Initial Evaluation: The initial evaluation for new clients takes place over two 60-minute appointments, scheduled 1-3 weeks apart. In some cases, an additional 1-2 sessions may be required in order to complete a comprehensive diagnostic assessment, discuss treatment recommendations, and establish care. During these initial appointments, we will discuss your current concerns, review your history, identify treatment goals, and collaborate on an initial treatment plan. I believe that a comprehensive assessment is the foundation client-centered treatment and an authentic therapeutic relationship. Therefore, I do not always recommend or prescribe medications or make medication adjustments until a thorough assessment has been completed. My approach to evaluation and treatment is exclusively clinical and based upon an ongoing therapeutic relationship. Therefore, I do not conduct non-clinical evaluations or assessments; including forensic evaluations, evaluations for determination of parental custody, or disability determination. I also do not provide diagnostic or treatment consultations prior to, or in lieu of, a complete initial evaluation.
Follow-Up Appointments: After the initial assessment is complete, follow-up appointments are 25-60 minutes in length. In the early treatment phase, I may request to meet with you every 2-4 weeks for ongoing assessment and treatment evaluation. The length and frequency of appointments are determined based on your collaborative treatment plan and individual needs. If you are prescribed a controlled substance, follow-up appointments must take place every 3 months, at a minimum.
Psychotherapy: I offer brief and supportive psychotherapy combined with medication management appointments based upon your treatment plan. I am currently unable to offer weekly appointments for traditional weekly psychotherapy. I am happy to coordinate with your current therapist or assist with therapy referrals if more frequent or more intensive therapy or counseling services are recommended.
Telemedicine: Telemedicine enables this healthcare provider to provide safe, effective, and convenient care through the use of technology via audio/video real-time conferencing to various off site locations, such as the patient’s home. As with any healthcare service, there are risks associated with the use of telemedicine/telehealth, including equipment failure, poor image resolution and information security issues. This provider will offer a secure, encrypted video teleconferencing service that allows for private conversations that meet HITECH and HIPAA standards. The patient will be responsible for having an electronic device with a stable Internet/data connection that allows for transmission of audio and video. The patient will also be responsible for providing a secure and private location during the visit to protect their privacy. Federal Law (Ryan Haight Act) requires that any time a healthcare provider prescribes a controlled substance they must have first seen the patient in person. If this provider recommends a controlled substance for the treatment of a mental health condition, the patient will be required to see the provider face-to-face for at least one visit prior to prescribing a controlled substance. For more information or to learn more about telemedicine visit: http://www.wsha.org/wp-content/uploads/Telemedicine-Frequently-Asked-Questions-for-Patients-Dec-2018.pdf.
Prior to any telemedicine/telehealth services rendered, the client is responsible for contacting their health insurance provider (Does not apply to private pay patients) to determine if telemedicine/telehealth is covered under their current plan and what steps need to be taken to ensure they are following all requirements set forth by their health insurance provider. Should the service not be covered under their health insurance plan the patient is responsible for all charges not covered by their health insurance provider.
MEDICATION AND REFILL POLICY
In order to ensure treatment quality and safety, all prescriptions should be requested and refilled during your appointments. This allows me to monitor efficacy, assess for potential side effects or complications, and discuss any concerns you might have. The subsequent follow-up appointment is always scheduled at the end of an appointment and prescriptions are provided with enough refills to last until your next scheduled appointment. If you cancel or miss an appointment and run low or out of medications without rescheduling in a timely manner, your refill request may be charged my standard fee of $30 per occurrence.
If extenuating circumstances require that you need a refill between appointments, please:
1) First check your prescription bottle for any remaining refills. If your current prescription has no remaining refills, please call your pharmacy, as there may be a new prescription on file that has not yet been filled.
2) If there are no remaining refills and no new prescriptions on file, please leave me a voicemail with the following information: your name, the name/dosage of the medication being requested, and the name and phone number of your pharmacy. I do not respond to faxed pharmacy refill requests without also receiving a verbal or written request from the client or their legal guardian, as these faxes are often automatically generated and sent without the patient’s knowledge.
