OFFICE BILLING & INSURANCE POLICIES/AUTHORIZATION FOR PATIENTS:
- I will provide all required insurance information when checking in for my appointment and will update any changed insurance information before the next visit.
- I authorize (co) payment in full to be made directly to this provider on the day of the appointment for all rendered services. This can take the form of cash, check or debit/credit card.
- I understand that the information my insurance company provides to me or Altman Psychiatric Associates is not a guarantee of the benefits provided or paid by my insurance company. I understand that I am responsible for payment of services I receive, whether or not my insurance company covers these services.
- I understand that it is my responsibility to pay any co-pay, deductible or co-insurance amount not paid by my insurance and this is due at the time of each visit. If payment is not made at the time of the scheduled appointment, a $10.00 administrative fee will be assessed.
- I understand that there is a $30.00 service charge for all returned checks.
- I understand that there is a minimum of $5.00 added to all amounts unpaid within 60 days from the date of service.
- Accounts that are 90 days past due or exceeding $200 will be subject to appointment cancellation and possible collections.
- There is a minimum $25 charge for releasing medical records plus $0.50/page for every page above 20 pages.
Please review this policy before your first visit with me.
CANCELLATION AND NO SHOW POLICY If you need to cancel your appointment or change your appointment, please do so as soon as possible by calling 781-436-8390. If cancellation does not occur at least 24 hours prior to your appointment, you may be charged for that appointment. If you no show for a scheduled appointment, you also may be charged. This will be discussed further on the day of your visit.
Appointment reminder calls 24-48 hours in advance may occur for initial evaluations, but these are considered courtesy calls. Thus if no call is received, you are still responsible for payment for a missed visit. Please let the office know if you choose not to receive reminder calls.
HIPPA Policy download pdf please review this policy before your first visit with me.
Emails should not be used for urgent communication as they may not always be checked daily. Thus the best form of communication for any urgent issues is by phone or ideally by appointment.
Phone messages will be returned during the same business day. If there is an urgent issue for which you do not receive a phone call as promptly as you feel is necessary, please call 911 or proceed to the nearest emergency room.
Controlled Substances Patient Agreement
Examples of controlled substances: Benzodiazepines (e.g. Ativan, Xanax, Klonopin), Stimulants (e.g. Adderall, Ritalin) and other medications that can be abused such as Neurontin and Promethazine
I will keep my medications safe, secure and out of the reach of children or anybody else who could have access to them.
I will not share, sell or otherwise permit others to have access to my medications. I will take my medications as prescribed.
I agree that medications will not be replaced if they are lost, stolen, destroyed, left somewhere else, flushed down the toilet, etc. [If your medication has been stolen and you complete a police report regarding the theft and present it to your psychiatrist, an exception could be made at your psychiatrist’s discretion]
I agree that early refills will not be given (earlier than allowed by the pharmacist and/or the insurance company). [Exceptions for psychiatrist being out of town or patient going out of town and needing to fill prescriptions early at your psychiatrist’s discretion]
I will not get prescriptions for controlled substances (or any of the medications mentioned above) from another doctor while in treatment with my psychiatrist.
I will report any side effects (for example, sedation) to my psychiatrist and will use caution when driving or operating heavy machinery. I will report to my psychiatrist if I am taking any prescription opiates (e.g. Suboxone, Methadone, Percocet, Vicodin, Oxycontin, etc). I understand that combining benzodiazepines with opiates can potentially make me more sedated and will report this to my doctor if this occurs.
My psychiatrist has the right to perform random pill counts or random urine drug screens at any time and cooperation is mandatory on the same day. If the results of these tests are consistent with abuse or misuse of prescribed controlled substances, it is your psychiatrist’s prerogative to cease prescribing of these medications (with a tapering schedule if necessary) and/or terminate treatment.
I agree that failure to adhere with any of the above policies may result in cessation of prescribing of controlled substances (tapering if necessary) as well as termination of treatment with referrals provided.