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  • The Nashville Center for Hope & Healing online registration form

  • NCHH Enrollment form

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  • Please read the following letter about our clinic and then, begin the application:  

     

    Hello and Welcome!

    As the medical director of the Nashville Center for Hope & Healing, I want to welcome you and thank you for inquiring about an appointment.

    I am board-certified in psychiatry with the American Board of Psychiatry and Neurology and have trained and seen patients in Nashville and Middle Tennessee since 1992. I have recruited the finest mental health professionals in the area to help you with your needs. In our office, we care for patients from ages 14 & up.

    We perform Comprehensive Team Evaluations and have a reputation for thoroughly evaluating and helping patients get well. We have adapted our team evaluations to better serve the needs of patients.  We have physician-led, and psychiatric nurse practitioner-led team evaluations, (see chart below).  Each team evaluation includes at least one prescriber and a licensed therapist. The physician-led team evaluation includes a psychiatrist, a psychiatric nurse practitioner and a therapist; these evaluations are long and thorough and are more expensive than a typical doctor’s visit. The psychiatric nurse practitioner-led evaluations include a therapist as well. In addition, we offer psychiatric nurse practitioner only intakes, and therapy only appointments.  

    The time varies depending on the evaluation selected.  The physician-led team evaluations generally last 3 to 3.5 hours and are comprehensive and well worth the price. A psychiatrist supervises the comprehensive evaluation and the follow-up care after the initial visit and is consulted by the team as needed in the follow-up. This delegation of service allows you to receive excellent, cost-effective care. The Psychiatric Nurse Practitioner-led team evaluations take approximately 2.5 hours; the nurse practitioner only and therapy only evaluations are 1.5 hours.  

    Type of 
    Evaluation, & chart of who is present in the appointment

    Physician 

    		 Psychiatric Nurse Practitioner Therapist Time Cost

    Comprehensive  Team with Physician Supervision

    		 Yes -Consultant to Team Yes Yes 3-3.5 hrs $1000
    Psychiatric Nurse Practitioner - led Team Evaluation Not present Yes-Leader Yes 2.5 hrs $695
    Psychiatric Nurse Practitioner Only New Appointment

    Not present

    		 Yes Not Present 2.0 hrs $495

    Therapist Only New Appointment  (no prescribing clinicians) 

    		 Not present Yes Yes 1.5 hrs $250 

     At our clinic, we are a TEAM, and we meet as a team weekly to review cases that we share. Most clinics, while they may look like a team (sharing a website and space), often they are just independent clinicians who market their practices together.  At the Nashville Center for Hope & Healing we are, truly, a functioning team of clinicians. Further information about our team can be found on our website, www.healnashville.com.

    All evaluations and follow-up services are “out-of-network” services in the Nashville Center for Hope & Healing (NCHH), and, as so, patients are asked to pay the full charge at the time of the visit. We are able to file insurance claims for our patients to all commercial insurance companies, but we cannot file with governmental plans such as Medicare, Medicaid, and TennCare as we are not in contract with these entities.

    After each encounter, our billing staff can file your claim with your insurance to help you get some reimbursement. Insurance payments typically take a few weeks and will be reimbursed to you directly or if you choose, you can apply any reimbursement as a credit to future visits to our clinic. As all insurance arrangements with patients are unique, insurance reimbursement from your plan is NOT guaranteed. Payment from an insurance company is dependent on the terms of your specific health insurance policy.

    In addition to our services, we offer Transcranial Magnetic Stimulation (TMS), Esketamine, VNS, or other services, through an arrangement with the NeuroScience & TMS Center; we can refer you for a TMS consultation and treatment (we also work with other referral sources if one is available for your needs). Please inquire at the initial appointment scheduling if you are interested in TMS & Esketamine.

    We cannot book time for any of the initial evaluations until this application and a deposit payment are complete.  The new appointment deposit is the entire fee of the appointment and covers for the potential of a Missed Appointment or Late Cancellation as our clinicians set aside significant time for each evaluation.

    Here are the steps to complete the process:

    STEP 1:  Complete this private, HIPAA compliant questionnaire Sign all Policies, Select Service(s), & Submit the form with a deposit payment*

    STEP 2:  Staff will send an email for you to complete your Medical History Questionnaire

    STEP 3:  Staff will email, or call you with options to schedule your first appointment

    * If you are unable to submit the deposit with a credit card payment, print the form, and contact our office manager for an alternative payment form.  


