Policies

Electronic Communication:

The preferred method of communication is through the secure patient portal. You will get the fastest and most complete response if you state your concern by sending a message through the portal. Please note that all communications will be added to your medical records. Messages received through the portal are checked daily during business hours Monday, Tuesday, Wednesday, Thursday, and Friday 9:00am-5:00pm. Messages received after hours, on weekends, or holidays are reviewed the next business day. Please allow at least 1-2 business days for a response for portal messages.

Portal communication is not for emergency or urgent issues. Please do not send us a message through the portal that is of an urgent or emergent nature. Please note if you need immediate assistance, are having suicidal or homicidal thoughts, a serious medication reaction, or any emergency, please call 911 or go to the emergency room. You may also contact the Suicide Prevention Hotline at 988. They have a 24/7 crisis line.

***Please note*** A fee may be charged for clinical phone calls/portal messages between appointments. This fee may not be covered by insurance. This fee does not apply to phone calls or messages strictly related to scheduling, billing, or other non-clinical questions. We do not communicate via text or email. These communications are not protected and cannot be guaranteed as private.

Phone Calls:

Phone hours are Monday to Friday 9:00am – 5:00pm. Brief phone calls of 5 minutes or less are not charged. Longer, more involved calls are charged as outlined in Professional Fees. Please note that all communications will be added to your medical records.

Most routine calls are returned within 48 hours during the above stated business hours. If you have an after hours concern that cannot wait for the next business day please call and leave a voicemail. Your call will be returned as soon as possible. For any emergencies, please do not wait for a call back. Instead, please go immediately to the emergency room or call 911. ***Please note a fee may be applied for after hours phone calls. Portal messages are not checked after hours, on holidays, or on the weekends. Please check our website for the holiday schedule. If you at any time feel that you require care that includes 24 hours per day coverage, Clearview Behavioral Health will provide information for another practice.

Please note that we do not schedule/cancel appointments or refill medications after hours, on holidays, or over the weekend.

Crisis Management: 

Clearview Behavioral Health and Wellness Services PLLC does not provide crisis management or emergency psychiatry services. If you are in crisis, are having suicidal or homicidal thoughts, or have any emergency, please call 911 or go to your nearest emergency room. You may also contact the Suicide Prevention Hotline at 988. They have a 24/7 crisis line.

Hospitalization: 

The providers at Clearview Behavioral Health and Wellness Services PLLC do not have admitting privileges. If there is a crisis regarding your safety, you will be directed to the closest hospital emergency room for evaluation and possible admission.

Patient Portal: 

Through the patient portal we may send you questionnaires or other information prior to your appointment. Please complete any forms/questionnaires at least 24 hours prior to being seen for a follow up appointment. For an initial evaluation, ALL paperwork/forms must be completed within 3 days after the request is accepted or the appointment may be cancelled. Again, the patient portal is not for urgent/emergency messages.

Controlled Substance Policy: 

We are generally inclined to prescribe non-habit forming medications. A habit forming medication is often described as a “controlled substance”. If a controlled substance is prescribed it may be written for a limited quantity and/or a short duration. If a controlled substance is prescribed please be aware that 90 day supplies may not be provided.

Clearview Behavioral Health and Wellness Services PLLC generally does not:

– Prescribe benzodiazepines to patients who are taking daily opiate pain medication.

– Prescribe benzodiazepines to patients who are taking stimulant medication.

– May not prescribe stimulant medication (Adderall, Ritalin, etc) unless appropriate diagnostic testing has previously been done and available for review.

– Prescribe controlled substances to patients who use marijuana or illicit substances.

– Will not replace lost or stolen prescriptions of controlled substances without a police report.

– Prescribe stimulant medications to patients with a history of hypertension unless blood pressure is within normal limits and consistently under good control.

We reserve the right to require random urine drug screens/saliva tests to obtain further refills for any controlled substance. We may also request you bring in your medication for a pill count. If you are prescribed controlled substances and do not comply with a pill count or drug screen request within 48 hours, you may be terminated from the practice.

