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Office Policies:
We are committed to providing you with the best care possible. Many states require that patients be provided with information to allow them to make informed decisions regarding participation in mental health treatment. Therefore, we are providing a transparent listing of what to expect when receiving care from us.
Paperwork or phone calls are an additional cost
Phone calls and paperwork in excess of those routinely required as part of evaluation and treatment will be charged in 15 minute increments pro-rated at $300/ hour. In general, we are happy to complete paperwork (FMLA, driving privileges, school accommodation, etc) or make collaboration phone calls (talking to another provider) for our patients but this is generally not part of routine patient care. If these items cannot be completed in 5 min or less during the scheduled appointment, then it will be considered “excess of those routinely required as part of evaluation and treatment” and would require the patient to reserve a separate time for the doctor to accomplish the paperwork or collaboration call. Payment for the reserved time to accomplish those items is required before the provider will complete the paperwork/phone call. Payment is via credit card or cash.
Initial if you understand that most paperwork or phone calls are an additional cost
Prescription refills
Medications are only refilled during an appointment.
Our policy is to provide a medication prescription that will authorize sufficient supplies to last until your scheduled follow up appointment. We do NOT refill medications simply because a pharmacy requests such. If medication refills are required, generally the patient must schedule an appointment to obtain the desired refill.
In the rare case that the medication provider is at fault of not providing a prescription that authorizes sufficient medication supplies to cover the period until your next agreed upon follow up appointment, you can send a secure message that indicates such and the clinic policy will be for the provider to send in a prescription that authorizes sufficient supplies to last until your appointment.
Initial if you understand that medication refills are only given in an appointment and that your pharmacy requesting a refill will not result in a refill being issued
Communication with your provider.
We generally require that our providers only communicate about medical and mental health information during a scheduled appointment.
We are dedicated to giving the best care possible. Best care involves being focused when working with our patients. Many oversights or medical errors happen when information is passed outside of a scheduled appointment. To avoid these error prone situations and to ensure the provider has time to carefully consider the details of your situation, emails, phone calls or other “out of appointment” communication about your situation or care is generally not permitted.
We understand that there will be times where it is necessary to communicate something non-medical/mental health related to your provider (such as scheduling changes or delivering requested information). In these cases, the normal communication format between patient and providers is via the secure messenger in the Valent “patient portal”.
Please ensure that patient portal messages are not used for urgent or life threatening situations. If you ever have an emergency, life threatening situation or the issue cannot wait for a response to an email, please call 911, go to your nearest emergency room or call the National Suicide Hotline at 1-800-273-8255.
Initial if you understand that medical or psychiatric communication generally only happens in a scheduled appointment.
Risks and Benefits of mental health treatment.
Most people seek treatment with a mental health provider to help them with problems related to mood, anxiety, stress, relationships, school and work. The goal of mental health treatment is reduction of these problems and an improvement in mood and level of functioning at work, school and in relationships.
During the course of this treatment, however, some people might experience an increase in anxiety, worsening of symptoms, and thoughts of self-harm that could lead to hospitalization. Therefore, it is important to be completely honest with your provider, follow recommendations made by the provider and verbalize concerns or side effects of treatment on a consistent basis.
Initial if you understand that proper treatment could lead to your condition worsening before it gets better and agree to be completely honest with your provider.
No emergency services provided.
We are an outpatient and telemedicine only practice that is not affiliated with any hospital. As such, we do not offer emergency services. If you ever have an emergency or life threatening situation, please call 911, go to your nearest emergency room or call the National Suicide Hotline at 1-800-273-8255.
Initial if you understand that we do not provide emergency services
No after hours access available.
If a patient’s situation is critical enough to require a provider that is routinely available for in-between session care or after hours calls, we may not be the best choice for your needs.
If our resources don’t meet your needs, we understand. If that is the case, we will always strive to identify this in the evaluation session(s) or to identify such when it becomes apparent in the treatment sessions. In these rare instances where your needs exceed our resources, we will be happy to facilitate the transfer of records to the provider you specify.
