Notice of Office Policies and Procedures

Notice of Office Policies & Procedures

Psychotherapy (Talk Therapy with Individual or Family)

Talk therapy may help you and/or your family in multiple ways including improvements in daily functioning, resolution of problems, reductions in stress, etc.

Medications

Psychotropic medications can be very useful in combination with psychotherapy. We will work together to find the optimal combination of medication (if warranted) and therapy that will help serve you best. When using medications, the risks, benefits, and side effects will be discussed with you.

Insurance (In-Network vs. Out of Network)

We are in-network with a select number of health plans and may accept your insurance benefits as reimbursement for our professional services as an in-network provider. It is your responsibility to confirm prior to your visit whether we are an in-network provider with your health insurance plan.

Professional Fees (When In-Network Provider)

For health plans where we are an in-network provider, we will be submitting a claim to your insurance company for the professional services rendered. In addition to any payment collected today (e.g. co-pay), you may be responsible for charges after your insurance company has processed and paid its portion of the visit. Therefore, the remaining balance is your responsibility. You will receive an Explanation of Benefits from your insurance company detailing the amounts covered and your responsibility for today’s visit. We require a credit card authorization form be completed prior to the visit in the event you owe a balance after your health insurance processed reimbursement for your visit(s).

Professional Fees (When Out-of-Network Provider)

New evaluations and consultations, office or telemedicine, usually consist of 1 to 2 clinical hours ($250 per hour). Follow-up visits, office or telemedicine, are 15 minutes to 1 clinical hour ($75 per 15 minutes, $150 per 30 minutes, $200 per 45 minutes, $250 per hour). The above rates apply for medication and/or therapy appointments. Please be aware that a "clinical hour" often consists of approximately 10 minutes of documentation time and a "clinical half hour" consists of approximately 5 minutes of documentation time. All other professional services such as report writing, scheduled phone appointments, preparation of treatment summaries, insurance prior authorizations, court proceedings (even if your treating clinician is compelled to testify by another party), care coordination, school observations, or time spent performing any other services you may request will be charged at a rate in accordance with our hourly rates or fractions thereof.

It is the patient's responsibility for full payment of the session fee, and it usual and customary to pay for out professional services when rendered. If you have a health benefits policy, it will usually provider some mental health coverage. Upon your request, you will be provided with a superbill that you may submit to your insurance company for reimbursement.

Cancellations and No-Show Policy

Once your appointment is scheduled, you will be expected to attend unless you provide at least 48 business hours advance notice of cancellation. If you do not provide at least 48 business hours’ notice, or fail to show for a scheduled appointment, you will be responsible for the full cost of the session.

Contacting Our Staff

We will return all calls within 48 hours. In case of an emergency, please call 911 or got the nearest Emergency Room (ER).

Electronic Mail and Text Messaging

Please be aware that e-mail and text messaging are not confidential means of communication. Text messaging and E-mail are not the appropriate or optimal modes to communicate confidential information or emergency issues. E-mail and text messaging are appropriate for brief and uncomplicated updates or questions. If you prefer not to text message or e-mail, please let your provider know.

Legal Testimony

It is often unforeseen but legal matters requiring the testimony of a mental health professional can and do arise. Legal testimony can often be damaging to the relationship between a patient and his/her therapist or physician. As such, we require that you employ independent forensic psychiatric services should this type of evaluation or testimony be required.

Confidentiality and Release of Information

Services you receive in this office are confidential, except in the circumstances listed below:

Threat of harm to self or others
Abuse of a child, vulnerable adult, or developmentally disabled person
A court order to release information
Subpoena of treatment records by an attorney. If you do not want this information released, you must obtain a protective order from the court within fourteen days
If you will be applying your health insurance benefits, we may be required to provide information to your health plan, including some or all of your record treatment in order for your carrier to reimburse you for services. By signing the Acknowledgement of Receipt of Office Policies & Procedures form, you consent to release of information to your health insurance plan
If you are party to child custody litigation at any time in the future, the court may order release of information about your treatment in this office
In some instances, as provided by the state law of California, information about your healthcare may be exchanged with other health care providers involved in your treatment. In circumstances other than these, Mend will not release information about your treatment without your written authorization.

Patient Records

An electronic record is kept of services you receive in this office. You have a right to see the record and receive a copy of it upon request. You may ask that factual errors in the record be corrected. You may authorize in writing that copies of the record be released to entities you designate, at your expense, according to charges stipulated by the state law of California. Under certain circumstances where seeing the record may put a patient or other person at risk, we may redact certain information in the record and/or require that you review the record in consultation with another healthcare provider. You may receive an accounting of non-routine uses and disclosures of your record.

This Notice of Office Policies and Procedures is updated as of September 1, 2021.