Please note it is a felony to accept a controlled substance prescription from the same (or similar) class from any other prescriber without both of those prescribers’ consent and notification. This is referred to as “doctor shopping”. If you receive controlled substances from another prescriber and do not notify the clinic, you will be terminated from the practice.

Professional Fees: 

Each provider at Clearview Behavioral Health and Wellness Services PLLC is in-network with most insurance carriers. Please visit our website to find a complete list of all accepted insurances. If insurance is not in network, you will have to pay the full amount at the time of service and may then submit a claim to your insurer. Fees are collected on the same day of 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. The expectations in this policy also reflect any future insurance companies with which Clearview Behavioral Health and Wellness Services PLLC may become in-network. 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.

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 amount of treatments for which you may receive reimbursement. Some services may not be reimbursable by insurance such as fees for filling out forms, writing letters, writing reports, etc. Please be aware insurance companies generally require some basic information about your care if you choose to seek reimbursement. Once this information is provided, it will be subject to the privacy policies of the insurance provider. Please check with your insurance company before making an appointment to determine what out-of-network benefits are available to you.

Insurance Claims: 

As a courtesy, Clearview Behavioral Health and Wellness Services PLLC will file insurance claims. Your insurance company, in lieu of reimbursing you directly, will pay the provider or Clearview Behavioral Health and Wellness Services PLLC any benefits for services rendered. Your medical insurance carrier may pay less than the actual bill for services, so you may be responsible for payment of some or all services rendered. You are responsible for making available complete insurance information for accurate filing of claims. To meet this end, we require updated insurance information at each visit. Reduction or rejection of your claim by your insurance company does not relieve the financial obligation you have incurred. It is your responsibility to know and understand your medical insurance coverage. Not all services are a covered benefit in all contracts. Please call your insurance company to verify your benefits.

Clearview Behavioral Health and Wellness Services PLLC will not be able to file claims to your insurance company unless you provide us with accurate and complete information about your insurance plan. 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.

By signing this agreement, you authorize Clearview Behavioral Health and Wellness Services PLLC to release all medical information necessary to your insurance company to secure payment. You also authorize payment of medical benefits to Clearview Behavioral Health and Wellness Services PLLC and your undersigned provider. You further understand your share of the cost of the services, e.g., co payments, co-insurance, and deductibles, will be collected on the same day or service, prior to or after the visit.

Referrals and Authorizations:

As a specialist, some insurance companies require that prior to any visit you must obtain an authorization or referral from your primary care physician. It is your responsibility to know if this is required by your insurance and, if so, to obtain the referral. If this is not done 48 hours before your appointment, you will be asked to either reschedule your appointment or pay the full amount for all services on the day of service. If your insurance company rejects a claim because a valid authorization or referral was not in place, the full cost of the visit will be your responsibility.

Payment for Service:

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 Clearview Behavioral Health and Wellness Services PLLC 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: 

Consultation appointment (45-60 min): $300

Short follow-up appointment (25 min): $175

Long follow-up appointment (40 min): $250

Extended follow-up appointment (55 min): $275

Psychotherapy appointment (55 min): $220

Psychotherapy appointment (40 min): $165

Telepsychiatry short follow-up (25 min): $175

Telepsychiatry long follow-up (40 min): $250

Telepsychiatry extended follow-up (55 min): $275

Telepsychiatry psychotherapy appointment (55 min): $220

Telepsychiatry psychotherapy appointment (40 min): $165

Phone calls: $50 per 10 minutes (phone calls under 5 minutes are not charged)

Bounced / invalid / returned check: $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 10-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.

Forensic Affairs: 

If your provider is subpoenaed to appear in a court action involving the care that was delivered to you, you will be charged a fee for court appearances. Please note the fees related to court cases (preparing for depositions, travel time, court time, etc.) are billed at a higher hourly rate than basic services. For more detailed information, please contact us directly.

