Clients must complete and sign this form prior to your first appointment. These policies and procedures will establish the expectations you will receive from Nicholson Psychiatry and what is expected from you as the client.
REQUEST INITIAL APPOINTMENT:
Once you have requested an initial appointment my staff will verify your insurance information. Once insurance information is verified, intake forms will be sent to you electronically that must be completed and returned to us before the requested appointment is confirmed. Make sure these forms are filled out completely. Once these forms are reviewed by my staff, they will then confirm the appointment and you will receive a confirmation email. Please note the date and time of the appointment as it may not be exactly the time you requested. We do try our best to honor your request but on occasion the requested time is no longer available. If you fail to attend the initial evaluation you will not be allowed to reschedule.
All appointments are being conducted virtually through HIPAA compliant video platform. The link to the online meeting does not become available until 30 minutes before the appointment time. This will be sent to your email. Please test your equipment 10 minutes before appointment time.
Late arrival of 8 minutes or greater for any appointment may need to be rescheduled. If the appointment must be rescheduled, then the appointment is considered missed without cancellation $150 fee for the appointment.Rescheduling appointments: You may reschedule or cancel your appointment 24 hours prior to the appointment. If you need to reschedule, call the office, or send message through the patient portal. (If rescheduling Monday appointment you must notify on the Friday before)
I do my very best to be on time as I know your time is valuable but there may be instances where I am running late. Please do not disconnect from the meeting link. Should you have to exit the meeting please call the office to reschedule. You will not be charged for the missed visit.MISSED APPOINTMENT:
If you have not cancelled your appointment in advance of 24 hours, you (not your insurance company), will be billed $150 for the appointment.
After two No Show Appointments or cancellations >24 hours in one year Nicholson Psychiatry reserves the right to dismiss you from their services.Repeated rescheduling of appointments will also be subject to dismissal of services at the discretion of Nicholson Psychiatry.
Any new patient appointment who fails to show for their initial evaluation will not be allowed to reschedule.MEDICATION REFILLS AND OTHER CLINICAL NEEDS:
If you have a life threatening or emergent need, please go to your nearest emergency room or call 911.
If you have a clinical/medication need please call the office 425-245-5240 and leave a brief message. Most calls left during business hours (Monday-Thursday) are usually returned by the next business day.Prescription Refills: During office appointments clients are given enough medication until their next appointment. Patients are responsible for knowing when medications will need to be refilled and the required method is to ask the provider during scheduled office visits. Therefore, refill requests outside of office appointments are subject to a $60 fee.
There will be no refills of controlled substances outside of an appointment.Refills will not be provided when the office is closed/outside of office hours or weekends and holidays. During these hours, patients must call their PCP or go to the local ER to avoid medication discontinuation or withdrawal effects.
Email Response: Emails (HIPPA Compliant) are addressed as time permits admin@nicholsonpsychiatry.com or through the patient portal.INSURANCE:
A current insurance card must be presented at the first visit and when your insurance has changed. If not, you will be responsible for the self-pay rate of the appointment.
If Nicholson Psychiatry is not contracted with your insurance carrier or your visit is a non-covered service, you are responsible for the charges. Please call your insurance to verify benefits before you schedule an appointmentCREDIT CARDS:
All appointments now require a credit card placed on file. The information will be stored in a secure vault within our electronic health record and considered on file.I hereby authorize Jeanne Nicholson, ARNP/Nicholson Psychiatry to charge the credit card on file for balances more than 60 days in arrears. This includes payments for missed appointments and fees not reimbursed or covered by insurance.
PAST DUE ACCOUNTS:Any remaining balance after insurance has been filed is your responsibility.
You will receive two bills from Nicholson Psychiatry. If you have not paid in full within 60 days your account will be turned over to a collection agency. If your account is sent to a collection attorney, they will report your past due status to a Credit Reporting Agency and you will be responsible for their fees.COMPLETION OF FORMS OR LETTERS:
A fee of $250 or higher depending on complexity, is charged for the completion of forms and letters including the following but not limited to: Disability, FMLA, Letters for Accommodations, and letters to employers. These letters are not provided on the initial visit you must be an established patient. The client will always be notified of any payment required prior to the release of the requested forms/letter.
These services are not provided at this practice
Custody evaluations, parental assessments for use in determining custody or visitationForensic evaluations for legal services
Court appearanceSubstance Abuse Treatment