Provision of Services

Please understand that Kindred offers a variety of mental health services, including but not limited to psychiatric assessment and treatment, telemedicine, and home consultations. 

 

During the initial evaluation, Denny will determine how he might best serve you and/or your child’s needs. Referrals to other practitioners will be provided if he determines you/your child would be best served by another professional. Our services are voluntary. You are free to terminate services at any time. If you choose to obtain services from our practice, you will be required to read and sign the last page of this document stating you understand, accept, and will abide by these policies and procedures. 

 

Scope of Practice

Denny’s practice is limited to child and adolescent psychiatry. He may consider accepting new patients over the age of 18 on a case-by-case basis.  The practice may continue to provide ongoing care for patients who have reached age 18 after taking into consideration developmental factors and the severity of a patient’s illness. In other circumstances, the practice may insist patients in need of ongoing care to transition to mental health practitioners who routinely care for adults or their primary care practice. 

• Youth over age 18 who have graduated high school, are not pursuing higher education, are employed full-time or close to full-time and living independently from their families are usually encouraged to transition to adult practitioners. 

• Youth over age 18 with complicated conditions who may require treatments not well-studied or approved for use in the child and adolescent population will be encouraged to transition to practitioners routinely offering psychiatric care to adults.

• Youth over age 18 who spend much of the year away at college and require frequent and regular appointments, especially youth attending college out of state who don’t come home on a regular basis will be required to transition to practitioners located near their college.

• Youth over the age of 18 who are attending college, require only routine follow-up for medication management, are available for follow-up visits in the State of Ohio may be followed until completion of their first college degree and a brief period to allow time for relocation and identification of new care providers.

• Youth with intellectual or developmental disabilities whose parents or caregivers hold Medical Power of Attorney may be followed until age 26. 

​

Appointments

Services are provided by appointment only. Appointments are scheduled directly with Denny. If you can’t keep a scheduled appointment, please notify him at least 24 hours prior to the appointment. If you cancel within 24 hours of a scheduled appointment (late-cancellation) or fail to come to a scheduled appointment (“no-show”) you will be charged 50% of the anticipated session fee.  

​

A parent or legal guardian needs to be present for any scheduled psychiatric appointment for patients under 18 years of age. A parent may be present by telehealth, but the patient must be accompanied in person by a responsible adult for in person appointments. 

​

Appointment Etiquette

To ensure a safe, private, and productive session, we highly recommend adhering to the following guidelines:

• Please remain in one place during your appointment. Participating in your session while in a moving vehicle is strongly discouraged, as it can be distracting and potentially unsafe.

• Ensure privacy by being in a quiet, secure environment. We recommend closing or locking doors to minimize interruptions and maintain confidentiality.

• Use a stable internet connection and a reliable device. This helps prevent disruptions and allows for a smoother, more effective session.

​

We reserve the right to reschedule the appointment and charge a late fee if the conditions above are not reasonably met.

​

Telephone Calls, Email and Texting

Denny does not respond to phone calls or text messages during sessions. Most phone calls will be directed to voicemail. Calls will usually be returned during breaks in the schedule or at the end of the day. Email or phone calls are preferred methods of communication. He usually responds to routine phone calls, email or texts within two business days. 

​

Denny’s phone number is (330) 919-5727. This number may be shared with your child’s pediatrician or primary care physician, psychologists, counselors, or therapists involved in your child’s care or teachers/ administrators from your child’s school. 

​

If your concern can’t be resolved with a brief phone call, email or text exchange, Denny will likely request you schedule a formal appointment to address the concern, either via telemedicine or in-person. 

​

Emergencies

In an emergency, call 911 for an immediate police response, or proceed immediately to the nearest emergency room. Screening for psychiatric emergencies is handled by emergency room staff or by local crisis response in hospitals throughout our region. Alternatively, in the state of Ohio, in the event of a mental health crisis, one can call, text, or chat the 988 Suicide & Crisis Lifeline to reach a trained specialist who can offer expert help and support related to mental health emergencies. Denny has no ability to directly “admit” your child to any psychiatric facility or program. When you have arrived at the emergency room, feel free to share Denny’s phone number with the emergency room staff.  

 

If your child is becoming violent to the point that they are at risk of causing serious harm to themselves or another person, please call 911 and then notify Denny.

Denny responds to emergencies only for active patients. An “active patient” is defined as a person who has received services from the practice within the past six months.

 

Letters and Forms

The production of letters and other forms of written communication can be extremely time-consuming for Denny. Time spent in response to requests will be billed on a pro-rated basis of Denny’s hourly rate with a minimum charge of $50.00 for any letters or reports requested of us by parents or school officials. Exceptions to the policy for which there is no charge include: 

• Forms for dispensing prescription medication at school 

• Brief letters including a diagnostic summary to support necessary accommodations at school

• An evaluation summary to your child’s referring clinician and/or primary care physician upon your signed, written request. 

​

Home, School, or Other Services Provided Outside the Office

Denny provides services via telemedicine or in your home. Charges for services are the same regardless of where they are delivered, except as set forth below. Denny may insist upon in-person encounters for clinical or regulatory reasons. 