    We look forward to helping you get a diagnosis, and treatment plan; we believe this is the key to getting well. If you have questions about the process, our clinic, or our team, visit our website www.healnashville.com, or email Jami Dalton, our Front Office Manager, support@healnashville.com.  


    Sincerely,

     

    Michelle Cochran MD, DLFAPA, FCTMSS                           

    Director of Nashville Center for Hope & Healing      

  • Step 1: Complete Questionnaire

  • The Custodial Parent or Legal Guardian should REVIEW AND SIGN this Consent to Treat Minor IF Patient is under 18 years of age or has a legal guardian. 

    If the patient is under the age of eighteen or unable to consent to treatment, a legal custodian of the Patient will be required to authorize and consent for the initial evaluation and on-going treatment on behalf of the Patient.

    I voluntarily consent that my child, or ward, will participate in a mental health evaluation (e.g. psychological or psychiatric) and/or treatment by staff from the Nashville Center for Hope & Healing. The evaluation and treatment will be made by a licensed mental health clinician (a psychotherapist, psychologist, psychiatric nurse practitioner, psychiatrist, or licensed therapist). I understand that following the evaluation and/or treatment, complete and accurate information may be provided concerning each of the following areas:

    1. The benefits of the proposed treatment 
    2. Alternative treatment modes and services
    3. The manner in which treatment will be administered
    4. Expected side effects from the treatment and/or the risks of side effects from medications (when applicable).
    5. Probable consequences of not receiving treatment 
    6. Expectations regarding the length and frequency of treatment

    It may be beneficial to my child, or ward, as well as the referring professional, to understand the nature and cause of any difficulties affecting my child’s, or ward’s, daily functioning, so that appropriate recommendations and treatments may be offered. Uses of this evaluation include diagnosis, evaluation of recovery or treatment, estimating prognosis, and education and rehabilitation planning. As a parent or guardian of the patient seeking evaluation and treatment, I may have useful information for the professionals doing the evaluation and ongoing treatment, because of this fact, please disclose all information which can be helpful to the treatment team at any point in the care process. Information can be given verbally, or in written communication.

    Treatment will hopefully give benefits, which may include improved cognitive or academic performance, emotional and physical health status, quality of life, and awareness of strengths and limitations.

    Fees are based on the length or type of the evaluation or treatment, which are determined by the nature of the service. As the parent or guardian of the patient, I will be responsible for charges. Fees are available to me upon request and may be referenced in the new patient packet.

    Information from my child’s, or ward’s, evaluation, and/or treatment is contained in a confidential medical record at the Nashville Center for Hope & Healing, and I consent to its use by staff for the purpose of continuity of my child’s, or ward’s, care. Per Tennessee mental health law, the information provided will be kept confidential with the following exceptions: 1) if my child, or ward, is deemed to present a danger to himself/herself or others; 2) if concerns about possible abuse or neglect arise, or 3) if a court order is issued to obtain records.

    I have the right to withdraw my consent for evaluation and/or treatment of my child, or my ward at any time by providing a written request to the treating clinician. I have read and understood the above, have had an opportunity to ask questions about this information, and I consent to the evaluation and treatment of my child or my ward. I also attest that I am the legal guardian and have the right to consent for the treatment of this child or ward. I understand that I have the right to ask questions of my child’s, or my ward’s service Clinician about the above information at any time.

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  • STEP 2: Complete the Insurance Section

  • We are out of network with insurance at NCHH.

    If you would like us to submit your insurance claim when you are seen  in the office, we will need information about your policy. If you are privately paying for the appointment (not filing insurance) or using insurance which we are not in-network clinicians, then you do NOT need to fill out this section, and can write "Not Applicable" (NA) or "NONE" in the sections below. 

    Dr. Cochran does not see in-network patients in this clinic; she supervises and consults to some of the Team Evaluations.  

    Again, we can not bill Medicare, TN Care, or Medicaid services.  

  • Please send a copy of your insurance card (FRONT & BACK) & driver's license with this form if you want us to file for out-of-network benefits

    If you lack the technology to do this, please email support@healnashville.com or call 615-379-8600, and we can discuss other ways you could send or drop off your information.
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  • STEP 3: Complete the Service Selection, Review policies here, and on our website, www.healnashville.com, and Sign & Submit

  • Service(s) Selection

    These are the appointment options at NCHH. The prices shown below are Private Out-of-Network prices. So we may allow the proper amount of time for your care, you will select the service and pay the deposit below.

