Payment for services provided by the Petit Psychiatry is due at the time that services are rendered. If the patient is covered under insurance, payment of any applicable copayment, co-insurance, or deductible is due at the time of service. If Petit Psychiatry is not contracted with the insurance, payment for services is due in full at the time that services are rendered. Petit Psychiatry makes every effort to verify your coverage with your insurance. However, you are strongly encouraged to verify your benefits and coverage to ensure you fully understand what is covered. You agree that it is your responsibility to inform the practice of any changes to insurance plan prior to each of your visits, or you may be responsible for the full fee. Some services may not be covered by health insurance.
You agree to be fully responsible for payment for all services that are not covered by your health plan. This may include charges for telephone consultations, written correspondence, or reports in connection with a client’s evaluation or treatment, including consultation or correspondence with the client, family members, past or current treatment providers, educational professionals, attorneys, courts, agencies, or others. If these charges are excluded from your coverage by your health plan, they will be your responsibility. There will be a charge of $50.00, including applicable fees from the financial institution(s) for returned checks or disputed credit card payments. All patients are required to have a credit card on file to initiate or continue care. It is your responsibility to update any expired cards. All outstanding balances are expected to be paid within 60 days. Payment plans can be provided upon request.
Fees Not Billed to Insurance/Professional Services
Petit Psychiatry may provide, on a case-by-case basis consultations with family members, past or current medical providers, educational professionals, attorneys, courts, agencies, or others. Limited telephone consultation is part of routine patient care and is undertaken without charge. However, when extensive or other than routine telephone consultations, written correspondence or reports are requested or required, a charge for these services will be applied. To comply with federal laws including HIPAA, this office must have a signed authorization from the patient, or responsible party stating who we are authorized to release information to. You can contact our office or visit our website for a copy of the form. If these charges are excluded from your coverage by the health plan, they will be your responsibility.
Listed below are the fees for professional services included but not limited to paperwork completion, consultations, court proceedings, holistic care, telepsychiatry (if not covered by insurance):
Nurse Practitioner/ Physician Assistant fee (Initial Visit): $200-350
Nurse Practitioner/ Physician Assistant fee (Subsequent Visit): $100-175
Requesting Records from Petit Psychiatry for self/provider/ other entities To request records from the Petit Psychiatry for yourself, another provider or entity we require that you complete the “HIPAA FORM B” form in entirety. Incomplete forms will not be processed and will delay your request. The cost is a $1.00 for the first 25 pages and afterwards 25 cents per page to fax or copy your record and additional cost for required certified mail (postage and handling included in invoice paid prior to receipt). We do NOT email records. Processing is 8-10 business days for most circumstances. Please be aware, although you may have signed a release for communication, if you are requesting that we send records, you will need to complete the above process each time you request records to yourself or to be sent to any provider or entity, which includes primary care or change of psychiatric provider upon termination.
Appointment Cancellation, No-Show, and Late Arrival Policy
Petit Psychiatry’s policy requires patients to cancel 1 business day in advance of their appointment to avoid a cancellation fee. If their appointment is on a Monday or following a long weekend, the cancellation must be made on the previous business day. Patients are expected to arrive on time for their scheduled appointments out of courtesy to the other patients and providers/clinicians. Patients who arrive more than 8 minutes late for any appointment, may not be seen and will be charged a late cancellation fee. Petit Psychiatry charges a $75.00 fee for all late cancellations, no-shows, or late arrivals. Petit Psychiatry makes every attempt to remain on time for appointments, however, occasionally circumstances arise that may result in an appointment delay.
Discharge Policy
At the discretion of Petit Psychiatry, a patient may be discharged from the Practice and their insurance notified if any of the following guidelines are not followed:
• Patient’s failure to follow the recommended treatment plan or medical instructions including the Controlled Substance Agreement, if applicable.
• Patient fails to meet financial responsibilities
• The provider cannot provide the level of care necessary to meet the patient’s needs
• The member and/or member’s family is abusive to the provider and/or staff.
• The patient or provider moves out of the service area.
Confidentiality
Confidentiality is a basis of mental health treatment and is protected by the law. Aside from emergency situations, information can only be released about your care with your written permission. A release is not needed for providers of Petit Psychiatry to consult with other providers within the Practice. If insurance reimbursement is pursued, insurance companies also often require information about diagnosis, treatment, and other important information in the Disclosure of Health Information as a condition of your insurance coverage. Several exceptions to confidentiality do exist that require disclosure by law:
(1) danger to self – if there is threat to harm yourself, we are required to seek hospitalization for the client, or to contact family members or others who can help provide protection;
(2) danger to others – if there is threat of serious bodily harm to others, we are required to take protective actions, which may include notifying the potential victim, notifying the police, or seeking appropriate hospitalization;
(3) grave disability or impairment – if due to mental illness, you are unable to meet your basic needs, such as clothing, food/water, medical care, and shelter, we may have to disclose information in order to access services to provide for your basic needs;
(4) suspicion of child, elder, or dependent abuse – if there is an indication of abuse to a child, an elderly person, or a disabled person, even if it is about a party other than yourself, we must file a report with the appropriate state agency;
(5) certain judicial proceedings – if you are involved in judicial proceedings, you have the right to prevent us from providing any information about your treatment. However, in some circumstances in which your emotional condition is an important element, a judge may require testimony through a court order. Although these situations can be rare, we will make every effort to discuss the proceedings accordingly.