The ability to observe your child’s body language and facial expressions is an essential component of any clinical encounter. Denny will discuss options for conducting appointments without masks or other interventions interfering with non-verbal communication during any public health emergency in a manner that complies with all applicable guidelines or advisories in the State of Ohio. 

​

In-home appointments or school-based meetings within 30 minutes of our business address will not incur an additional charge. In-home appointments more than 30 minutes from our business address that can’t be scheduled immediately before or after another appointment in the area will result in a surcharge for travel time billed at 50% of the Denny’s hourly rate on a pro-rated basis.

​

Financial Responsibility and Billing Information

We require you keep a current credit card on file that will be used to collect payment in full for services, generally within a few days of a clinical encounter or completing a requested service. You may pay by cash, check, money order, Visa, Master Card, Discover or American Express, but you are still required to keep a credit card on file. Payment is due on the day of service and is non-refundable, excluding claims of charges above the Good Faith Estimate. 

​

We do not participate in any insurance networks and do not accept insurance coverage as payment. We will not file claims on your behalf to your insurance company for out of network services. If you request, the office will provide a statement containing the necessary billing codes and information to submit your claim to your insurance company. 

​

When the patient is a dependent child of separated or divorced parents, the parent bringing the child for treatment is responsible for payment, unless other arrangements have been made in advance. Any court agreement regarding payment of medical services is between the parents. 

​

Please be aware that if your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure payment. This may involve hiring a collection agency or filing a claim in small claims court. If such legal action is necessary, the additional costs associated with collection will be included in the claim. Such claims will be filed in Cuyahoga County. In most collection situations, the only information we release is the patient’s name, the nature of the service provided, and the amount due. Refusal to pay for services may result in termination of care. 

​

Termination of Services

Kindred shall have the option to terminate services in the following cases:

1. In the event the patient account is not kept current, defined as paid in full without other arrangements having been made. 

2. In the event that the patient has more than 2 late-cancellations or “no-shows” for scheduled appointments.

3. If the patient has not been seen for more than 6 months and is not able to be reached at the provided methods of communication.

​

Once services are terminated, patients have the option to contact Denny to request resumption of services.  The decision to resume services will be made at Denny’s discretion.  

​

Prescription Refills

Patients obtaining services from our agency will receive prescriptions sufficient to last until the next scheduled follow-up visit. Exceptions may occur when Denny is initiating a new medication, adjusting the dose of medication, or discontinuing medication. If you cancel or reschedule an appointment and need a new prescription or refills prior to your next appointment, please email at least five working days in advance of the prescription running out. Kindred does not accept prescription requests from pharmacies by phone or fax. There will be a minimum $50.00 charge for prescriptions provided outside of scheduled appointments unless a medication change is initiated by Denny. If more than one prescription is requested outside of a scheduled appointment, there will be a $10.00 charge for each additional prescription. The credit card you keep on file with us will be charged. 

​

Please remember that many of the medications Denny prescribes (especially stimulant medications for ADHD) cannot by law be phoned or faxed to a pharmacy. 

​

Some insurers insist on the office submitting prescriptions on behalf of patients directly to mail-order pharmacies or pharmacy benefit managers. If you want Denny to perform that service, the charges for requesting prescriptions or refills outside of scheduled appointments will apply. 

​

Pharmacy Benefit Managers/Prior Authorization for Medication

The vast majority of prescriptions Denny writes are for medications available in generic form for a modest cost. Some medications (branded products for which there is no generic version, and many extended-release medications for ADHD) often require a “prior authorization” process, even in situations when the family is required to pay the full price of the medication because of not having met a deductible. Some companies demand prior authorization for relatively inexpensive medications when arbitrary limits are exceeded on the number of pills in a prescription – more than one pill a day or 30 pills per month.  

​

Such requests are time-consuming because companies demand detailed explanations of why previous medication trials failed. The same policy that applies to letters and reports will apply to prior authorization requests - time spent in response to requests will be billed on a pro-rated basis of Denny’s hourly rate with a minimum charge of $50.00. Prior to submitting such requests, Denny will attempt to notify parents if the cost of the medication does not justify the anticipated time required for the prior authorization process.  

​

Kindred does not participate in the prior authorization process for prescription medications available in a generic version. 

​

It is your responsibility to pay for any medication prescribed to you or your child. If you are unable to do so, please contact Denny. He is happy to work with families to identify affordable treatment alternatives. 

​

Educational Services

Any classes, workshops, or online training provided by Denny are educational in nature and are not considered “treatment.” There is no assurance of confidentiality in such activities.

​

Treatment Coordination

Denny needs the ability to share information for the purpose of coordinating care with your child’s primary care physician as well as with other behavioral healthcare professionals involved serving your child/family. Denny doesn’t charge for routine communication with other professionals providing treatment to your child. He reserves the right to insist you sign a release to communicate with other professionals involved in your child’s care. He also reserves the right to insist you discontinue services with other behavioral healthcare professionals if he believes their recommendations or services interfere with his ability to provide the highest quality of care to your child/family. 