3) Please allow 3 business days to process this request, while keeping in mind that refill delays may occur due to issues with insurance authorization or pharmacy stock. It is your responsibility to monitor your supply to avoid running out of medication.
I am not able to provide prescriptions for new medications between appointments, as these treatment changes require clinical assessment and further discussion.
I am not able to refill any medications written by other providers for conditions I am not treating.
To fulfill your refill request, you must have a future appointment scheduled with me.
I do not monitor refill requests outside of office hours.
I do not provide refills of medications designated as controlled substances outside of appointments.
AVAILABILITY AND COMMUNICATION
The structure of my practice limits the scope and complexity of clinical services that I am able to provide in the outpatient private practice setting. I am not able to provide on-call or crisis management services, and am not available outside of my normal business hours. If more intensive services are required or recommended, I am able to provide referrals to a better-suited practice or treatment setting. Most clinical issues should be discussed and shared during our appointments. However, issues that may need to be addressed between appointments include unexpected medication side effects and adverse reactions. I make every effort to respond to messages promptly, but please note that the majority of my practice hours are spent meeting with clients, and therefore, it may take 48 business hours for me to respond to messages.
Patient Portal: I ask that clients communicate via my secure patient portal, Onpatient. This ensures confidentiality and continuity of your records, and allows for more direct communication and faster response times. You can login to the portal by visiting Onpatient.com or via the “Patient Portal” link on my website, brookeheymanarnp.com. Onpatient can also be accessed through their free smart phone app. If you need another invitation email sent, are unable to login, or have questions about using the portal, contact the office via phone or email.
Email: Please be aware that emails are not HIPAA-secure, and therefore, I cannot guarantee the security of any information communicated via email.
Emergencies: In the event of an emergency (medical emergency, or suicidal or homicidal thoughts or behaviors) please call 911 or go to the closest Emergency Room.
Urgent Consultation: I am not able to provide non-urgent consultations or check-ins between scheduled appointments. If you have an urgent need for consultation during business hours, but are not experiencing an emergency or crisis, please call my office at 206-531-0499 and send a secure message via the onpatient portal. Consultations between appointments are handled on a case-by-case basis and are conducted via telephone or telemedicine, which may be subject to a fee not covered by your insurance.
After Hours Resources: If you have an urgent concern after hours or on a weekend/holiday, please call the local crisis clinic at 1-866-4-CRISIS (1-866-427-4747) or go to the nearest Emergency Department. If you have a non-emergent concern about a potential medication side effect or adverse reaction, you may also contact your pharmacist for consultation. Please note that these support resources are not a safe substitute for seeking emergency care for medical or psychiatric emergencies, including suicidal or homicidal thoughts or behaviors. Additional crisis support resources include:
24-hour crisis line: 206-461-3222
National Suicide Prevention Lifeline: 1-800-273-8255
King County Crisis Clinic: 800-621-4636, open M-F 8am-6pm
CANCELLATION, LATENESS, AND NO-SHOW POLICY
I require a minimum of 48 hours notice when cancelling or rescheduling an appointment in order to avoid a late cancellation fee. Please contact the office at 206-531-0499 or through the onpatient portal to cancel or reschedule appointments. Missed appointments or appointments cancelled or rescheduled with less than 48 hours notice will incur the following fees, which are not covered by insurance:
25 minute follow-up: $100
45-55 minute follow-up appointment: $150
Late Arrivals: If you are more than 10 minutes late to a scheduled appointment, your appointment may be cancelled and charged the above missed appointment fee.
