THE FINE PRINT
_________ PATIENT RIGHTS At any time, patients may question and/or refuse therapeutic or diagnostic procedures or methods, or gain whatever information they wish to know about the process and course of their treatment. Patients are also assured confidentiality that is protected both ethically by the practice and legally by Texas State Law. There are important exceptions to confidentiality that are legally mandated. In general terms, these exceptions include the following: 1) The law requires notification of relevant others if it is judged that a patient has an intention to harm him/herself or another individual. 2) The law obliges us to report any incident of suspected child abuse, neglect or molestation in order to protect the children involved.
_________ DEPENDENT PATIENTS If you are requesting care as the guardian of a dependent adult, the same general practice as outlined above will apply. However, as the dependent adult’s psychiatric care provider, it is important that the patient be able to trust us. As such, the physician/staff will keep the content of the patient’s visits confidential in the same way that they would an independent adult patient’s visits. This is an ethical principle of the practice and is also a legal requirement. This is true even when the guardian is financially responsible for the patient’s appointments. In general, specific information given by the patient will not be released. However, it is appropriate and necessary to discuss the patient’s treatment and progress with the guardian as the guardian’s positive participation in the patient’s care is very important. Any issues that represent imminent safety concerns will be discussed with the guardian.
_________ APPOINTMENTS For fastest service, appointments can be booked by calling the office at (361) 703-5026. Appointment times are generally on Monday thru Thursday from 9-7 but subject to change without formal notice. These dates and times may vary and availability can be checked on the website which is kept up to date. If you have an emergency, we will do our absolute best to work you in, keep in mind this may cause a wait and we ask for your patience in this regard. Scheduling an appointment will not construe the formation of a doctor patient relationship until after you have been seen for your first appointment. Prior to the appointment, Kourtne Roberts, MD reserves the right to decline the formation of the doctor patient relationship. In this case, we will refund any amount that you have pre-paid in full and provide referrals to other providers as necessary. We do not see patients under the age of 18 at this time.
_________ CANCELLATIONS If you need to cancel or reschedule your appointment, please do so within48 hours of the appointment time to avoid being charged for the service (cash rate).Unless the cancellation is due to an emergency, you will be billed for the full amount and no refills will be provided or further appointments scheduled until this bill is paid in full.
_________ CREDIT CARD ON FILE A credit card must be kept on file in order to bill for no shows and missed appointments.
_________FORMS Appointments will not be scheduled until all forms are received.
_________ MESSAGES For non-emergent questions and concerns (refills, minor side effects, appointment scheduling, etc) please contact us by phone and a staff member will assist you. If no one is available, please leave us a voicemail message and your call will be returned as soon as possible, but kindly allow 72 hours. If you have an urgent concern, you may contact the after hours answering service
• In the event of a life threatening emergency (planning on injuring yourself, someone else, or ending you life), you must call 911 or go to the nearest emergency room to ensure immediate care. These situations cannot be handled by leaving a message no matter how compulsively we check our messages.
• Brief phone calls can be an important part of monitoring an individual’s response to treatment. If a patient’s calls are of increasing frequency and or duration it is highly likely that they need to be seen sooner and may be asked to make an appointment. In order to prevent the abuse of such calls Dr. Roberts may charge $5/minute if a call requires more than 5 minutes to complete.
_________ MEDICATION REFILLS Medications are prescribed based on assessment and discussion with the patient, and only after in-person evaluation and exploration of the conditions involved.
• Medication will generally be prescribed in sufficient quantity to last until your next visit. If needed, we will refill routine prescriptions by calling your pharmacy. These refills and any related prior authorization paperwork will not be completed outside of normal business hours. However, if a patient does not follow the recommended time course of follow up or misses a scheduled appointment at no fault of Dr. Roberts, then Dr. Roberts reserves the right to refuse refilling the medication until the patient is seen in the office.
_________STIMULANTS like Ritalin, Vyvanse and Adderall, for example, are closely monitored and regulated by the Drug Enforcement Administration (DEA). These medications require a special type of written prescription (called a triplicate prescription) and cannot be called in to pharmacies. Patients taking these medications must be seen more frequently and come for office visits for refills.
_________SUBOXONE When taking Suboxone or other medication for opiate dependence, you must follow the drug screen and office visit protocol that you discussed and received a copy of during your appointment with Dr. Roberts. Suboxone and other medications used for opiate dependence are highly regulated by the DEA and we cannot refill these medications without meeting certain requirements. If you fail to follow protocols, we may not be able to prescribe the medication.
_________PREGNANCY Be sure to notify Dr. Roberts if you are pregnant or think you may be pregnant. This is very important because if you become pregnant while taking psychiatric medication, we absolutely must discuss the risks and benefits of that particular medication and then make an informed decision together for your treatment.
_______REQUESTS FOR MEDICAL RECORDS If you have an appointment with another physician and need to have your medical records sent to this provider, please notify us at least one week before your appointment date. Before any records can be released, you will need to sign a consent form. The consent form is available for download on the website. All of the information in your chart is strictly confidential and cannot be released to anyone without your written consent. Records transferred to any persons other than physicians or therapists, i.e., patients, lawyer, insurance companies, etc. are subject to a fee. The fee for this depends on the volume of the record: $25 for first 20 pages and .50 cents per page after.
_________ LETTERS/ADDITIONAL PAPERWORK REQUESTS The time taken to compose letters or complete forms will be assessed a fee depending on their complexity. Any letters to persons or companies aside from your other physicians or therapists will be assessed a fee of $25. Complex forms will be assessed a fee depending on the amount of time required to complete them. Patients are expected to pay for all requested documents before they can be sent or picked up. Simple forms that you bring with you to your appointment and can be completed during you appointment time do not have a fee.
We will not fill out any paperwork, forms or write any letters in regard to CHL (concealed handgun license) clearance or support animals.
_________ BILLING Dr. Roberts is currently in the process of being contracted with various standard insurance companies. When this process is complete we will contact insurance companies regarding claims/eligibility and file claims to insurance companies.
_________ PAYMENT POLICY/FEE AGREEMENTPayment by cash or credit card is required prior to receiving services. Checks are not accepted. No refunds will be given for rendered services. Accounts need to remain current in order to maintain ongoing treatment.
_________ TERMINATION While we do not expect this to be the case, there are rare occasions when it is necessary to terminate the physician-patient relationship. Termination of treatment may occur at any time and may be initiated by either the patient or the doctor. Reasons for termination by the physician are generally due to patient non-compliance with treatment, missed appointments, patient threats or violence towards the physician or staff. Dr. Roberts will continue to provide care for 30 days after a notice of termination in order to allow you sufficient time to find a new physician.
We trust that you understand the necessity for these policies and sincerely thank you for your cooperation. If you have any questions, please do not hesitate to ask.