up with your provider before any prescription runs out. All medication refills and changes are done during an office visit. If a refill is needed outside of an office visit, kindly send a medication refill request from your patient portal and allow 42-72 hours to process.

Medication Prior Authorization
Prior authorization requests need to be sent to our office by the pharmacy electronically. Please allow 48-72 hours for your insurance to process the request. We advise each patient to obtain a copy of your formulary list before your visit, to ensure that the medications being prescribed are covered by your insurance company, and to allow you to discuss alternatives if possible. This will help to avoid charges incurred secondary to this policy.

Paperwork
There is a $25.00 charge for all FMLA, or other paperwork that require a physician to complete. Please present your paperwork via your patient portal or on the day of your appointment. It’s at your provider’s discretion to complete it or not. All paperwork will require 7 business days to be completed, regardless of the due date as it is the patient’s responsibility to get the paperwork to us promptly.

Medical records
If you need a copy of your medical record, you must give office a signed records request/release from the patient. Fees for medical records are $25.00 for the first 20 pages, and $0.50 for each page thereafter and may take up to 15 business days to obtain.

Communications

We may contact you by telephone, text, mail, email to provide appointment reminders. We may communicate over the telephone or via patient portal for health related concerns.