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 New patient appointment in order to avoid charges.
If you have to cancel or reschedule the 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.
Again, 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:
- First appointment = Comprehensive Evaluation w/Physician, Nurse Practitioner, and Therapist = $1095.00
- First appointment =Comprehensive Evaluation w/Psychiatric Nurse Practitioner & Therapist, $695.00
- First appointment =Nurse Practitioner Evaluation-Only Evaluation, $495,
- First appointment =Therapist only Evaluation= $250.00
- Follow up Session with Nurse Practitioner, 20-30-min = $150,
- Follow up Session with Nurse Practitioner, 45-60-min= $210,
- Follow up Session with Nurse Practitioner, 90 min = $400
- Follow up Session with Physician, 20-30-min = $275,
- Follow up Session with Physician, 50-60-min = $375,
- Follow up Session with Physician, 90 minutes = $650
- Follow up Session with 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 office policy is to refill all medication within an appointment with an assessment/evaluation of the patient. To put this another way, the policy is that we 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 many medications can be very inexpensive and could cost you less per month than the cost of the paperwork for prior authorization, 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.