Medical Record Requests, Letter, and Forms: 

We will try to complete all work during our scheduled sessions. It may occasionally be necessary for us to charge on a prorated basis for professional services that require extensive time commitment such as report/letter writing, completing forms, telephone conversations lasting longer than 5 minutes, and consultations with other professionals that you have requested.

Medical records requested for the patient’s own use carry a charge and may be provided in the form of a treatment summary at the discretion of the provider and if you are in agreement. Parts of your record that could potentially be detrimental to your psychological well-being may be withheld. Insurance does not cover these fees. Please allow for at least two weeks for processing of records/letters/forms requests.

Record Fee: 

To cover the costs incurred in handling, copying, and mailing medical records to the patient or the patient’s designated representative the maximum fee for each request shall be seventy-five cents (75¢) per page for the first 25 pages, fifty cents (50¢) per page for pages 26 through 100, and twenty-five cents (25¢) for each page in excess of 100 pages, provided that the health care provider may impose a minimum fee of up to ten dollars ($10.00), inclusive of copying costs for sending medical records for the patient or the patient’s designated representative.

If requested by the patient or the patient’s designated representative, nothing herein shall limit a reasonable professional fee charged by a provider for the review and preparation of a narrative summary of the patient’s medical record. This section shall not apply to Department of Health and Human Services Disability Determination Services requests for copies of medical records made on behalf of an applicant for Social Security or Supplemental Security Income disability. (1993, c. 529, s. 4.3; 1993 (Reg. Sess., 1994), c. 679, s. 5.5; 1995 (Reg. Sess., 1996), c. 742, s. 36; 1997-443, ss. 11.3, 11A.118(b).)

Medication Refills/Medication Disclosures: 

At your appointment, you will be provided with enough medication until your next recommended follow-up visit. When medications are first 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. The longest interval between visits is typically three months. 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 provider 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 provider 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.

Typically, the providers at Clearview Behavioral Health and Wellness Services PLLC do not co-manage psychiatric conditions with other prescribers. Therefore, it is expected that you only receive psychiatric medications through your provider at Clearview Behavioral Health and Wellness Services PLLC while you are under his or her care. If you obtain psychiatric medications through another provider it will be assumed you have transferred your care.

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. Please review the holiday schedule posted on the website. 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. However, if you miss or cancel a scheduled appointment and require a medication refill before your next visit a charge may apply for this service.

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 for 90 days your file will be formally closed and the provider will no longer be your provider of 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. A formal letter will be sent through the patient portal and mail explaining the separation as well as additional resources of other mental health professionals in the area.

Laboratory Studies/Additional Testing: 

At times, laboratory studies may be required. Please be aware that the cost of laboratory work is not included in your visit charge and is your responsibility. Completion of necessary lab work may be required prior to initiating or continuing medication. Your insurance policy may cover these labs such as urine drug screenings. Please contact your insurance to confirm if covered.

In addition, you may be referred to psychological testing if warranted which may incur additional costs.

Confidentiality: 

Any confidential information disclosed during treatment, or any other confidential information we obtain while attending to you professionally, shall be held in confidence unless you permit us to disclose such information or where we are required to disclose such information by law. Some examples include, but are not limited to the following:

– child/elder/vulnerable person abuse

– imminent threat of danger to oneself or others

– court order/subpoena

– if a mental illness prevents you from providing for your own basic needs such as food, water, shelter, we will be required to disclose information in order to seek hospitalization.

– if there is a reasonable degree of certainty that a patient cannot operate a motor vehicle or heavy machinery due to epilepsy, dementia, TBI or any other cognitive dysfunction.

Should you choose to submit a super bill for reimbursement for treatment from your insurance company or if you are using your insurance to pay for treatment, it may be necessary to communicate details of your care with them. By signing this contract, you are agreeing to the disclosure of confidential information where such disclosure is necessary to obtain certification, authorization, payment, transfer of care, etc… for your treatment.

