Essential Patient Information-- Please Read This Before Your First Appointment
Introduction to Mindful Ways.... :
We appreciate the opportunity to provide you with mental health services. We strive to
integrate the wisdom and compassion of psychotherapeutic approaches with the power of
recent discoveries regarding brain chemistry and function. We are aware of the pressing need
to find treatments that are economical as well as effective.
Please take a few minutes to review this information about your care. If you have
additional questions, ask us.
Appointments:
The office is open from 8:00 am to 6:00 pm, Monday through Thursday, and 8:00 am to
5:00 pm Emergencies:
If an emergency arises, please call. During the work day, dial 603-356-3100; on
evenings or weekends, dial 603-356-2516. If one of us does not answer the phone, please
leave a message indicating the nature and urgency of the situation. We will call back as soon
as we get the message. In most circumstances, one of us will return your call within four hours.
If we are likely to be unavailable for more than eight hours, we will try to arrange for
another doctor to provide backup for our patients, and will leave that information on the
answering machine. It is not always possible for us to arrange backup. If we are not available,
and the situation is critical, you can access emergency services by calling your family doctor or
by going to the nearest hospital emergency room.
Confidentiality:
The confidentiality of psychiatric and substance abuse is protected, ethically and legally.
This information will not be released without your written consent, except if a few, special
circumstances. These exceptions have to do with safety:
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Reporting possible abuse or neglect of children, disabled individuals, or elderly
individuals to state authorities,
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Assuring the safety of individuals who intend suicide or self harm, or who are unable to
provide for their basic needs,
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Notifying police and potential victims of threats to harm or kill someone or damage
property, and
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Releasing material under court order.
Your insurer will, or case management firms working for your insurer, will require clinical
information in order to reimburse your claim. This information may include history, symptoms,
diagnoses, treatments and progress related to psychiatric or substance abuse problems. If we
are to submit claims to your insurer on your behalf, then you must authorize this release of
information by signing the "Insurance Billing and Financial Responsibility" section of the "Basic
Information" sheet.
Patient Access to Medical Records:
You have a right to:
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Obtain a copy of your medical record,
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Request that corrections or explanations be added to your medical record,
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Ask that we provide a list, to you, of the instances in which we have released information
from your record, and the nature of the information released.
If you have such a request, present it to your clinician in writing.
It can take several hours for a staff member to copy a complete chart. Please give us
several week's notice so that we can respond to your request without disrupting the care of
others.
New Hampshire statutes recognize 50 cents per page as a reasonable charge for
duplicating medical records. We will bill you at this rate if you request a copy of your record, or
of substantial portions of it.
Handicapped Access:
Our office is located on the second floor of the building. If you have difficulty with stairs,
we will make alternative arrangements to see you. If you have a disability or sensory
impairment, let us know so that we can accommodate you safely.
Prescription Refills:
It has been our experience that patients often wait until they're almost out of medication,
then telephone to request a prescription refill. This makes extra work for patient, staff, provider
and pharmacist. At each step in the chain, there is opportunity for misunderstanding or error.
Therefore, we ask our patients to make every effort to track their medications, and to request
refills at their regularly scheduled medication checkups. This assures that communication is
clear, and that needed medication adjustments are made.
State and federal laws require written prescriptions for certain classes of medication,
notably, narcotics and stimulants. We cannot telephone prescriptions for these medications to
the pharmacy. Plan ahead to avoid last minute "emergencies".
We will not renew prescriptions for patients who we have not seen in six months.
Fees and Payment:
Please remember that you, ultimately, are responsible for your account. Never assume
"My insurance has taken care of it." Read the Statements and the"Explanation of Benefits"
forms from your insurer carefully. If you can't understand them, or think that there is an error,
call your insurer or our business office.
If you have insurance, and we have an agreement with your carrier, we will bill the carrier
directly, for your convenience. To make this work, we have to have correct, up to date,
information. Keep us current. We submit claims to insurers through the mail, using paper
forms. We do not use "electronic claim submission".
For some companies, we have made arrangements for direct reimbursement of claims.
When we bill them, they send us a check for their portion of the charges that they cover. In this
case, we will ask you to pay your co-payment at the time of service. Other companies send the
check to the policy holder, even if we do the billing. If this is the case with your insurer, we will
ask you to pay us the full fee at the time of service.
If payment at the time of service will be difficult for you, let us know about your situation.
We will do our best to work out a way for you to get the services you need.
Please be prompt with your payments. If there is an outstanding balance due from you
on your account for over 30 days, we will charge 1.5% interest monthly on this balance. We will
also charge a $5.00 handling fee to cover the costs of billing you for months in which you do not
make payments. Finally, if you have a balance due over 90 days, and have not negotiated and
maintained a signed payment agreement with us, we will notify you, and turn your account over
to a collection service.
Managed Care:
Many insurers practice "managed care". This means that they require patients to get
authorization from the before starting treatment, and at regular intervals while continuing
treatment. To avoid complications regarding payment, contact your insurer before your first
appointment. This is your responsibility. We will hold you responsible for payment if you do not
follow your insurer's requirements.
"Not Covered" Services:
Insurance companies provide reimbursement for face-to-face treatment. They do not
pay for treatment by telephone, for preparation of reports, or for conferences between the doctor
and third parties (e.g., case managers, school representatives). Therefore, if you request such
services, be aware that we will bill you for such services directly. Similarly, if you make frequent
or extended telephone calls, we will bill you for these services.
Missed Appointments and Late Cancellations:
We will excuse each patient's first late cancellation or "no show", as a courtesy, no
questions asked. For the second, and successive, misses, we will bill at full fee for the allotted
time. We will require you to settle this fee at the time of your next office visit, along with your
usual co-payment. If we think that missed appointments are interfering with your care, we will
bring that up with you.
"Patient Assistance" Programs:
Some pharmaceutical companies provide medications for individuals who cannot afford
medications. The application process is different for each company. Generally, the prescriber
has to complete forms, and office staff members have to track the status of applications and the
inventory of medications received. Therefore, we will bill a handling charge to patients enrolled
in patient assistance programs. If we mail medications to you, we will charge you for postage
and handling.
Ending Treatment at Mindful Ways....:
We are happy to see patients improve, and to "graduate" from treatment. If you are
nearing "graduation", we will discuss this with you.
Sometimes treatment ends for other reasons, or in circumstances in which patients
need continued care. If you wish to transfer your care to another individual or agency, we will be
glad to discuss your options with you, and to provide case summaries if they are needed.
If you miss three appointments in a row, or are out of touch with us for more than six
months, we will assume that you are choosing to end treatment.
We will not renew prescriptions for patients who are not in treatment.
Mindful Ways.... on the Internet :
We maintain a web site with information about the practice. It includes many links to
sites which provide mental health information. www.mindfulways.com is the web "address".
Though many individuals find e-mail a convenient way to communicate, e-mail has not
become an accepted part of medical practice. It is difficult to guarantee the confidentiality of e-mail, and to assure that it is received promptly. Therefore, we communicate with our clients by
telephone, facsimile, and mail. Please do not e-mail us.