Practice policies and procedures

Provision of services

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 I determine how I might best serve you and your child’s needs. If I judge that you or your child would be better served by another professional, I will provide a referral. Services are voluntary and you are free to terminate them at any time. If you choose to obtain services from this practice you will be asked to read and sign the last page of this document, stating that you understand, accept and will abide by these policies and procedures.

Scope of practice

My practice is limited to child and adolescent psychiatry. I may consider accepting new patients over the age of 18 on a case-by-case basis, and may continue ongoing care for patients who have reached 18 after taking developmental factors and the severity of the illness into account. In other circumstances I may require a patient to transition to practitioners who routinely care for adults, or to their primary care practice.

• Young people over 18 who have graduated high school, are not pursuing higher education, are employed full time or close to it and living independently are usually encouraged to transition to adult practitioners.
• Young people over 18 with complicated conditions who may require treatments not well studied or approved for the child and adolescent population will be encouraged to transition to practitioners routinely offering adult psychiatric care.
• Young people over 18 who spend much of the year away at college and require frequent, regular appointments — particularly those attending college out of state who do not come home regularly — will be required to transition to practitioners near their college.
• Young people over 18 attending college who require only routine follow-up for medication management and are available for follow-up visits in the State of Ohio may be followed until completion of their first degree, plus a brief period to allow time to relocate and identify new care providers.
• Young people 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, and appointments are scheduled directly with me. If you cannot keep a scheduled appointment, please let me know at least 24 hours beforehand. If you cancel within 24 hours of a scheduled appointment, or do not attend, 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. 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 keep a session safe, private and productive:

• Please remain in one place during your appointment. Taking part from a moving vehicle is strongly discouraged — it is distracting and potentially unsafe.
• Be somewhere quiet and secure. Closing or locking doors minimises interruptions and protects confidentiality.
• Use a stable internet connection and a reliable device, so the session is not disrupted.

I reserve the right to reschedule an appointment and charge a late fee if these conditions are not reasonably met.

Telephone calls, email and texting

I do not respond to phone calls or text messages during sessions. Most calls go to voicemail, and I usually return them during breaks in the schedule or at the end of the day. Email and phone are the preferred methods of communication, and I usually respond to routine calls, email or texts within two business days.

My 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, and with teachers or administrators from your child’s school.

If a concern cannot be resolved with a brief call, email or text exchange, I will likely ask you to schedule a formal appointment to address it, either by telemedicine or in person.

Emergencies

In an emergency, call 911 for an immediate police response, or go immediately to the nearest emergency room. Screening for psychiatric emergencies is handled by emergency room staff or by local crisis response. In Ohio you can also call, text or chat 988, the Suicide & Crisis Lifeline, to reach a trained specialist. I have no ability to directly admit your child to any psychiatric facility or program. Once you have arrived at the emergency room, feel free to share my phone number with the staff there.

If your child is becoming violent to the point of risking serious harm to themselves or another person, call 911 first and then notify me.

I respond to emergencies only for active patients — a person who has received services from the practice within the past six months.

Letters and forms

Producing letters and other written communication can be extremely time-consuming. Time spent in response to such requests is billed pro-rated against my hourly rate, with a minimum charge of $50.00 for any letter or report requested by parents or school officials. There is no charge for:

• 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 or primary care physician, at your signed, written request.

These charges are also listed on the services and fees page.

Home, school and other services outside the office

I provide services by telemedicine or in your home. Charges are the same regardless of where they are delivered, except as set out below. I may require in-person encounters for clinical or regulatory reasons.

Being able to observe your child’s body language and facial expressions is an essential part of any clinical encounter. During any public health emergency I will discuss options for conducting appointments without masks or other interventions that interfere with non-verbal communication, in a way that complies with all applicable guidelines in the State of Ohio.

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

Financial responsibility and billing

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

I do not participate in any insurance network and do not accept insurance coverage as payment. I will not file claims on your behalf for out-of-network services. On request, I will provide a statement containing the billing codes and information you need to submit your own claim.

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 a matter between the parents.

If an account has not been paid for more than 60 days and no payment arrangement has been agreed, I have the option of using legal means to secure payment. That may involve a collection agency or a claim in small claims court, and the additional costs of collection would be included in the claim. Such claims are filed in Cuyahoga County. In most collection situations the only information released 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 may terminate services in the following cases:

1. The patient account is not kept current — that is, paid in full without other arrangements having been made.
2. The patient has more than two late cancellations or missed appointments.
3. The patient has not been seen for more than six months and cannot be reached by the contact methods provided.

Once services are terminated you may contact me to request that they resume. That decision is at my discretion.

Prescription refills

Patients receive prescriptions sufficient to last until the next scheduled follow-up visit. Exceptions may occur when I am starting a new medication, adjusting a dose or discontinuing medication. If you cancel or reschedule an appointment and need a new prescription or refill before your next appointment, please email at least five working days before the prescription runs out. I do not accept prescription requests from pharmacies by phone or fax.

