Office Policies
​
Office No-Show/Late Cancel, Legal and Medication Policies
No-Show/Late Cancel Policies
​
**Your appointment is reserved just for you.
Please call 24 hours in advance if it is necessary to change or cancel your appointment, otherwise your visit will be
considered a missed appointment. The scheduled time for your appointment is your responsibility. Cancellations for
illness, weather conditions and similar situations are reasonably considered. The agreement to the office policies entails
responsibility for all treatment fees, missed appointment fees in addition to any collection agency fees after 45 days of
treatment/service date.
​
**Missed appointment fee**
There will be a $50 fee for a missed follow-up visit with your psychiatric provider or therapist. **If we do not hear from
you within 48 hours of your missed appointment, we will charge your card on file a $50 no- show fee. **
Third missed appointment (psychiatric provider and/or therapist) will result in discharge from the practice.
​
Legal Policies
There is a $20 fee for returned check and you will not be allowed to write checks for future appointments if we received a
returned check.
​
All collection agency fees for up to an additional 45% (forty-five percent) of the unpaid balance due.
​
Collaborative Adult Psychiatry and all practitioners including therapists and psychiatrists do not become involved with
any legal matters whatsoever including criminal/civil cases, workers compensation claims, or disability suits. Any
subpoena will result in a $500/hr per charge for any/all legal matters including review of records, travel, discussions with
legal counsel or any time involving legal matters.
​
Medication and Prescription Policies
-Please note that State and Federal Guidelines, as well as those mandated by our own Insurance Company contracts require
an appointment with our medical providers prior to prescribing medications and/or medication refills. This policy applies
to both existing and new patients.
​
-All intakes/first appointments do acknowledge that current medications may or may not be prescribed by any psychiatrist
here at Collaborative Adult Psychiatry after initial examination and some medications may remain with other current
providers (internist/family physician) if deemed beyond FDA limits or safe/tolerable prescribing practice.
There is no “guarantee” any psychiatric provider at Collaborative Adult Psychiatry will take over any medicine.
​
-All prescription refill requests must be made by the patient/caregiver (must have ROI on file). No refill requests will be
accepted by the pharmacy via fax or phone call.
​
Medicare, Aetna, Cigna and United Healthcare, Humana & BCBS Patients
We are only contracted with government Medicare, Aetna, Cigna, United Healthcare, Humana and Blue Cross Blue
Shield. Please check with your insurer to determine whether prior authorizations are required or if you have a
copay/coinsurance or deductible to meet. Please check with your insurer to determine whether or not Collaborative
Adult Psychiatry and its providers are contracted providers. **If your insurance status changes (loss of insurance/change to a different insurer) it is your responsibility to notify us within five days of policy change or you become responsible for all future bills. All fees (copay/coinsurance and/or deductible) are due at the time of service **
MEDICARE
- We are participating government only Medicare providers. We will bill Medicare and you will be responsible for
payment of the annual deductible, any copayments or coinsurance, and charges for non- covered services.-Medicare and supplemental coverage-After Medicare is billed, we will bill your supplemental plan whether we are
​
contracted or not with the supplemental carrier. If no payment is received from your secondary/supplemental carrier within
60 days after we file a claim, you will be sent a bill and will be responsible for the balance.
​
AETNA/CIGNA/UNITED HEALTHCARE/HUMANA/BCBS
-If we participate (are contracted) with a commercial plan under which you are covered, we will bill the carrier. We will bill your primary and secondary insurances for contracted plans. You will be responsible for payment of the annual deductible, copayments and/or coinsurance and any non-covered services.