policies
Late Cancellation and No-shows
If you do not show for an appointment or cancel without a minimum of 48 hours notice you will incur a missed appointment/ late cancellation fee as follows:
•$ 75 per missed appointment
Insurance does NOT cover this fee.
Please understand that this policy is in place as a means of respecting the time and efforts of your provider, as well as other patients who would have benefited from a visit during this time. If a pattern of cancelled appointments develops (whether providing 48 hours notice or not), I may be unable to continue to provide services, and reserve the right to cancel future appointments. I will always communicate about this with you, and determine if we’re a good fit prior to making changes to your scheduled appointments. I will make every effort to provide you with adequate notice if I will be unavailable for a scheduled appointment and be more than happy to reschedule as needed.
Phone Consultations
Contact Information
Psychiatric treatments are individualized and often require multiple changes. As such, I do not offer extensive consultations via email and I do not communicate by texting on the phone. You may email me with short, concise questions that should be no more that 3‐5 lines long and pertain to your current treatment plan. Email or nonurgent phone calls outside of appointment times are not a substitute for an office visit. Email correspondence is intended for brief questions or clarifications that can await response 7 days or more. My practice utilizes OnPatient, an online patient portal where you can send me secure HIPPA-compliant messages and access lab results, medication lists, appointment scheduling and health summaries. You must have an email address to use this portal and there is an OnPatient app available to send secure message from your phone or tablet.
To report acute symptoms not requiring emergency care, please call my office. Urgent calls will be returned as soon as I am able within 48-72 hours and non-urgent calls are generally returned during current office hours. I do not answer my phone while I am with patients and at various other times. In an emergency, do not email, send an patient portal message or call my office. Call 911, call the Suicide Crisis Line 1 (800) 273‐8255 or proceed to the ER. Please note that email and text are not considered to be secure forms of communication and you are accepting the risk that your message may be intercepted or otherwise seen by an unauthorized third party.
Please note: Most clinical issues should be shared in your session. If calls and case management become excessive, I may charge for case management time, at an hourly rate. I will always inform you prior to providing this service and prior to billing for it. Many issues including insurance or billing questions, appointment changes, medication questions or medication refills can be resolved during normal business hours, Monday through Wednesday 9 am – 5 pm.
Insurance and Payment
Please provide full insurance information and your insurance card upon your initial visit. I am currently in-network with Premera/Lifewise, Regence and First Choice Health. It is your responsibility to determine eligibility of benefits, understand your coverage, and obtain authorization from your insurance provider when necessary prior to your first visit. If the visit is not covered, then you will be responsible for the bill. If you have a change in insurance, please let me know as soon as possible, so I can ensure payment. Many insurances have deductibles and it is your responsibility to pay your balance if you have not met your deductible.
It is your responsibility to pay in full at the time of each visit, including private pay amounts, copays, coinsurance and deductibles. You will be billed for any remaining balance and have the option to pay online via the patient portal. I accept exact cash, checks and all major credit cards. Bounced checks incur a $25 processing fee. I reserve the right to bill my standard fees for case coordination, clinical write‐ups, and phone consultations exceeding 5 minutes per week. There is no charge for routine telephone calls regarding scheduling, appointments, or billing. I generally do not fill out forms for L&I, disability, custody disputes or court. My time is best-served providing high quality professional services to you while you are here in session.
Medication Refills
Medication prescriptions should be written during a session, which allows us to discuss how they are working and how long you should take them. You will be given refills for your prescriptions during your medication management appointments. If you cancel this appointment, but need a refill, you will be responsible to provide me with SEVEN BUSINESS DAYS notice prior to you running out of your current prescription, and will need to be seen for further refills. Keep an eye on your dosage amount to avoid a rush, and to give the pharmacy and myself enough time to get your refill processed.
I will not authorize refills if you have no future appointment, as I am legally required to ensure that you are in active treatment if I prescribe medications. Please note that in the event of a missed, rescheduled, or cancelled appointment, your medications may not be refilled.
If a pattern of repeated cancellations and refill requests over the phone develops, this will be addressed and a service charge of $50 for phone refill requests may be charged for each occurrence. I am unable to provide refills of medications provided by other doctors or for other medical conditions, including narcotic pain medications, and may not prescribe any medications on your first visit.