Please recognize that we do not have an on call provider and do not provide services outside of normal business hours.
Moreover, there will be times when the provider may be out of town or otherwise unavailable for an extended period of time. Every effort will be made to respond to portal messages in a timely manner but a rapid response cannot be guaranteed. When in doubt or if your need requires more rapid response, seek urgent or emergency medical care through the emergency room or urgent care clinic as applicable.
Initial if you understand that there is no after hours access to care
Recording Sessions.
While most patients opt to perform their care via video, you agree that no sessions will be recorded in any format (audio or video) without written consent from both parties. Verbal consent is not acceptable.
Initial if you understand and attest that you will NOT record any interaction without written consent
Identifying your location and emergency services before the video session starts. Patients usually choose to participate in care via video (telemedicine.) In addition to the federal requirement, reality shows us that there occasionally arises a situation that requires emergency services to go to the patient’s location. Therefore, patients agree to only engaging in telemedicine care when in a predetermined location where contact information for emergency services has been identified/provided to the provider.
Real life dictates that there may be rare times where the treating provider will pre-approve the patient to do the telemedicine appointment in another location due to extenuating circumstances. This exception will always require pre-approval from the treating provider (always before the appointment time) and the patient must provide (via the patient portal) 1) the address where you will be located during the appointment and 2) contact information for emergency services (local telephone number to local police) at the pre-approved location.
Initial if you understand and agree to get approval and provide the details of your location before the video session starts
Treatment Fees and Payment Policies.
CoPays: A consultation during which the doctor discusses medical advice, a treatment plan and/or recommendations is considered by the insurance companies as an office visit. In order to accept insurance, you and we agreed (with your insurance company) and are responsible to pay the appropriate copay at each office visit as well as an annual deductible any time you are scheduled to see the doctor. Since we saw you, gave medical advice or updated your treatment
plan and since we participate in your plan, it is our responsibility to collect that co-pay/balance from you. Failure to do so puts us both in violation of your contract. Therefore, copays are due prior to receiving services.
Copays are most easily paid and it is generally expected that the patient will pay their copay (before their visit) via the Patient Portal.
Initial if you understand that copay payment is required before you can participate in your appointment
Unpaid balances
If a patient has a balance that they fail to pay for 90 days or longer, an 11% interest charge will be applied to that balance.
Unpaid balances will also result in the patient being prohibited from scheduling their next appointment.
Initial if you understand and agree to paying interest on any unpaid balance that is 90 days or older and not being allowed to schedule a follow up for unpaid balances.
Good Faith Estimate
You can easily find a list of expected charges for care with us at dynamicpsychiatryutah.com. “The estimated costs are valid for 12 months from the date of the Good Faith Estimate.”
Initial if you have read and understand the estimated cost of services can be found at the website above
Session Times.
All initial sessions are 45-50 minutes long and are referred to as an “hour.” The remaining 10-15 minutes are used for administrative requirements (completing paperwork, prescribing meds, etc.) Ongoing care for psychotherapy or psychotherapy with medication management sessions will require “hour” long follow up sessions. Appointments that are strictly medication management will be 20 minute appointments and are referred to as a “half hour.” Most new patient appointments consist of 1-2 “hour” long evaluation/treatment planning sessions.
Initial if you understand the actual time for an hour or half hour session
Timeliness
We know your time is valuable and we make every effort to keep on schedule. If we are running late, you will be given the full appointment time you have reserved. If we are late, we may even offer a no-cost reschedule if it better accommodates your situation. (It is our goal that you are never penalized for us being late.)
If you are running late, we will be happy to meet with you for the remaining time left in your appointment but any remaining items you want to cover will be deferred to the next appointment.
Initial if you understand the late policy
Credit Card On File
The patient is expected to enter credit card information via the Patient Portal before starting care. The patient is expected to update credit card information in the Patient Portal if that information changes.
The patient gives consent for the practice to charge their card for any no show fees or other applicable charges.
Initial if you understand that must have valid credit card information entered before receiving care
Scheduling Policies.