​

Confidentiality

In general, state and federal laws protect the privacy of all communications between a patient and physician. Information about your/your child’s treatment will only be released with your written permission. There are a few exceptions to the rules regarding confidentiality: 

• When a patient is in such a mental or emotional state such that he/she poses a danger to him/herself or others, or the property of another person.

• When a patient presents a clear and substantial risk of imminent harm to another person, Denny is required to notify the intended victim(s) and/or law enforcement personnel.

• To report suspicions/allegations of abuse or neglect of a child, elder, or vulnerable adult (i.e., someone who is disabled), to the appropriate authorities in the patient’s county of residence.

• To report a crime committed on premises or a crime against a Kindred staff member. 

• If a patient chooses to file a lawsuit or complaint against the practice, relevant information may be disclosed as part of defense proceedings. 

• To assist medical personnel in providing treatment in a legitimate medical emergency if the patient is unable to provide such information. 

• If a government agency is requesting information for health oversight activities the practice Kindred may be required to provide it. 

​

Our practice periodically receives requests from insurance companies for copies of your child’s medical records. Denny will insist you provide a release with written consent before sharing any information with your health plan. This information will likely become part of your insurance company’s records and be stored electronically. Kindred has no control over the information once in your insurance company’s possession. 

​

Denny may occasionally seek clinical consultation with other professionals. No names or specific identifying information will be released, and the consultant is also legally bound to confidentiality regarding any information shared. 

 

Other situations may arise that require only that you provide written consent in advance. Your signature on this Agreement provides consent for those activities, as follows: 

• In the event Kindred hires additional professionals or support staff, Denny needs to share protected information among members of our staff for clinical and administrative purposes, including scheduling, billing, treatment coordination and quality assurance. All professionals employed by the practice are bound by the same rules of confidentiality. All staff members have received training on protecting your privacy. 

• Kindred has formal business associate contracts with billing, data processing, collection and telecommunication services that promise to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law. If you wish, Kindred can provide you with the names of these organizations and/or a blank copy of this contract. 

​

Professional Records

The laws and standards of our profession require that we keep treatment records. We will maintain your medical record including intake and treatment information. You have a right to view and obtain a copy of your medical records as provided for in the Federal and Ohio law and professional ethics. You are entitled to receive a copy of your records, or we can prepare a summary of the record for you. Professional records can be misinterpreted and/or upsetting to untrained readers. If you wish to see your records, we recommend you review them with Denny so he might discuss the content of the records and answer any questions you might have. This service is provided at no charge. 

​

Patients will be charged an appropriate fee for any professional time spent in responding to record or information requests. 

​

Patients under 18 years of age who are not emancipated minors and their parents should be aware that the law allows parents to examine their child’s treatment records. For patients ages 18 and over, it is Kindred policy to request an agreement between the patient and his/her parents allowing Kindred to share general information about the progress of the child’s treatment and his/her attendance at scheduled sessions. 

​

Legal Issues

We do not provide legal advice or forensic services as part of our practice. Please notify Denny immediately if you or your child become involved in a legal or criminal matter that may require his participation. If you become involved in legal proceedings and require Denny’s participation, you will be charged for professional time rendered at double Denny’s customary hourly rate for clinical services, including any travel or preparation time. Also, potential conflicts may arise from involving Denny in legal proceedings that preclude him from providing ongoing mental health care to your child. 

​

Minor Children and Divorced, Unmarried, or Separated Parents

When treatment is provided to a minor child whose parents have been divorced, never married or separated; there may be an ethical and legal obligation by Kindred to provide information concerning treatment of the minor child to both parents. To understand our role as treatment providers, we will require a copy of the divorce decree that establishes custody and allocation of parenting time. For purposes of this Agreement for services, the parent presenting the minor child for services is defined as the “presenting” parent, and the other parent as the “non-presenting” parent. 

​

The non-presenting parent is typically entitled to the same information as the presenting parent concerning the nature of treatment, treatment plan, time and date of appointments and any comments concerning treatment and treatment recommendation made to the custodial parent. Both parents should understand that they are not the patient and neither parent has the right to privilege or confidentiality with respect to information they provide inside or outside of scheduled appointments. In most circumstances, the other parent is entitled to any information provided to Denny. The non-presenting parent is not entitled to attend an appointment with the child unless appointments occur on their visitation day, or the presenting parent consents to making an appointment on a non-visitation day. The non-presenting parent is responsible for payment when attending an appointment that the non-presenting parent has scheduled, unless both parents have made other arrangements in writing that are satisfactory to Kindred. 

​

Kindred may recommend treatment requiring participation of the non-presenting parent. The rationale for any such recommendations will be discussed with you, and your input will be sought. If our treatment recommendations are declined by the presenting parent, we reserve the right to terminate services. Input of both parents in planning and conducting treatment is essential. 

​

Please contact Denny for clarification of any of these policies or procedures.