Dismissal/Termination of care:
You have the right to terminate care with me for any reason, however if you have any questions or concerns about your treatment, please feel free to discuss them with me. There are some situations in which I may terminate the Provider and Client relationship such as:
Remission of Illness
If treatment reaches a point of consistent symptoms remission and no further treatment is needed, you or your provider may decide to terminate care.
Stability Allowing Transfer of Further Care to Primary Care
If medication treatment reaches a point of consistent symptoms stability, there may be an option to transfer medication management to your primary care provider. This requires your primary care provider to be comfortable prescribing your medications and managing your mental health care. This option may be requested by you due to cost or convenience, or recommended by me if specialist care is no longer assessed to be required.
Transfer of Care
A transfer of care may be requested by you or your provider for many reasons. Reasons include, but are not limited to, you or your provider relocating, change in your insurance, change in insurance accepted by your provider, or a variety of treatment concerns (see below).
Lack of Improvement with Treatments Offered
If your symptoms do not improve with treatments offered by your provider, you may request or your provider may require termination of treatment and transfer of care.
Level of Severity/Need Exceeds Services Available
If your symptoms are outside of your provider’s area of expertise, or severity of symptoms/level of treatment need exceeds services offered within my practice, you may request or your provider may require termination of treatment and transfer of care.Lack of Adherence to Treatment Recommendations
If you are not following treatment recommendations given and/or are misusing medication prescribed by this practice, your provider may require termination of treatment and transfer of care, as this may impact treatment outcomes.Lack of Return for Treatment
If you do not return for treatment for two months after your provider’s recommended follow timeframe, your care will be considered terminated and your chart will be closed. If you only need to return for care as needed, your care will be considered terminated and your chart closed if you have not returned for treatment for four months.
Poor Fit for Practice/Provider
If you or your provider do not feel that the care relationship, or policies of this office, are a good fit, you may request or your provider may require termination of treatment and transfer of care.
Nonpayment
If your account is over 90 days past due, please be aware that if a balance remains unpaid, your account will be referred to a collection agency and you and your immediate family members may be discharged from this practice. If you are sent to collections, you will be notified by mail that you have 30 days to find alternative medical care. If needed, you will also be provided 30 day prescriptions of non-controlled substances. During that 30-day period, your provider will only be able to treat you on an emergency basis. Need for stimulant medication does not constitute emergency care. Thirty days after the notification is sent, care will be fully terminated and you will not be able to return to this practice for treatment.
Frequently Missed Appointments or Inappropriate Behavior.
Two sessions in a row have been missed without 48 hours notice, or appointments are frequently missed with or without contact.
Hostile, aggressive, or disruptive behavior by you, your family member or significant other on the premises or to myself.
There may be additional reasons for termination of care that may be made at the discretion of your provider.
Confidentiality
Information discussed during the course of psychiatric treatment is confidential. By law, information concerning your treatment may be released only with the consent (written or verbal) of the person treated (or the person's guardian if applicable). In the event where there is suspected child or elder abuse or an imminent danger of harm to one's self or others, the law requires the release of confidential information. In these instances we are required to make a report to the appropriate authorities. In addition, the courts may subpoena treatment records in certain circumstances. Any type of release of confidential information will be discussed with you.
I am compliant with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to personal health care information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices. This Notice, which is attached to this agreement, explains HIPAA in detail and its application to your personal health care information. An electronic copy can be found on our website at www.mindfultherapygroup.com/faqs
I may ask you to allow an intern or other licensed professional in training to sit in on your sessions or participate in your care. Any use of your information for teaching purposes will not be transferred outside of our practice, and your PHI will be protected in accordance with our Privacy Practices as described below. You may opt out of this at any time.
Age of Consent In accordance with RCW 71.34.530: Any minor thirteen years or older may request and receive outpatient mental health treatment without the consent of the minor's parent. Parental authorization, or authorization from a person who may consent on behalf of the minor pursuant to RCW 7.70.065, is required for outpatient treatment of a minor under the age of thirteen.
For adolescents age 13 and older, I request an agreement between the client and the parents allowing me to share general information about treatment progress and attendance, as well as a treatment summary upon completion of therapy. All other communication will require the adolescent’s agreement, unless I feel there is a safety concern, in which case I will make every effort to notify the adolescent of my intention to disclose information ahead of time and to discuss any objections that are raised.