In order for your treatment to be covered, we may be required to periodically communicate details of your condition and treatment. By signing this contract, you are agreeing to the disclosure of confidential information to other physicians, providers, or therapists involved in your case, where your provider decides it is clinically appropriate to do so. This includes the provider who referred you for care if applicable. Similarly, if we refer you to another provider within Clearview Behavioral Health and Wellness Services PLLC for treatment, that provider will have access to your records and may communicate with your previous provider. In addition, covering providers will have access to your clinical information should you require care while your provider is out of the office.

Please be aware that the audio or video recording of any session is not permitted secondary to therapeutic and privacy issues. If an unauthorized recording is made, it is grounds for immediate termination of the therapeutic relationship. 

Mental Health Records: 

Medical records are required by law. Clearview Behavioral Health and Wellness Services PLLC currently uses an electronic health record (EHR) to record and store patient information. This EHR system is secure and also abides by the HIPAA laws/regulations. However, as with all electronic systems, there are factors that are sometimes outside of our control. We will always strive to ensure your information is kept confidential and compliant with HIPPA regulations. We reserve the right to change electronic health record systems at any time.

The Practice Status:

At Clearview Behavioral Health and Wellness Services PLLC, your records will be accessed by your current provider as well as covering providers. If you are referred to another community therapist/provider, it may be helpful to collaborate and coordinate your care. Any clinician to whom you are referred will be responsible for the care they provide to you. Please note, however, that although we attempt to identify top quality professionals with very high standards of care, we cannot be responsible for the services/treatment that they provide. It is always your responsibility to determine if a professional referral is acceptable, and alternative options will be considered.

Consumer Etiquette: 

Disrespectful/ abusive behavior or harassment towards office staff or providers will not be tolerated and patients will be immediately terminated from the practice should this occur.

Fraternization:

It is important that your provider has a professional and therapeutic relationship with you and, therefore, not any other type of social or personal relationship. If you feel there is a strong pre-existing relationship (friend, family, etc.) that may affect your decisions, you should consider seeking care from another provider. If you feel that you do not have any other practical treatment alternative, this must be discussed and agreed to before engaging in active treatment. Further, there is never room for a romantic relationship between patient and provider/psychotherapist.

Discontinuation of Treatment: 

The provider may discontinue treatment with a patient usually for one of the following reasons:

– Non-payment of your account.

– Canceling/missing appointments too often.

– Non-compliance with treatment recommendations.

– Withdrawal of treatment is necessary due to medical, financial, or legal problems or geographic relocation.

– Lack of attendance and/or motivation prevents further progress toward goal achievement.

– Inappropriate behavior relative to self, staff or other clients (i.e. threatening and/or intimidating behaviors)

– Modification of medications prescribed by your provider is made by patient without first consulting the provider or a covering provider.

– Obtaining psychiatric medications from another prescriber.

– Failure to comply with the provisions of the Policies and Procedures as stated in this document.

– Successful completion of the treatment program initially agreed upon, implying that the patient has made significant progress toward meeting treatment goals.

– Patient chooses to terminate treatment.

If you foresee problems in any of these areas, please let your provider know your concerns. If you decide to discontinue treatment, you can do so at any time in person, by phone, or in writing.

In the event that you discontinue treatment without notifying your provider, it will be assumed that your therapeutic relationship with him or her terminated 90 days after your last visit, unless you have an appointment scheduled for a future date, beyond which Clearview Behavioral Health and Wellness Services PLLC carries no further responsibility for your care. You may re-enter treatment with your provider at Clearview Behavioral Health and Wellness Services PLLC as long as your treatment ends in good standing and he/she is accepting new patients.

Thank you for reading through this important information. We look forward to working with you.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice. We reserve the right to make the revised notice effective for medical information we already have about you as well as any information we receive in the future This Agreement shall not be amended except by written instrument executed by both parties hereto. Should any provision of this Agreement be declared void or ineffective by virtue of any state or federal statute or regulation, or decision of any court or regulatory authority, such declaration shall not invalidate any of the provisions of this Agreement that otherwise remain in full force and effect. By signing below, you certify that you have read and understand the terms stated in this Policies and Procedures Treatment Consent Form. You agree to abide by the terms stated above throughout the course of the professional relationship.