REIFF MENTAL HEALTH 

TERMS OF SERVICE

Thank you for choosing Reiff Mental Health (RMH) as your mental health care provider! Our goal is that by providing you with the best possible care you will be successful and you will thrive. Please read the following Terms of Service and sign them electronically to confirm that you understand and agree to them. 

 

Appointment scheduling

1. Appointments must be Cancelled or Rescheduled >24 hours prior to the appointment.

2. Patients are expected to use the patient portal (www.onpatient.com) to self-schedule and reschedule. Call the practice manager if you need assistance.

3. If a follow-up appointment is a no show or rescheduled <24 hour before the appointment start:

   1. All commercial insurance and self-pay clients will be charged $75.00 per missed appointment. This fee will need to be collected prior to another appointment being scheduled. This will not be covered by your insurance.

   2. After 2 No Shows or cancellations made <24 hours before the appointment the client will be discharged from the practice.

4. After 1 no show or cancellation of an initial appointment <24 hours before the appointment you will not be seen. 

5. Clients arriving more than 10 minutes late for their appointment will be considered a no show and need to reschedule the appointment. 

6. New patients must fill out the new patient paperwork before their first appointment by “checking in” for the appointment through OnPatient or their appointment may be canceled.

7. A photo ID of the patient, or the guardian in the case of minors, must be on file to receive care.

 

Medication refills

1. RMH requires 72 hours to refill a prescription. It is your responsibility to make sure you do not run out of medications.

2. Controlled Substances will NOT be refilled on weekends or after-hours.

3. All patients must provide their weight, blood pressure, and heart rate once per year. Children must also provide their height once per year.

4. Medications will NOT be prescribed if you missed your last scheduled appointment and have still not been seen.

 

Psychostimulants

In order to receive an initial prescription or refill of a psychostimulant (e.g. Adderall, Vyvanse, Ritalin ) patients must provide their blood pressure and heart rate at the time of every visit. Children will additionally need to provide their current height and weight. 

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Fees, payments, insurance 

1. Payment is due at the time of service.

2. You are responsible for all charges for professional services rendered for you, or on behalf of the identified patient in the case of dependents, including any charges not reimbursed by your insurance carrier.

3. You must have a zero balance with RMH or payment plan in place before services will be provided. 

4. RMH requires that you have a valid credit card on file with us before services will be provided.

5. Your card will be charged the morning of your appointment for copays, coinsurance, deductible amounts, no show fees, or the full out-of-pocket amount if you are self-pay or have insurance for which we are not a participating provider.

6. RMH will submit claims to your insurance company on your behalf if we are a participating provider. If we are not in-network for your insurance provider we will provide a super bill through OnPatient so that you can submit a claim for reimbursement to your insurance company.

7. By signing this form, you also agree to allow RMH to release information to your insurance provider upon request for claim processing or auditing.

8. RMH reserves the right to charge your credit card for any remaining balances due after your insurance company processes your claim. You will be notified via email 24 hours before charging your credit card.

9. Fees for self-pay patients are billed at $250.00 for an initial 60-90-minute evaluation. Routine medication management follow-ups begin at $150.00 for 30-minute appointments. 

10. Written evaluation reports and request of medical records are not included in the cost of your session. A separate fee is charged for these requests. This fee will be assessed based on time spent for preparation and will be due in full prior to the release of these documents. These services will be billed at $50.00 per 15 minutes. Please expect a seven to ten-day turn-a-round for requests for letters.

 

Other information

1. We do not do paperwork for disability, service animals or other legal issues.

2. We do not prescribe benzodiazepines (Xanax, Valium etc).  If you have been prescribed this by another provider we will taper this medication.  

3. We do not prescribe opioids.

4. We do not prescribe Suboxone.

5. Information shared in treatment is confidential and is not discussed with anyone without a signed release of information form. Legal limits to confidentiality include:

• Judge-ordered testimony involving child custody.

• Concerns about child/elder abuse.

• Concerns that a client is a threat of serious bodily harm to self or others.