If you do not show for an appointment or cancel without a minimum of 48 hours notice you will incur a missed appointment/ late cancellation fee as follows:
•$ 75 per missed appointment
Insurance does NOT cover this fee.
Please understand that this policy is in place as a means of respecting the time and efforts of your provider, as well as other patients who would have benefited from a visit during this time. If a pattern of cancelled appointments develops (whether providing 48 hours notice or not), I may be unable to continue to provide services, and reserve the right to cancel future appointments. I will always communicate about this with you, and determine if we’re a good fit prior to making changes to your scheduled appointments. I will make every effort to provide you with adequate notice if I will be unavailable for a scheduled appointment and be more than happy to reschedule as needed.
Phone Consultations
Contact Information
Psychiatric treatments are individualized and often require multiple changes. As such, I do not offer extensive consultations via email and I do not communicate by texting on the phone. You may email me with short, concise questions that should be no more that 3‐5 lines long and pertain to your current treatment plan. Email or nonurgent phone calls outside of appointment times are not a substitute for an office visit. Email correspondence is intended for brief questions or clarifications that can await response 7 days or more. My practice utilizes OnPatient, an online patient portal where you can send me secure HIPPA-compliant messages and access lab results, medication lists, appointment scheduling and health summaries. You must have an email address to use this portal and there is an OnPatient app available to send secure message from your phone or tablet.
To report acute symptoms not requiring emergency care, please call my office. Urgent calls will be returned as soon as I am able within 48-72 hours and non-urgent calls are generally returned during current office hours. I do not answer my phone while I am with patients and at various other times. In an emergency, do not email, send an patient portal message or call my office. Call 911, call the Suicide Crisis Line 1 (800) 273‐8255 or proceed to the ER. Please note that email and text are not considered to be secure forms of communication and you are accepting the risk that your message may be intercepted or otherwise seen by an unauthorized third party.
Please note: Most clinical issues should be shared in your session. If calls and case management become excessive, I may charge for case management time, at an hourly rate. I will always inform you prior to providing this service and prior to billing for it. Many issues including insurance or billing questions, appointment changes, medication questions or medication refills can be resolved during normal business hours, Monday through Wednesday 9 am – 5 pm.
Insurance and Payment
Please provide full insurance information and your insurance card upon your initial visit. I am currently in-network with Premera/Lifewise, Regence and First Choice Health. It is your responsibility to determine eligibility of benefits, understand your coverage, and obtain authorization from your insurance provider when necessary prior to your first visit. If the visit is not covered, then you will be responsible for the bill. If you have a change in insurance, please let me know as soon as possible, so I can ensure payment. Many insurances have deductibles and it is your responsibility to pay your balance if you have not met your deductible.
It is your responsibility to pay in full at the time of each visit, including private pay amounts, copays, coinsurance and deductibles. You will be billed for any remaining balance and have the option to pay online via the patient portal. I accept exact cash, checks and all major credit cards. Bounced checks incur a $25 processing fee. I reserve the right to bill my standard fees for case coordination, clinical write‐ups, and phone consultations exceeding 5 minutes per week. There is no charge for routine telephone calls regarding scheduling, appointments, or billing. I generally do not fill out forms for L&I, disability, custody disputes or court. My time is best-served providing high quality professional services to you while you are here in session.
Medication Refills
Medication prescriptions should be written during a session, which allows us to discuss how they are working and how long you should take them. You will be given refills for your prescriptions during your medication management appointments. If you cancel this appointment, but need a refill, you will be responsible to provide me with SEVEN BUSINESS DAYS notice prior to you running out of your current prescription, and will need to be seen for further refills. Keep an eye on your dosage amount to avoid a rush, and to give the pharmacy and myself enough time to get your refill processed.
I will not authorize refills if you have no future appointment, as I am legally required to ensure that you are in active treatment if I prescribe medications. Please note that in the event of a missed, rescheduled, or cancelled appointment, your medications may not be refilled.
If a pattern of repeated cancellations and refill requests over the phone develops, this will be addressed and a service charge of $50 for phone refill requests may be charged for each occurrence. I am unable to provide refills of medications provided by other doctors or for other medical conditions, including narcotic pain medications, and may not prescribe any medications on your first visit.
