OFFICE POLICY STATEMENT
Payment of Service
My fees are noted below and payment is due at the time service is provided. Longer or shorter sessions are generally prorated from this base fee. You will be charged the standard fee for telephone calls, prorated according to the length of the call. Of course, there will be no charge for brief telephone calls, such as those made to schedule appointments.
Professional services are rendered and charged to you. I will give you a statement at each office visit, which you may submit to your insurance carrier for reimbursement. However, it is your responsibility to pay for each session at the time of the visit. Payment may be made by check, cash, Venmo or credit card. If payment is not made at the time of service, the charges outlined above will be assessed to your credit card on file. Despite having this credit card on file, I would prefer you pay by check at the time of service. Please notify me if any problem arises which affects your ability to make timely payments.
The scheduling of an appointment means that I reserve that time for you. Therefore, you will be billed for a session that you cancel with less than 24 hours notice. Please be aware that insurance companies will not generally reimburse for a cancelled session.
Telephone and Emergency Procedures
If you need to contact me, please call my office at the number above. Phone and FAX are the same number. If you need me to call you back, please be sure to leave your telephone number and some times when I may reach you. I will call you back as soon as I am available.
If I am out of town, the name and telephone number of another physician will be available on my office answering machine. In the event of an urgent matter when I am away, your primary care physician, local emergency room or crisis intervention service may be contacted.
All information disclosed within session is confidential and may not be revealed to anyone without your written permission, except when disclosure may be required by law. Disclosure may be required in the following circumstances:
When there is a reasonable suspicion of child, elder or dependent adult abuse or neglect.
When there is reasonable suspicion that you or your child present a danger of violence to others, or to the property of others, or if you or your child are likely to harm yourself unless protective measures are taken.
Disclosure may also be required pursuant to a legal proceeding.
Medication Management Issues
If I am prescribing medication for your child, the standard of care dictates that I see your child at least every 3 months. There may be cases in which office visits every 6 months are acceptable.
Refills may be requested by phone or email or your pharmacy may FAX me a refill request. There will be a $ 40.00 charge made for all stimulant prescriptions made outside of an office visit. If you are requesting a stimulant prescription please include your child’s name, medication, strength and address when you contact me. Please note, there will be no charge made for stimulant refills if you are requesting a 90 day supply.
1st 60 minute consultation… $400.00
45 minute after school session… $300.00
30 minute session… $200.00
Phone consultation… 15 minutes minimum charge and then according to time spent. (Usually $100 for speaking with therapists, teachers, etc.)
Record Review/Scoring… According to time spent
Medication Refill… $ 40.00 for all refills
Letter or report writing… According to time spent at $300.00 per hour.
Insurance Information for Prospective Patients
As noted in my Office Policy Statement, I do not bill insurance companies. Rather, I bill families and give them the information to submit to their insurance companies. I encourage you to call your insurance company to discuss their coverage for these services before our first visit. If I am an out-of-network provider in your plan, you may be able to set up a "single case agreement," and get prior authorization to cover the cost (or a fraction) of the visits.These are some of the codes that I typically use for a four visit evaluation process:
99245 (1st visit)
99215 (all subsequent visits)
You may wish to check with your pediatrician about which codes seem most appropriate to your child. These are a few of the ICD-10 diagnostic codes that are frequently used:
Autistic Spectrum Disorder (F84)
Adjustment Reaction (F43.20)
Anxiety Disorder-Not Otherwise Specified (F41.9)