  • These are our NEW Patient appointment options and charges: 

    • Comprehensive Team Evaluation with Physician,  $1000.  This appointment includes the patient, a Doctor - Psychiatrist, Psychiatric Nurse Practitioner, and a Therapist - Booking 3 to 3.5 hrs in-office time.  
    • Psychiatric Nurse Practitioner Led Team Evaluation,  $695.  This appointment includes the patient, a Psychiatric Nurse Practitioner, and a Therapist - Booking up to 2.5 hrs in-office time. 
    • Psychiatric Nurse Practitioner Evaluation-Only,  $495 for 1.5 hr evaluation 
    • Therapist Only** - Initial Evaluation, $250  - 1.5 hrs 

    These are our Follow-up appointment options and charges:  

    • Psychiatric Nurse Practitioner Follow-ups:   30min = $150, 1 hour = $210
    • Therapist Follow-up appointments:   45-60 min= $155 for an Individual; $165 for Couples

  • If you would like a FREE Screening consultation about TMS Esketamine, or VNS, please call 615-224-9800 or text via our secure text line now: 615-551-5853

  • READ ALL of the NCHH Policies (Privacy, General Office, and Insurance & Payment Policies),  which can be found on the website, www.healnashville.com

    After reading the policies, sign below:

    These policies, below, are given as a GOOD FAITH ESTIMATE of your charges as highlighted for emphasis.  

    Late Cancellation/Missed Appointment Policy

    Notification must be received by 4:00 pm CDT, five (5) 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 five (5) 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 120-hour (five business-day) notice in order to potentially reschedule the time. If you cancel the new patient appointment or miss the appointment you will be responsible for the full fee for the appointment scheduled and this can not be billed to insurance. 

    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. 

    A Good Faith Estimate of these late/missed charges are here: 

    • Comprehensive Evaluation w/Physician = $1000.00
    • Comprehensive Evaluation w/Psychiatric Nurse Practitioner & 
    • Nurse Practitioner Evaluation-Only Evaluation, $495,
    • Therapist only Evaluation= $250.00
    • Nurse Practitioner follow up session, 20-30-min = $150, 
    • Nurse Practitioner follow up session, 45-60-min=  $210, 
    • Nurse Practitioner follow up session, 90 min = $400
    • Physician follow up session, 20-30-min = $275,
    • Physician follow up session, 50-60-min = $375,
    • Physician follow up session, 90 minutes = $650
    • Therapist 60-minute appointments = $155 for Individuals; $165 for Couples

    Again, Late Cancellations and Missed Appointment fees are not covered by insurance. 

    Prescription Refill Policy and Charges for Prior Authorization Paperwork

    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 $50 (as of Jan 1, 2022). This fee is not billable to your insurance.

    If your appointment is rescheduled because of unforeseen circumstances, on our part, or we fail to fill a medication appropriately, there will not be a charge. 

    In addition, insurance companies are requiring prior authorization for more and more medications, including generic medications which are often very inexpensive.  This practice is burdensome and requires the prescriber to log onto a separate system and give medical information to the insurance company so they can approve the medication with no thought to the time needed to complete the paperwork.  Insurance does not pay for this time (frequency 15+min).  If we believe a medication to be the best option for you, we will prescribe it.  If your insurance company is refusing to pay for the medication which we have prescribed, unless prior authorization paperwork is completed, we can do this paperwork, but will charge you for the time to complete the paperwork.  Because the medication can be very inexpensive and could cost you less per month than the cost of the paperwork, we recommend looking at GoodRx.com before requesting that we complete the paperwork for insurance approval.  

     

    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 Nashville Center for Hope & Healing  (NCHH) 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, again this is a Good Faith Estimate as we can not know how your particular insurance works until we charge them:

    • 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 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.

  • By signing below, I am acknowledging that I have read all of the policies on the Nashville Center for Hope & Healing website.

    I agree with my cardholder policy and I authorize the full fee charge of the appointment scheduled as a deposit, as well as, all outstanding fees, non-covered fees, and late cancellations or missed appointment fees to be charged to my credit card as explained in the Insurance & Payment policies and the General Office policies.

    I have read & agreed to all policies of the Nashville Center for Hope & Healing website (Privacy, General Office, and Insurance & Payment) and any and all of those policies that may be amended and published on www.HealNashville.com.

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  • How to Pay

     

    After you submit this form, you will be sent to a Thank You page with instructions and links on how to pay.

     

    You should also receive an email with this same information provided you chose to allow us to email you.  Please check your spam folder if you do not see it.

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