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Overview of Office Policies

Below is an overview of my office policies. I review all policies before treatment begins and give all patients a copy of all policies.

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Health Insurance

I am an out-of-network provider and do not submit claims directly to insurance companies.

Patients are encouraged to contact their insurance carrier before beginning treatment to understand what their plan covers, as cash-based services may be reimbursable. 

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When speaking with their insurance company, patients may find it helpful to ask:

• Which mental health and psychiatric services are included in my plan?

• What are the policies regarding deductibles, visit limits, and out-of-network reimbursement?

• Are there exclusions for certain diagnoses or treatment types?

• How much will my plan reimburse for sessions with an out-of-network psychiatrist?

• Do I need a referral or prior authorization from my primary care physician?

 

I can supply procedure (CPT) codes to patients to give to their insurance company as needed. Common codes includes: 90792, 99204, 99213, 99214, 99215, 90833.

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Payment

I accept debit and major credit cards. Payment is due at the time of each appointment and patients must keep a card on file.

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I send each patient a monthly receipt or superbill, which includes the necessary details to submit for out-of-network reimbursement.

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Good Faith Estimates

In compliance with the No Surprises Act (effective January 1, 2022), patients who are uninsured or choosing not to use insurance are entitled to receive a Good Faith Estimate (GFE) outlining anticipated treatment costs.

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Key points regarding the GFE:

• You are entitled to a written estimate of expected charges for non-emergency services.

• Receiving a GFE does not require you to obtain services from this practice.

• The GFE is provided in the Policies document before becoming a patient.

• Actual costs may differ depending on the course of care or additional services recommended.

• If actual charges are substantially higher than estimated, you have the right to a dispute resolution process.

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For questions or more information about your right to a GFE, visit www.cms.gov/nosurprises.

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Telemedicine

Telehealth sessions are offered through doxy.me, which is fully HIPAA-compliant.

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Cancellations

I reserve your appointment time specifically for you. If you miss or cancel a visit without at least 24 hours of notice, a fee of $100 will be charged. This fee will be billed to your credit card on file.

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Medication Refills

Established patients needing medication refills should have their pharmacy send an electronic request. Please make these requests at least 5–7 business days before running out of medication.

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Confidentiality

Everything we discuss in treatment is kept private. There are only a few situations where I’m legally or ethically required to share information:

• With your consent: If you give me permission verbally or in writing to communicate with another person or professional. HIPAA does permit sharing of relevant information related to treatment, referrals, or continuity of care to coordinate with your other clinicians, without a release of information. Generally, though, I will ask for your permission to coordinate care.

• To protect safety: If there is a serious risk of harm to yourself or someone else, I may need to share information to help keep everyone safe.

• By court order: If a judge issues a court order or subpoena requiring release of records.

• In cases of abuse or neglect: I am legally required to report suspected abuse or neglect of children, or of vulnerable or dependent adults, to the appropriate protective services agency.

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Emergencies

For urgent or life-threatening situations, patients should call 911, 988, or go to the nearest emergency department.

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If I am unavailable or out of town, another physician will cover my practice. When this occurs, their name and contact information will be provided.