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Policies

Insurance: We participate with many insurance plans.  We are not in network with Medicare or Medicaid at this time. Your insurance coverage and benefits are a contract between you and your insurance company. Please provide a copy of your insurance card at each visit. The insurance authorization form in the portal may be updated with insurance changes prior to a scheduled visit.

Services Not Covered by Insurance:    It is your responsibility to check with your insurance company to determine covered benefits.  The patient/guarantor is responsible for 100% of charges the insurance company chooses not to cover, including but not limited to co-payments, deductibles, mental health screenings, and document charges.

Medication Management and Psychotherapy visit services: Initiating/changing a medication, ADHD, etc., or if your care is medically complex, your insurance company may bill you per their contract.  The provider codes accurately and by the rules that govern all insurance plans. 

Credit Card on File Policy: We participate with CardPointe, a secure Payment Processing Platform such as the ones used for online retail stores. The stored credit card can be used to pay co-pays and charges at future visits.  This service is secure, encrypted, and our staff does not have knowledge of your credit card number. Additionally, Headway and Alma are used as our medical billing services. If you are in-network, you will receive an email from Alma and/or Headway explaining your payment responsibility. If you have questions, please feel free to reach out directly to them at hello@headway.co for Headway clients or at support@helloalma.com for Alma clients.  Our in-house billing representative may be reached at: billing@magnoliapmw.com

 

Circumstances, when your card would be charged by Magnolia PMW, include but are not limited to:

-  Co-pays and insurance deductibles

-  Missed or canceled appointments without appropriate notice (see below)

-  Any non-covered services and/or denial of services allocated to patient responsibility

-  Any amount not paid by your insurance 90 days after a corrected claim has been filed

This in no way will compromise your ability to dispute a charge or question your insurance company’s determination of payment.

 

If your balance due is larger than $200.00, we will provide a courtesy call and email to let you know we will be charging your card on file or determine if you need to establish a payment plan.

 

For patients who don’t have insurance or are not using insurance:  Per federal CMS rules, you have the right to request a Good Faith Estimate for the total cost of any non-emergency items and services.  This includes related costs like medical screenings and office fees.   This is an estimate, not a bill.  Please ask for a Good Faith Estimate at the time of scheduling your visit, and you will receive this in writing at least 1 business day before your appointment.  For more information, go to cms.gov.

 

Financial Hardship:   Should you have extraordinary financial pressures; we will assist you with a payment plan.  This plan will need to be IN WRITING with our billing department prior to scheduling future visits.  No balance over $250.00 can be carried on a family account unless a payment plan has been signed and the arrangement is being followed.  The balance should be paid off in the next 12 months.

Missed Appointments: There is a $50 no-show fee that will be charged to the credit card on file.  Cancellation policy: Speak to a Magnolia PMW employee at least 24 hours in advance. After 3 missed appointments, we reserve the right to dismiss the family from the office.  

Form and letter fee (school forms, work forms, travel letters, etc.):  There will be a $10 fee (per patient, per form) for forms. Please allow 7 days for the forms to be completed.  Most are completed in a timely way, but any form that is needed in < 3 business days will have a charge of $30.  

Individual letters from the provider will incur a fee of $10/letter.   Letters to return to activities or school excuses are free.  Forms that can be completed during the scope of the visit are free.

 

Copying medical records: With your written consent, we will provide you with a copy of your medical record for a fee of $20. 

Scheduling and triage: The scheduling team is available to assist with your scheduling needs Monday-Friday 9 AM-5 PM. Please leave a voice message or text message and you will receive a return call. The provider is not available by email for scheduling needs. An intake request form is also available on the website. Please note, intake documents are required prior to scheduling. This includes privacy and consent forms, insurance and payment authorization forms, as well as additional requests for emergency contact, history, and more. Medication changes require a visit. Please call 919-635-6202 for all scheduling needs.

Medication Refill Request: Please contact the pharmacy for medication refill requests. An electronic request will be forwarded to the provider by the pharmacy. Medication changes require an office visit. Stimulants and controlled medication requests should be directed to the office by calling 919-635-6202. Please allow 5 business days for all refill requests. 

ADHD Screening: The Vanderbilt Screening is a free screening that is completed by parents and teachers to assist in the diagnosis of ADHD for children <18 years of age. ADHD screening for adults is offered using the CNS Vital Signs online screening program. There is a $50 charge for this screening, which is not covered by insurance. An official report is provided and may be used by colleges for accommodations. 

Ethical Practices: The psychiatric provider and staff will exhibit honesty and integrity with the patient. The team is engaged, collaborative, and committed to service. The treatment plan will be tailored using a patient-centered approach. This therapeutic alliance is important in mutually developed treatment goals, alignment on treatment tasks, and the care between provider and patient. Patient will cooperate with the mutually agreed upon treatment plan. Patient/family will refrain from being disruptive in the clinical setting. The provider will ensure the care patients receive is safe, effective, patient-centered, timely, efficient, and equitable. Disrespectful, derogatory, or prejudiced language or conduct will not be tolerated and if the patient refuses to “modify the conduct,” the provider reserves the right to transfer the patient’s care.

Service charges: Keeping a credit card on file prevents most service charges.   Service charges are only accrued if there are late payments, inaccurate insurance information, or failure to pay bills. 

  $15 administrative fee will be charged if the co-pay is not received within 48 hours of service.

  $35 administrative service charge will be added for:

- Re-filing of insurance due to incomplete or incorrect information given at the time of service, including if the insurance has been terminated.

- Administrative fees associated with accounts turned over to collection agencies.

- Returned checks.

  

Any amount not covered by the patient’s insurance including applicable deductibles, additional copays, etc. will be due 30 days from the time of the service.  Late payments will incur an additional $10 per month billing fee.

  

Accounts will be turned over to a collection agency if past due 90 days or more.  Failure to pay the balance may result in discharge from the practice. The patient/family is responsible for all collection costs involved with the collection of your account including court costs, reasonable attorney fees, and all other expenses incurred with collection if there is a default on any unpaid balance.   

 

Telehealth: The Biden Administration has declared its intention to end the Covid-19 public health emergency (PHE) on May 11, 2023. There is currently a transition period, with extension. This was in place during the pandemic, offering flexibility during unprecedented times. 

 

Changes enforced starting August 10, 2023:

  1. Telehealth and In-Person care will no longer be treated equally. It is the patient’s responsibility to understand their personal insurance benefits. 

  2. The Ryan Haight and Telemedicine Controlled Substances Act in-person exam requirement will be reinstated. A patient will be required to have at least one in-person medical evaluation with the provider. If the patient has never been seen in person, then the patient will no longer be able to receive certain prescriptions without first seeing the provider in person. 

  3. Telehealth and Remote Patient Monitoring Copayment Waivers will cease. Copayments must be collected at the time of service. 

  4. Remote Patient Monitoring Services will once again be limited to established patients. Provider will conduct new patient evaluation and management services before rendering RPM services. 

  5. HIPAA-related Enforcement Discretion will end. Platforms/software/technology usage must be HIPAA compliant. 

 

HIPAA/ Notice of Privacy Policies

Magnolia PMW follows all the HIPAA regulations.   Medical information will not be released unless we have written authorization from you in the office. 

 

Custody Agreements

In those families where there is a separation or divorce or a change in guardianship, we must have on file a court document indicating which parent/guardian is authorized to provide medical care, make medical decisions, and receive medical information on the child(ren).  If a court document is not available, then the primary caregiver is responsible for notifying our office in writing of the above information as soon as there is a change in guardianship or custodial status.

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