Dismissal/Termination of care:
You have the right to terminate care with me for any reason, however if you have any questions or concerns about your treatment, please feel free to discuss them with me. There are some situations in which I may terminate the Provider and Client relationship such as:
Remission of Illness
If treatment reaches a point of consistent symptoms remission and no further treatment is needed, you or your provider may decide to terminate care.
Stability Allowing Transfer of Further Care to Primary Care
If medication treatment reaches a point of consistent symptoms stability, there may be an option to transfer medication management to your primary care provider. This requires your primary care provider to be comfortable prescribing your medications and managing your mental health care. This option may be requested by you due to cost or convenience, or recommended by me if specialist care is no longer assessed to be required.
Transfer of Care
A transfer of care may be requested by you or your provider for many reasons. Reasons include, but are not limited to, you or your provider relocating, change in your insurance, change in insurance accepted by your provider, or a variety of treatment concerns (see below).
Lack of Improvement with Treatments Offered
If your symptoms do not improve with treatments offered by your provider, you may request or your provider may require termination of treatment and transfer of care.
Level of Severity/Need Exceeds Services Available
If your symptoms are outside of your provider’s area of expertise, or severity of symptoms/level of treatment need exceeds services offered within my practice, you may request or your provider may require termination of treatment and transfer of care.Lack of Adherence to Treatment Recommendations
If you are not following treatment recommendations given and/or are misusing medication prescribed by this practice, your provider may require termination of treatment and transfer of care, as this may impact treatment outcomes.Lack of Return for Treatment
If you do not return for treatment for two months after your provider’s recommended follow timeframe, your care will be considered terminated and your chart will be closed. If you only need to return for care as needed, your care will be considered terminated and your chart closed if you have not returned for treatment for four months.
Poor Fit for Practice/Provider
If you or your provider do not feel that the care relationship, or policies of this office, are a good fit, you may request or your provider may require termination of treatment and transfer of care.
Nonpayment
If your account is over 90 days past due, please be aware that if a balance remains unpaid, your account will be referred to a collection agency and you and your immediate family members may be discharged from this practice. If you are sent to collections, you will be notified by mail that you have 30 days to find alternative medical care. If needed, you will also be provided 30 day prescriptions of non-controlled substances. During that 30-day period, your provider will only be able to treat you on an emergency basis. Need for stimulant medication does not constitute emergency care. Thirty days after the notification is sent, care will be fully terminated and you will not be able to return to this practice for treatment.
Frequently Missed Appointments or Inappropriate Behavior.
Two sessions in a row have been missed without 48 hours notice, or appointments are frequently missed with or without contact.
Hostile, aggressive, or disruptive behavior by you, your family member or significant other on the premises or to myself.
There may be additional reasons for termination of care that may be made at the discretion of your provider.
Confidentiality
Information discussed during the course of psychiatric treatment is confidential. By law, information concerning your treatment may be released only with the consent (written or verbal) of the person treated (or the person's guardian if applicable). In the event where there is suspected child or elder abuse or an imminent danger of harm to one's self or others, the law requires the release of confidential information. In these instances we are required to make a report to the appropriate authorities. In addition, the courts may subpoena treatment records in certain circumstances. Any type of release of confidential information will be discussed with you.
I am compliant with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to personal health care information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices. This Notice, which is attached to this agreement, explains HIPAA in detail and its application to your personal health care information. An electronic copy can be found on our website at www.mindfultherapygroup.com/faqs
I may ask you to allow an intern or other licensed professional in training to sit in on your sessions or participate in your care. Any use of your information for teaching purposes will not be transferred outside of our practice, and your PHI will be protected in accordance with our Privacy Practices as described below. You may opt out of this at any time.
Age of Consent In accordance with RCW 71.34.530: Any minor thirteen years or older may request and receive outpatient mental health treatment without the consent of the minor's parent. Parental authorization, or authorization from a person who may consent on behalf of the minor pursuant to RCW 7.70.065, is required for outpatient treatment of a minor under the age of thirteen.
For adolescents age 13 and older, I request an agreement between the client and the parents allowing me to share general information about treatment progress and attendance, as well as a treatment summary upon completion of therapy. All other communication will require the adolescent’s agreement, unless I feel there is a safety concern, in which case I will make every effort to notify the adolescent of my intention to disclose information ahead of time and to discuss any objections that are raised.