OFFICE HOURS:
Regular office hours are 8:00 a.m. to 4:00 p.m. Monday-Friday.  We believe strongly in the value of your time and will strive to adhere to the scheduled appointment times.  We request 24 hours notice if you find it necessary to cancel your appointment.  WE CHARGE FOR APPOINTMENTS MISSED, CANCELED, OR BROKEN WITHOUT 24 HOURS ADVANCE NOTICE.  As insurance does not pay for these appointments, the patient-guarantor is responsible.  Two consecutive missed appointments could result in being discharged from care.

CONFIDENTIALITY AND PRIVACY (See Privacy Statement in office waiting area or see staff for copy)
Patient confidentiality will be respected at all levels of communication and is protected by the Federal and State Laws.  There are, however, situations in which confidentiality may be compromised and the provider’s professional and legal duty to protect may override the dictates of confidentiality.  Briefly, these situations may include a strong indication of imminent danger to self or others or indication of abuse or neglect of another.  Patients under the age of 18 require a parent or legal guardians to receive services. Please discuss your concerns about the limits of confidentiality with your provider and read the HIPPA privacy statements provided in the waiting area or please ask the receptionist for a copy.  
 
RELEASE OF INFORMATION
Following the execution of a valid Patient Authorization Form (Release of Information), patient records, or a treatment summary will be forwarded to a licensed professional.  Requests to obtain personal copy of your medical chart and requests to release records to any other entity (including attorneys) will be reviewed on an individual basis. This service is billed at the actual cost of supplying the records, and includes cost of copying, mailing, and professional time.  Any request for release of records must allow at least two weeks preparation time.
 
TELEPHONE CALLS/MISC PAPERWORK/LETTERS:
Our telephones are answered from 9:00 a.m. to 4:00 p.m.  Our employees have been instructed to handle all incoming calls. This allows the providers to attend to their scheduled patients with a minimum amount of interruption.  If you need to speak with the doctor or therapist during office hours, there may be a charge for the call.  Each doctor or therapist in the clinic may decide this on a case-by-case basis.  If you have an emergency and find it necessary to contact the doctor or therapist after hours, their voice mail will forward emergent messages to the doctor or therapist directly.  THERE MAY BE A CHARGE FOR EMERGENT CALLS TO THE PROVIDERS:  EACH PROVIDER DETERMINES THEIR OWN POLICY.  Non-emergency messages may be left on the office voice mail.  After hours telephone calls from patients or other parties acting on behalf of the patient may be charged.  Expenses incurred by emergent calls will not be billed to the insurance company, as they will not pay for this service; therefore, these charged are the sole responsibility of the patient. Paperwork or letters written on behalf of the patient by the doctor or therapist will also incur the hourly rate of the provider, pro-rated by the quarter hour.  
 
PRESCRIPTION AND REFILLS
Medication refills will only be handled during office hours, during scheduled appointments, and only if you are CURRENTLY under our care.  If you are prescribed medication, you will be given enough medication to cover you until your next scheduled appointment. If your appointment is rescheduled because of unforeseen circumstances, contact the provider via the office staff to arrange for medication refills to prevent running out of your prescriptions.  MEDICATION IS NOT REFILLED ON THE WEEKENDS OR AFTER OFFICE HOURS.  WE REQUEST AT LEAST 48 HOURS NOTICE FOR A REFILL.   Certain medications legally require your doctor to write a prescription.  Prescriptions for these controlled substances must be picked up in person at the office.  There will be a $10 charge for any prescriptions obtained outside of an appointment.
 
FEES & PAYMENTS & INSURANCE:
Your co-payment or percentage is due at the time of service.  For your convenience we accept cash, money orders, Visa, MasterCard, and personal checks.  Also, if paying by cash please try to have correct change.  We do not normally have cash on hand.  If your check is returned from your financial institution, we will no longer be able to accept them.  You will be subject to a $25 service charge and in the future will be required to pay with either cash or a credit/debit card.  At your request we will file primary insurance and secondary in-network insurance.  We do not file secondary out of network insurance claims.  We typically do not obtain authorization for out-of-network insurance, complete treatment reports, or any other forms requested by out-of-network insurance unless we are asked by the patient/guarantor for assistance.  If a situation arises in which assistance is required, there will be a $10 charge incurred for each request made by you or your insurance company.  You are responsible for notifying the billing manager if you wish to use this service, otherwise we will not assist in this process without the patient/guarantor’s approval.  

If, after 45 days, your insurance has not paid your claim(s), payment in full is expected from you.  It is your responsibility to pay the deductible amounts, coinsurance, or any other balance not paid by your insurance company. There are certain services that are not covered by your insurance.  Examples are, but not limited to, telephone consults/sessions, missed appointments, summaries of treatment, and visits by family members without the patient present.    YOU ARE ULTIMATELY RESPONSIBLE FOR YOUR BILL.



The best healthcare is based on friendly, mutual understanding among the staff, Provider, and Patient.  If any problems or questions arise, regardless of the nature, do not hesitate to bring them to our attention immediately. We thank you for coming to this office.  We are looking forward to getting to know you.

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