To access your new patient paperwork:
OFFERING TELEMEDICINE. ALL APPOINTMENTS ARE VIRTUAL!
DO YOU TAKE INSURANCE?
HOW CAN I MAKE A PAYMENT?
If your credit card is not on file 72 hours prior to appointment please contact our biller Renee Shadley at [email protected] or you may call her office at 1-877-454-9036.
We accept most major credit cards as forms of payment. All co-pays, co-insurances, and deductible payments will be processed through Easy Pay, a secure, online payment platform that stores debit and/or credit card information. 24 hours after your visit, the amount you owe will be automatically deducted, so there will be no need for you to present a card to be swiped. At the time of scheduling your first visit, you will be required to provide the debit or credit card that you wish to be stored for payment purposes.
As a courtesy to you, we will file claims for your sessions electronically; however, payment of all applicable co-pays, co-insurances and deductibles are required at the time of service. We will not be able to file claims with your insurance company unless you provide complete and accurate information about your insurance. It is your responsibility to ensure that we have the correct information and that you promptly inform the practice of any changes in your coverage. If, for any reason, your insurance company does not reimburse Integrative Behavioral Health & Healing Practice for services rendered, you will be responsible for those charges. Attempts to collect this balance will be made for 30-90 days past due. Any balances that age past 90 days will be transferred to a collection agency.
WHAT IS YOUR CANCELLATION POLICY?
We set aside this time especially for you. We hope this time is as valuable for you. In the case of an emergency, we ask for a 24-hour notice to not incur a charge. No-show appointments are charged based upon the time set aside for you.
If you are a new patient, a no-show or less than 24 hr cancellation of your new patient appointment is subject to a $300 fee. (not covered by insurance)
If you are an established patient, should you need to cancel your appointment, please do so at least 24 hours prior. Missed appointments and late cancellations are subject to charges on the card on file of $75.00.
If you cannot be reached by your provider within 10 mins of the start time of your appointment you may be considered a no-show and you will have to reschedule and be charged a fee for a missed appointment to your card on file.
WHAT ABOUT REFILLS?
Patients are required to be seen every 2-3 months in order to obtain refills.
Call your pharmacy 3-5 days prior to running out of medication and they will send us a refill request.
Allow 48-72 business hours for refill requests.
If it is a refill for a class II controlled substance (ADHD stimulants) call the office at 984-288-0880 and request a refill. Refills are not considered an emergency and will be handled during regular business hours of 7:40am and 4pm, within 72 business hours.
LIMITS OF CONFIDENTIALITY
Duty to Warn: medical providers are mandated by law to disclose pertinent information discussed in appointments if the patient:
- Has intent or plan to harm another person. We are required to inform the intended victim and notify legal authorities.
- When there is reasonable cause to believe child/elder abuse or neglect has occurred.
- When an emergency situation requires sharing of information.
- When required for insurance billing purposes.
- When a court order is received.
For after-hour emergencies ONLY you may contact our on-call provider on weekends at the following number 000-000-0000. Please note a charge will be applied for contacting the on-call provider.
If an emergency is needed please call 911 or go to the nearest emergency room. Emergency situations include serious psychiatric medication reactions or risk of harm to oneself or someone else.
ANY OTHER QUESTIONS?
Please contact us with any additional questions you may have. We look forward to hearing from you!
WHAT CAN I DO TO HELP?
We are so glad and honored that you are dedicated to starting treatment with Integrative Behavioral Health & Healing Practice, PLLC. Your active participation and dedication will be crucial to your success.
WHAT ARE YOUR SELF-PAY RATES IF I DON'T HAVE INSURANCE
You will ONLY pay this amount if you HAVE NO INSURANCE. otherwise your insurance covers cost of visit and will only have to pay for your copay cost.
|New Patient Evaluation, 60 minutes||—||$300.00|
|Follow Up Appointment, 40 minutes||—||$200.00|
|Follow Up Appointment, 20 minutes||—||$150.00|
|Completion of forms/letters outside a session||—||Depends on length of time. Based on $300.00/hour|