Office Policy for Rochelle Long, LMHC
COMMITMENT TO CHANGE: An effective treatment program requires openness, commitment to change, and an attitude of collaboration between the client and provider. Since many of the aspects of these requirements are intangible and the response to medications and therapy is variable, the degree of success of any treatment or therapy cannot be fully guaranteed.
COMMUNICATIONS: As we provide services for adults and children, clients are expected to communicate on their own behalf or parents, guardians, regarding any need for services, appointments, and billing. Unless allowed by a release of information signed by the client, no communications can be accepted from any third party on behalf of the client. No exceptions will made to this policy due to confidentiality and accountability requirements.
FEE FOR SERVICE APPOINTMENT: The fee for appointments is based upon the type of appointment you have scheduled. A staff person can discuss what your fee is at the time that you schedule an appointment. Your session begins at the scheduled time, not when you arrive. A fee of $150.00* will be charged for missed follow-up appointments and cancellations not made at least 24 business hours prior to the scheduled appointment time, not including weekends. Telephone and email appointment reminders are a courtesy only, and we are not responsible for the content or delivery of the appointment reminders (as they are provided by a third-party system).
FORMS: If you require forms to be completed by your provider, you must schedule an appointment. Forms will not be completed outside of scheduled appointment times without the prior knowledge and consent of your provider. Any forms and letters completed outside of an appointment time are subject to the availability of your provider and will result in a fee.*
PAYMENT: Payments and co-pays will be requested at the time of your appointment. A finance charge will be applied to any unpaid balance, 30 days past due, at the rate of 1.5% per month. This office reserves the right to send a bill for collection after 90 days without payment. Any questions regarding payment needs to be directed to billing.
INSURANCE COVERAGE: Some insurance plans cover therapeutic services. If you are unsure about your coverage, call your insurance company to inquire if your plan covers outpatient mental health services. It is YOUR responsibility to pay your co-payment at the time of service. We will bill your insurance company for the portion that your insurance benefits cover.
CONFIDENTIALITY: All issues discussed in the course of treatment and therapy are strictly confidential. By law, information concerning treatment or evaluation may be released only with the written consent of the person treated or such person’s parent or guardian. However, the law requires the release of confidential information in three situations: suspected child abuse, potential suicidal behavior, or threatened harm to another. In addition, in certain select circumstances, the court may subpoena treatment records. Your provider will discuss the release of confidential information with you.
ETHICS AND PROFESSIONAL STANDARDS: Your provider is licensed and certified in the specialty of psychiatric nursing. If you have any concerns about the course of treatment, please discuss them with your provider. Should you feel that your provider has been unethical or unprofessional, you may contact the Licensing Department in Olympia.
EMERGENCY AVAILABILITY: Your provider is available after hours in case of emergency by calling (425) 322-3540. Emergencies are defined as “life threatening” problems that cannot wait to be resolved on the next working day. If this emergency system fails for any reason, please use good judgment and obtain emergent care through a local hospital emergency room, your primary care physician, or through the designated crisis plan. Non-emergent issues should be brought up at scheduled appointments or during regular business hours Monday through Friday. Please keep in mind that your provider will return messages left at the after-hours telephone number as soon as possible. However, your provider may not be able to return calls on the same day in the event of extenuating circumstances. If your provider determines that your message is not emergent, your call may be returned during normal business hours.
MEDICATION REFILLS: Your provider endeavors to provide enough medication to get to the next scheduled appointment. If called for refills during non-business hours, there is no guaranteed access to the medical file and adequate information with which to determine appropriate action. Therefore, it is expected that clients will make appointments to discuss medication changes or refills, and it is your responsibility to make sure you schedule an appointment for discussion of medication issues. It is for this reason that NO MEDICATION REFILLS will be called in outside of normal business hours. If prescription refills are required and you have failed to schedule an appointment to address these issues, enough medication will be called in to the pharmacy to allow you to make it to your next appointment (with a fee for medication management after hours*). No new medications can be prescribed over the telephone, and you must make an appointment if medications need to be changed. It is your provider’s intention to be a responsible practitioner working with responsible clients. It is office policy that requests for refills, prescriptions for ADD / ADHD medications, and samples be submitted at least 5 business days in advance, and this does not include weekends.
OFFICE POLICY Rev 01/11/12*These fees are billable to the client, not to insurance.