The policies, below, are highlighted for emphasis:
****Read ALL the Policies (Privacy, General Office, and Insurance & Payment Policies), on the website, www.hopeforyourbrain.com, then sign below.****
Late Cancellation/Missed Appointment Policy
Notification must be received by 4:00 pm CDT, three (3) business days before the scheduled appointment in order to avoid charges.
If you have to cancel or reschedule my new patient appointment, you must give three (3) business days' notice prior to the date of the appointment in order to receive a full refund. A large block of time is booked for the new appointment, and we must have a 72-hour (three business-day) notice in order to potentially reschedule the time. If you cancel the new patient psychiatric appointment or miss this appointment, you will be responsible for the full-fee ($395) and this can not be billed to insurance. We will use your deposit for part of this late cancellation/missed appointment but you will still owe $220, (total charge $395 - deposit $175 = Remaining balance of $220).
The initial therapy appointments are $250 and are not in-network charges. We require a full deposit for new therapy appointments. If you cancel the new therapy appointment with less than three business days' notice or miss this appointment, you will be responsible for the full-fee ($250). We will use your deposit for the late cancellation or missed appointment.
For all follow-up appointments, we also have a 72-hour cancellation policy. If you miss an appointment OR do not cancel with a three (3) business-day notice, you will be obligated to pay the full fee of the service. For example, the Late cancellation or missed Nurse Practitioner session/30-minute appointment would cost $120/a late cancel or missed Nurse Practitioner session/30-minute appointment would cost $200.
Again, Late Cancellations and Missed Appointment fees are not covered by insurance.
Prescription Refill Policy
The policy in the office is to refill all medication within an appointment, and because of this we generally, do not prescribe medication outside office visits.
Medication refills are handled during office hours, during scheduled appointments, when an assessment can be made of the patient. We refill medications only for patients currently under our care.
If you are prescribed medication, you will be given enough medication to cover you until your next scheduled appointment. If you have to cancel please reschedule quickly to avoid running out of medication. Contact us directly if you need a refill of prescribed medication, and allow 72 hours for refills to be sent.
Prescription refills outside of an office visit will be charged $30. This fee is not billable to your insurance.
If your appointment is rescheduled because of unforeseen circumstances, on our part, there will not be a charge.
Payment of Charges Policy
All charges must be paid at the time of service. The office staff will collect for the booked amount of time with the Clinician (or co-pay and deductible if applicable).
You are agreeing to allow Neuroscience & TMS Treatment Centers (NS-TMS) to charge the credit card on file for any fees due that are outstanding following the appointment or outside of an appointment.
The following are a few common examples of when this might happen:
• If you have insurance coverage for your appointments and we incorrectly collected a lower estimated co-pay, co-insurance, and/or deductible, and then later receive an Explanation of Benefits (EOB) from your insurance showing that we did not collect enough money from you, then we will notify you and charge the balance to your card on file.
• If your appointment goes beyond the originally booked time, then the clinician will bill for the additional amount of time in the session, and this could mean that you might have a larger charge than you paid when you arrived for the appointment.
• The clinicians charge their hourly rate for any service on your behalf (letter writing, review of medical records, calls to outside therapists/or clinicians caring or you, review of labs/tests, completing special insurance forms, emergency call after hours, refills outside of your appointment, late cancellations/no-show charges, etc.).
Likewise, if we overcharge you, we will immediately apply the credit to your account. If you prefer, notify us and we can refund the charge.