(6) in the event of a national emergency such as a global pandemic, terrorism, wartime or any other catastrophic event, Petit Psychiatry will follow the Governor’s Orders of each state of the patients’ residence to ensure continuation of health care for reasonable amount of time.
* We also reserve the right to consult with other professionals when appropriate. In these circumstances, your identity will not be revealed, and only important clinical information will be discussed. Please note that such consultants are also legally bound to keep this information confidential.
Contacting
Your Provider Providers are not immediately available by office telephone, please call the office at 561-444- 2351. Calls are generally returned within 2 business days, however, for all prescription refill dial office number and choose 2. Always leave a phone number where you can be reached along with any updated contact information. As we are an outpatient practice, we do not service walk ins or provide crisis services. If your call is an emergency, please call 911 immediately instead of calling the office. Emergency psychiatric services are provided by all hospitals through their emergency rooms and do not require appointments. Emergency room physicians can contact your provider at any time so please provide them with their contact information. When your provider is unavailable for extended periods of time (i.e., vacation, conferences, etc.), a trusted colleague will provide coverage, if deemed necessary. Please also note that email should never be used for urgent or emergency issues. Per the agreement with your insurance provider, our practice provides on call services 24/7 for nonlife threatening and nonroutine care (please note refill requests and scheduling appointments are considered routine care).
Appointment Confirmations
Petit Psychiatry will attempt to confirm appointments via email and text upon your consent, however, it is your responsibility to know the date, time, and location of your appointment. Petit Psychiatry has no control in regard to your phone or email connection or reliability. Inability or failure to receive a reminder or appointment confirmation via text or email is not a reason for waiver of fees.
Communication for Appointment Reminders
Petit Psychiatry may need to use your name, phone number, email address (“Contact Information”) to contact you with appointment reminders via phone, text, or email. If this communication is made by text, a text message will be left on your phone. If this communication is made by email, a message will be left at your email address.
Messages will contain: Name of Provider: Petit Psychiatry, Location of Appointment, Name of Patient, Date & Time of Appointment. You have the right to refuse to give Petit Psychiatry your consent to use your telephone number and/or email address for appointment reminders. If you chose to give your consent, you have the right to revoke it, in writing, at any time in the future. Should you agree to communicate via email, telephone or any electronic method of communication, Petit Psychiatry cannot guarantee that those communications will remain confidential. There is a risk that the electronic or telephone communications may be compromised. There is never a 100% guarantee that information will remain confidential when transmitted electronically.
Pharmacy:
Petit Psychiatry may have access to your prescription history from other providers through the electronic medical record. Once a prescription is sent to your pharmacy provider will only make one accommodation if medication is not available in the original pharmacy.
Legal
Legal matters requiring the testimony of a mental health professional can arise. This, however, can be damaging to the relationship between a patient and their provider. As such, we generally recommend that you hire an independent forensic mental health professional for such services.
Recording Sessions
Patients are not allowed to record sessions or providers/clinicians under any circumstances.
Forms Policy
Any form brought to your appointment will be subject to a full-time frame of 3 to 7 business days, not including any weekends the office maybe open. Form fee structure is $100.00 - $500.00 final price will be determine by the type of form need to be completed. Fee will be patient responsibility and will not be submitted to insurance.
Inclement Weather:
The Petit Psychiatry closes for inclement weather per the discretion of the Practice and will offer telehealth sessions if able to be given weather circumstances. If the Practice closes for inclement weather, it will be posted on the website. Patients are instructed check the website for updates and will be contacted via phone if their appointment requires rescheduling.
By signing the Consent for Treatment/Acknowledgment Agreement Signature Form, you agree that you have read, agree with and understand this document, which contains information on Petit Psychiatry’s financial policy, professional fees, cancellation/noshow/late arrival, discharge policies, confidentiality, contracting your provider, confirmation and communication for appointment reminders, pharmacy, legal recording sessions, controlled substances, and inclement weather and you agree to abide by its terms during the professional relationship. You also understand and agree that our policies can change at any time and are updated on our website.
