CapeSide Psychiatry, PLLC Patient Policies

The following policies have been adopted by CapeSide Psychiatry, please review and maintain these policies for referencing; any staff member will be more than happy to answer questions or concerns you may have regarding these policies.

1. Insurance Filing:

   • Copays are collected at time of visit, if unable to pay the full copay amount, your appointment will be rescheduled

   • Credit Cards are accepted for co-pay amounts

   • We will file your insurance to which we are not in network; however, you could have an Out- of-Network extended expense

     • Insurance information that has been changed or updated must be kept updated in our system. If not, the balance due becomes your responsibility.

     • Insurance does not guarantee payment in full. Services deemed medically unnecessary by the insurance carrier become your responsibility.

     • CapeSide’s Finance Department will assist you with filing insurance to a secondary or tertiary company

2. Self-Pay Accounts:

   • All accounts that are self-pay must be paid at time of services rendered, unless a payment schedule has been set up with the administrative team

   • Accounts with an outstanding balance must be paid in full within 60 days

   • Credit cards are accepted for self-pay payments

3. Statement of Accounts:

   • CapeSide will send out a statement to the address on file once payment has or has not been received from your insurance carrier

   • In the event your payment is not received within 30 days, you will receive a second notification of past due amount owed

4. Appointments: Require 24 Hours’ Notice for any cancellation

   • A $25.00 Cancellation Fee is processed for any appointment that is not canceled within a 24-hour window, arrive unprepared for (ie: driving, not in a private location or without consistent wifi) or arrive late to, (see below). All NS fees  must be paid in full prior to your next appointment

   • If you are 10 or more minutes late for your scheduled appointment you will be asked to reschedule.

   • All payments must be made through your Valant patient portal prior to your appointment.  Payments will no longer be taken by phone or electronically through your Valant patient portal, prior to your appointment arrival time.  Payments

5. After Hours:

   • Emergencies Dial 911

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Medication Responsibilities

I understand that NO MEDICATION is kept on site including Suboxone, Subutex, or any other Narcotic. I agree that group is a requirement of treatment, and I must attend at least two groups within a 28-day period to receive my prescription. Any missed group sessions prior to my doctors’ appointment will result in me not being able to get medication until my next scheduled visit and once I meet all the treatment requirements to remain in compliance.

1. I agree that the medication I receive is my responsibility and that I will keep it in a safe and secure location. I agree that lost medication will not be replaced regardless of reason.

2. I agree to take my medication exactly as prescribed by the doctor and not to alter my medication schedule without first consulting the doctor. It is a felony to be found trading or selling your prescription; prescription/ medication counting may be utilized during my treatment to ensure I am taking the medication exactly as prescribed. I agree not to sell, share, or give away any of my medication to another person. I understand that such mishandling of my medication is a serious violation of this agreement and would result in discharge from treatment without recourse for appeal or reimbursement.

3. I agree not to obtain medications from any physicians, pharmacists, or other sources without informing my treatment physician. I understand that mixing Suboxone/Buprenorphine with other medications, especially Benzodiazepines (such as: Valium-(diazepam), Xanax-(alprazolam), Librium-(chlordiazepoxide), Ativan-(lorazepam), Klonopin, and/or any other drugs of abuse including alcohol can be dangerous. I also understand the number of deaths has been reported in persons mixing Suboxone/Buprenorphine with Benzodiazepines.

I understand that I may be discharged immediately if I test positive for any controlled substances.

 

CapeSide Psychiatry Drug Screening Policy

It is the policy of CapeSide Psychiatry to randomly biochemically (urine) and/or swab test our patients. This is done to maintain the integrity of care provided to the patients within CapeSide Psychiatry. This testing provides us assurance that all medications prescribed are being taken properly and are at the correct therapeutic level within the patient’s system.  Testing is done at the discretion of the prescribing provider, and if at any time you are requested to complete a test, please understand this is a requirement and if refused could terminate your treatment with CapeSide Psychiatry.  It is the policy of CapeSide Psychiatry for all patients participating in our psychiatry program to attend one group a month prior to his/her scheduled appointment with provider.  Please refer to the letter received from Al Capps, CEO.

With your signature to this document, you agree to follow these guidelines and understand this is a requirement for treatment.