There is a minimum $50.00 charge for prescriptions provided outside of scheduled appointments, unless the medication change is one I initiate. If more than one prescription is requested outside a scheduled appointment there is a $10.00 charge for each additional prescription. The credit card kept on file will be charged.

Please remember that many of the medications I prescribe — especially stimulant medications for ADHD — cannot by law be phoned or faxed to a pharmacy.

Some insurers insist the office submit prescriptions directly to mail-order pharmacies or pharmacy benefit managers. If you want me to perform that service, the charges for requesting prescriptions or refills outside scheduled appointments apply.

Pharmacy benefit managers and prior authorization

The vast majority of prescriptions I write are for medications available in generic form at modest cost. Some medications — branded products with no generic version, and many extended-release medications for ADHD — often require prior authorization, even when the family is paying full price because a deductible has not been met. Some companies demand prior authorization for relatively inexpensive medications when arbitrary limits are exceeded, such as more than one pill a day or 30 pills a month.

These requests are time-consuming, because companies demand detailed explanations of why previous medication trials failed. The same policy that applies to letters and reports applies here: time spent is billed pro-rated against my hourly rate with a minimum charge of $50.00. Before submitting such a request I will try to let parents know if the cost of the medication does not justify the time the process is likely to take.

Kindred does not take part 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 me — I am glad to work with families to identify affordable alternatives.

Educational services

Any classes, workshops or online training I provide are educational in nature and are not considered treatment. There is no assurance of confidentiality in such activities.

Treatment coordination

I need to be able to share information in order to coordinate care with your child’s primary care physician and with other behavioural healthcare professionals involved with your child and family. I do not charge for routine communication with other professionals providing treatment to your child. I reserve the right to require a signed release before communicating with other professionals involved in your child’s care. I also reserve the right to ask you to discontinue services with other behavioural healthcare professionals if I believe their recommendations or services interfere with my ability to provide the highest quality of care to your child and family.

Confidentiality

In general, state and federal law protects the privacy of all communications between a patient and a provider. Information about treatment is released only with your written permission. There are a few exceptions:

• When a patient is in such a mental or emotional state that they pose a danger to themselves, to others, or to another person’s property.
• When a patient presents a clear and substantial risk of imminent harm to another person, I am required to notify the intended victim, law enforcement, or both.
• To report suspicions or allegations of abuse or neglect of a child, an elder or a vulnerable adult to the appropriate authorities in the patient’s county of residence.
• To report a crime committed on the premises or a crime against a Kindred staff member.
• If a patient files 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 the information themselves.
• If a government agency requests information for health oversight activities, the practice may be required to provide it.

The practice periodically receives requests from insurance companies for copies of a child’s medical records. I will require a release with written consent before sharing any information with your health plan. That information will likely become part of your insurance company’s records and be stored electronically, and Kindred has no control over it once it is in the insurer’s possession.

I may occasionally seek clinical consultation with other professionals. No names or specific identifying information are released, and the consultant is also legally bound to confidentiality.

Other situations require only that you provide written consent in advance. Your signature on the agreement provides consent for the following:

• If Kindred hires additional professionals or support staff, I need to share protected information among members of staff for clinical and administrative purposes — scheduling, billing, treatment coordination and quality assurance. All professionals employed by the practice are bound by the same rules of confidentiality and have been trained in protecting your privacy.
• Kindred has formal business associate contracts with billing, data processing, collection and telecommunication services, which promise to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law. On request I can give you the names of these organizations, or a blank copy of the contract.

Professional records

The laws and standards of the profession require that treatment records are kept. I maintain a medical record including intake and treatment information. You have the right to view and obtain a copy of your records as provided for in federal and Ohio law and professional ethics, and you are entitled either to a copy of the records or to a prepared summary.

Professional records can be misinterpreted, and can be upsetting to untrained readers. If you wish to see them, I recommend reviewing them with me so I can discuss the content and answer any questions. There is no charge for that. Patients are charged an appropriate fee for professional time spent responding to record or information requests.

Patients under 18 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 18 and over, it is Kindred policy to request an agreement between the patient and their parents allowing general information about treatment progress and attendance to be shared.

Legal issues

I do not provide legal advice or forensic services. Please notify me immediately if you or your child become involved in a legal or criminal matter that may require my participation. If you become involved in legal proceedings and require my participation, you will be charged for professional time at double my customary hourly rate for clinical services, including any travel or preparation time. Involving me in legal proceedings can also create conflicts that preclude me 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 are divorced, never married or separated, there may be an ethical and legal obligation to provide information concerning the child’s treatment to both parents. To understand my role, I require a copy of the divorce decree establishing custody and the allocation of parenting time. For the purposes of the agreement for services, the parent presenting the child for services is the “presenting” parent and the other is the “non-presenting” parent.

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

I may recommend treatment that requires the participation of the non-presenting parent. I will discuss the rationale for any such recommendation with you and seek your input. If treatment recommendations are declined by the presenting parent, I reserve the right to terminate services. The input of both parents in planning and conducting treatment is essential.

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