FINANCIAL RESPONSIBILITY AND BILLING PRACTICES
I am an in-netowrk provider with BCBS affiliates, Premera, Regence, and LifeWise. Please call your insurance provider prior to our first appointment to verify your coverage and determine your copay or other related fees under your plan for mental health services. Some large insurance providers I am in-network with form smaller sub-companies or contract with other smaller insurance carriers with whom I am not in-network. For example, I am not an in-network provider for every plan with an insurance card marked “Regence.” When this occurs, visits or services rendered may not be covered. As insurance companies often do not advertise sub-contracting or make it widely known, calling ahead of time to confirm benefits and coverage is important in order to avoid unforeseen charges.
As a part of our treatment relationship, it is important that you are aware that any additional costs not covered or reimbursed by your insurance company are your financial responsibility. All copays, deductibles, and private pay fees are due at the time of service. Clients are responsible for paying any outstanding charges not covered by their insurance carrier within 60 days. Please direct billing and payment questions to my office at 206-531-0499.
FEES FOR SERVICES
If you do not have health insurance or I do not participate with your insurance plan, I offer services at a private pay rate. Private pay rates are available upon request, and fees are due at the time of service. If your insurance company offers out-of-network benefits, I can provide you with required documentation to submit to your insurance company for reimbursement.
Case Management Fees: Professional services rendered or time spent performing services on your behalf outside of scheduled appointments exceeding 10 minutes will be charged a Case Management fee of $35.00 per 10 minute increment. Examples include report writing, telephone consultation, preparation of treatment summaries or letters, paperwork for work or school, and care coordination with other providers. Insurance does not cover these services. I will discuss potential fees with you and notify you if a service is expected to take longer than 10 minutes prior to charging any fees.
TERMINATION OF CARE
You have the right to terminate care at any time, for any reason. Upon termination, I will make every reasonable effort to make appropriate referrals for continued care. I reserve the right to terminate our treatment relationship under the following conditions:
If I believe that my services are no longer beneficial to you or that you would be better served by a higher level of care or alternative clinical setting.
If I suspect prescription medication abuse or undisclosed substance abuse.
If there is a pattern of frequent cancellations or missed appointments
If you miss an appointment and do not contact the office to reschedule or provide notification that you wish to continue care within 30 days of the missed appointment.
If I deem interpersonal dynamics are not conducive to a therapeutic relationship or if you or a family member are hostile or aggressive to either my support staff or myself.
CLIENT RIGHTS AND CONFIDENTIALITY
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), I maintain a confidential clinical record of your treatment information, which is considered Protected Health Information (PHI). Your clinical record includes your reasons for seeking treatment, your psychiatric and medical history, any psychiatric diagnoses, your treatment goals, our treatment plan, your clinical progress based upon my assessments, your billing records, and any records you provide to me from other treatment providers. You have the right to ask questions and provide honest feedback about your treatment, as well as review and correct any information in your record at any time. Requests to review records will be granted within 14 business days. All treatment information, including your record and any content discussed during sessions, is confidential. Treatment information may only be released upon the written or verbal consent of the patient or patient’s legal guardian, if applicable. If you authorize disclosure of information, you have the right to ask that I limit the information shared, except in cases that require breach of confidentiality by Washington State law. Circumstances that require breach of confidentiality include:
Suspected abuse of a child, dependent adult, or vulnerable person
If I believe there is a clear and imminent risk of harm to yourself or others, including situations of suicidal behavior or threatened harm to another individual
When legally required by a court order
During medical and psychiatric emergencies
When required by your insurance company for billing and payment operations. This information includes appointment dates, diagnosis codes, services rendered, and any other additional clinical information that the insurance company may request.
If you feel that your patient rights have been violated, you have the right to report any concerns or complaints to the Department of Health by contacting the Health Systems Quality Assurance Complaint Intake at 360-236-4700 or HSQAComplaintIntake@doh.wa.gov
Age of Consent: In accordance with RCW 71.34.530, any minor thirteen years or older may request and receive outpatient mental health treatment without consent of the minor’s parent or guardian. For minors under the age of 13, parental authorization, or authorization from a person who may consent on behalf of the minor, pursuant to RCW 7.70.065, is required for outpatient mental health treatment.