POLICIES

Professional Standards and Ethics

This provider is licensed by the State of Iowa and has fulfilled all the requirements required to provide your psychiatric and mental health services. You may search individual credentials on the Iowa Board of Nursing website nursing.iowa.gov. This provider is also credentialed through the American Nurses Credentialing Center (ANCC) and maintains the requirements expected of this national organization. ANCC can be contacted at 1.800.284.2378. This provider is a licensed Advanced Registered Nurse Practitioner in the State of Iowa.

Services Provided

Medication Management and Psychiatric Evaluation:

New Patients– you will have 2-4 initial visits to establish a proper diagnosis and thorough evaluation. This provider generally does not prescribe medication on the first visit. The first appointment is 60-90 minutes, and subsequent appointments will likely be 20-50 minutes. These appointments will be used to evaluate, educate and determine a mental health diagnosis, as well as discuss side effects and efficacy of any prescribed medication. This provider will see you weekly as his/her schedule permits until either your symptoms are alleviated, or your condition is stabilized. This provider will then determine and recommend your subsequent visit frequency based on your health, treatment goals and stability of your condition.

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:
• 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.
• 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.
• 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.

PLEASE NOTE:
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 over the weekend of after hours.
• I do not provide refills of medications designated as controlled substances
CONTROLLED SUBSTANCES
Medications such as benzodiazepines and stimulants are tightly regulated by the DEA. These medications can be very useful when indicated but require more frequent monitoring and must be part of a comprehensive treatment plan. This treatment plan may include a referral with a therapist to help develop effective coping mechanisms associated with mental health issues that require a prescription for a benzodiazepine. Controlled substances will not be refilled early and cannot be refilled without an appointment. At my discretion, a urinary drug screen may be utilized to determine compliance with our initial agreement on the controlled substance being prescribed.
This practice utilizes the Iowa Prescription Monitoring Program (PMP), a statewide database which allows providers to see the history of controlled substances prescribed to an individual. This initiative was designed to limit the abuse and diversion of certain medications, by informing providers about current and past prescriptions and helping them prescribe medication more safely and effectively.

Records Request: You have a right to your medical records. This provider will honor your request by providing you with your records within 2 weeks of the request. The client must provide a letter with their name, date and the specific request. The letter must be signed by the client if age 13 years of age or older and by their parent is under 13 years of age. For clients seeking medical records they may:

1. Have another medical provider request them for free. Discuss this process with said provider.
2. For personal records request a fee applies. See Below for fee rate. Fee will be applied to the account and it is expected that the fee will be paid at the time the client picks the record up.

Case Management: Case management can be addressed during visits in some cases and will be determined by the provider. Examples of case management include medication forms for school, L&I paperwork, FMLA paperwork, Letters for school or other entities or letters for legal purposes. If the provider determines that case management cannot be done during the visit or your request is outside of a scheduled visit a fee will apply. The provider will respond to the request within 14 days. Case management fees will be charged to the client’s account and are not covered by insurance. It is expected that the fee be paid when the client picks up the document or at the next visit (which ever comes first). See below for fee rates.

Forensic Evaluation or Court Appearance: I DO NOT provide this as a service. If this provider is required by subpoena for court appearance to testify a fee will apply. See below regarding fee amount. It is expected that a deposit for 8 hours of service be paid prior to court appearance.

Cancellation Policy:
This provider asks that you provide a minimum of 48 hours’ notice if you are unable to make it to your appointment. If the patient has a temperature of 100 degrees F or higher, is vomiting or has diarrhea within 24 hours or an emergency occurs such as hospitalization or car accident the fee will be waived. Documentation must be provided. If you are unable to provide us with this notice, you will incur a missed appointment/ late cancellation fee as follows:

• $100 for 30-minute scheduled appointments (20 min with provider)
• $150 for 60 minutes Scheduled appointments (50 min with provider)

Insurance does NOT cover this fee. The fee will be charged on the day of the missed appointment and is non-refundable.

If there is a pattern of cancelled appointments (whether providing 48 hours’ notice or not) or no shows this provider may be unable to continue to provide services and reserves the right to cancel future appointments. If this provider cancels future appointments the client will be provided a medication supply to assist in transfer of care. This may include a taper off of medications and/or no greater than a 3-month supply of medication. The client will also be provided 3 referrals to appropriate providers within a 50-mile radius. It is the responsibility of the client to make arrangements with future providers. Further refills will not be provided. If the client wishes to resume care with this provider they must speak directly to this provider and their account must be paid in full prior to resuming care.

Fees for Services

This provider accepts a number of different insurances which include, but are not limited to Cigna, Blue Cross Blue Shield, and Tri Care. If you have another insurance or no insurance, the full fee will be due at the time of service. For out of network reimbursement please work with the administration team who will provide you with required documentation for billing purposes.

1. 30 minute scheduled appointments (20 min with provider): $150
2. 60 minutes Scheduled appointments (50 min with provider): $300
3. Court appearance: Minimum fee of $500. $400 per 60 minutes including travel time
4. Personal records request: $5 per occurrence/visit
5. Case management fee: Minimum Charge of $50. $50 dollars per 15 minutes.
6. For School Medication Forms or a letter indicating diagnosis: $20

PAYMENT
Payment is due for each visit at the end of your appointment. We accept Master Card, Visa, American Express, and Discover debit and credit cards. Checks should be made payable to “New Horizon Mental Health and Wellness” or “New Horizon MHW”

Telemedicine Services:
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.

Telemedicine/telehealth enables this health care provider to provide safe, effective and convenient care through the use of technology via audio/video real time conferencing to various different off site locations such as the patient’s home. As with any health care 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 which meets HITECH and HIPAA standards. You (the patient) will be responsible for having an electronic device that allows you to have a stable Internet/data connection which allows for transmission of audio and video. You will also be need to provide yourself with a secure and private location during visit to protect your 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 follow this link: http://www.wsha.org/wp-content/uploads/Telemedicine-Frequently-Asked-Questions-for-Patients-Dec-2018.pdf.

Dismissal/Termination of care:

• f I believe that my services are no longer beneficial to you.
• If I believe that you would be better served by a higher level of care or by a different provider.
• If I suspect prescription medication abuse or undisclosed substance abuse.
• If there is a pattern of frequent cancellations/no-shows
• If you cancel or miss an appointment and do not reschedule within 30 days of the missed appointment or notify me that you wish to continue care if extenuating circumstances prevent you from rescheduling 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.

Distinguishing between an emergency, urgent, and non-urgent request:

In the event of an emergency (you feel suicidal, homicidal, or have a medical emergency) you should call
911 or go to the closest emergency department.

If you have an urgent need for consultation you should call this provider directly at 712-389-2508. After hours and on weekends if you have an urgent need for help you should go to the nearest emergency department.

If you have an urgent concern about a possible side effect from a prescribed medication and this provider does not return your call within a timely manner, contact your pharmacist to consult about medication side effects or adverse effects.
• In the event of a psychiatric emergency please go to your local Emergency Department for assistance or call 911.
• Iowa Crisis Line; Call, text, or Chat, at 855.800.1239 or Visit https://www.iowacrisischat.org
• National Suicide Prevention Lifeline: 1-800-273-8255.