We are dedicated to patient self-empowerment. One of the many ways we enable this is by giving full autonomy to the patient to schedule their own appointments. While the provider and patient will agree on a recommended follow-up timeframe, the patient has the full responsibility to schedule their next appointment using the “request an appointment link” in the patient portal. (A patient portal link is found on the homepage.) This means that scheduling is not generally done by calling a secretary at the office. (Although our office staff will be happy to help you learn how to request an appointment if that is helpful).
Initial if you understand and agree that you will be required to submit your own appointment requests via the patient portal
Completing Pre-Appointment Paperwork Before Your Appointment is Approved Your medical/psychiatric history is very valuable and we use that history to help identify a customized treatment plan designed to help you. Instead of using your first appointment’s time to ask the history questions, we have you communicate that information via a questionnaire in the patient portal before your first appointment. This allows our providers the option to review the historical information before you even arrive at your first appointment.
Therefore, filling out this form with full answers to all questions is required before permission to schedule your first appointment will be given. Moreover, follow up questionnaires will be required before some subsequent appointments.
Initial if you understand that filling out the questionnaires is a requirement before your appointment(s).
Rescheduling An Appointment.
Sometimes real life happens and you might need to cancel or reschedule an appointment. If this happens and you are 24 hours or more before the appointment time, these are the steps to follow.
1) You will cancel the existing appointment. This can only be done by calling the office and requesting a cancellation or reschedule. If there is no answer, leave a message and
the time that you left the message will be used to determine if you met the 24 hours prior requirement.
2) If you are rescheduling an appointment, you simply cancel the existing appointment by calling and then request a new appointment via your patient portal.
Initial if you understand that reschedules must be done by the patient and more than 24 hours in advance
Confidentiality:
We generally are not required to share your information with anyone unless you request such in writing or when the law requires. (see examples below.) Your treatment and psychotherapy records are confidential, and generally will only be shared in exceptions listed below: 1. Information may be released to designated parties by written authorization of patients or legal guardians.
Initial if you understand and agree to these terms
Controlled substance prescriptions
We recognize that while the majority of patients will never need a medication that fits into this category, there are a small set of patients who require medications that have additional requirements for prescribing (such as some ADHD medications). We are experts in identifying when it would be appropriate and inappropriate for these medications and are very comfortable managing them for the right patients.
However, the Ryan Haight Act of 2008 makes it illegal to prescribe these medications without first seeing the patient “in person” (we are still waiting on the DEA to make their promised exception for psychiatry.) Therefore, in a small number of cases, there might be a requirement for a telemedicine patient to attend an in person appointment prior to receiving the needed prescription.
Initial if you understand that a telepsychiatry patient may need to attend an in person appointment before getting controlled substance medications.
Board Certification.
Our providers strive to give the best and most comprehensive care available. As such, our providers are evaluated before being affiliated. This evaluation and further training continue even after becoming an affiliated provider. Furthermore, our provider’s only accept patient types (child vs adult vs geriatric) for which they feel comfortable.
While all providers have completed appropriate training and have the necessary expertise in treating the different types of patients, not all have taken the extra step of gaining additional board certifications. (E.G. child and adolescent or geriatric psychiatry, etc)
The patient or legal representative acknowledges that the provider may be a general trained provider, and may not be board certified in certain specialties. The patient or legal representative consents to treatment even if it is from a general provider or other mental health provider that has not completed the extra step of board certification in that area.
Initial if agree to accepting the treatment from a general trained provider.
Patient Responsibilities and Contract I, ______________________________________, have read and understand the office policies. I consent to an evaluation and treatment planning. I understand that treatment sessions are used to verify that the provider’s resources meet the patient’s needs. I understand that in rare cases, completion of the evaluation and treatment planning may reveal that the patient’s needs may exceed the provider’s resources. In these rare cases, the recommendation may be to find a different provider/clinic that has the needed resources.
I commit to being open and honest during the course of the evaluation, treatment planning and treatment sessions in order to receive the most accurate treatment options for my problems.
______________________________________ ___________
Signature and date
