A Copy of the SOMH Office Policies is available for download at the bottom of the page.
OFFICE POLICIES / TREATMENT AGREEMENT
Our mission is to provide you with personalized attention and care in a warm and friendly environment. We maintain our schedule by only booking one appointment at any given time allowing the doctor and nurse practitioners (NPs) to spend more time with you addressing your concerns and as this helps minimize any wait that you might experience. We are able to provide this by asking that you abide by our office policies and treatment agreement. We recognize that healthcare is expensive, insurance requirements are frustrating, and discussing payment arrangements when you don’t feel well may be unpleasant. While we will make every effort to obtain appropriate payment from your insurance carrier, payment for services rendered is ultimately your responsibility.
Notice of Privacy Practices and Confidentiality
All information is guarded by strict confidentiality and in accordance with HIPAA regulations. We require your written consent in order to release/obtain information. By completing this form you acknowledge that you were provided a copy of, or electronic access to, the Notice of Privacy Practices. A copy of our Privacy Practices is available on our website stateofmindhealth.com and information release forms can be obtained as needed onsite.
Insurance
State of Mind Health does not currently accept insurance, but will supply a superbill with all requisite coding to any patients that request one. Patients can submit their superbill to their insurance for reimbursement or partial reimbursement if their insurance includes out-of-network coverage.
Office Hours
State of Mind Health’s office hours are Monday - Thursday 9:00 AM to 4:00 PM, and Wednesday 9:00 AM - 6:00 PM. In our effort to be as accommodating as possible for our patients, exceptions can be made for appointments outside of office hours accompanied with a fee increase that will be discussed at the time the appointment is booked.
Appointments
Patients are seen on an appointment-only basis during office hours. We do not offer walk-in appointments, however we will try to accommodate your scheduling needs whenever possible. Please call our office during business hours to schedule an appointment or request an appointment via the patient portal. The first appointment after the initial consultation is always a 30-minute follow-up. Once a patient is stable, 15 minute follow-up appointments will be available.
Appointment Reminders
We have an automated service that will provide you with a reminder email prior to your scheduled appointment. All initial visits will require an appointment confirmation 48 hours prior to the scheduled appointment, and if the appointment is not confirmed, it will be canceled and the time-slot forfeited. All follow up appointments require an appointment confirmation 24 hours prior to the scheduled appointment, and if the appointment is not confirmed, it will be canceled and the time-slot forfeited.
Payment for Services
State of Mind Health requires all patients to have a credit card on file with us at all times. We accept cash, check, HSA cards, and credit card as payment for a visit, simply notify us prior to your appointment your preferred payment form. For any patients who do not specify otherwise, we will charge the credit card on file once the patient's appointment ends.
Past Due Balances
Balances that are not paid within 30 days from the date of service are considered past‐due. Patients with past‐due balances will be required to make payment arrangements before additional services will be scheduled. If we are unable to charge the credit card on file for any past-due balances after 60 days, we will send the balance to collections.
We will securely store your credit card information and use it to automatically charge any “No Show” fees or unpaid “Past Due Balances” on your account. Should you wish to make alternative payment arrangements or have any questions about your bill, you may address these by contacting our front office.
Bounced Check Fee
There will be a $25 fee automatically charged to your credit card on file for any bounced checks.
No‐Show and Late Cancellation Fees
While we make every effort to maintain our daily schedule, unforeseen issues often arise and we may run behind schedule. We absolutely guarantee every patient their time with the Psychiatric Nurse Practitioner and will make every attempt to keep your wait to a minimum. In order to accomplish this we do not “double book” our appointments and every individual is provided with their own schedule time. To allow us to minimize your wait and schedule only one person to a time slot, we must charge a fee for individuals who do not show for their confirmed scheduled appointment and do not provide sufficient notice for us to repopulate the time slot.
Patients who are “no-shows” to their appointment will be charged for the full amount of the scheduled appointment.
Emergencies
All patients are strongly urged to call 911 or go to the nearest hospital emergency room should they become acutely symptomatic or experience suicidal or homicidal thoughts. We also would encourage anyone requiring urgent assistance to contact the Rockland County Behavioral Health Response Team at 845-517-0400. This is a 24 hour per day emergency service that is free of charge and is staffed by trained mental health professionals. Please also contact our office after seeking emergency care / treatment on the next business day.
Contacting Our Office
Questions about your treatment or medication should be done face-to-face during your next visit. Our providers offer telemedicine through a HIPPA compliant website that is available for urgent situations.
If you need to report medication effects or changes in your symptoms prior to your next visit, you must explain in detail your situation when you contact our office and the front office will do their best to assist you.
Prior Authorizations for Medications
Some insurance plans require prior authorization for medications that are prescribed to you. (Specifically ADHD medications and newer brand medications) If your insurance plan requires a prior authorization, please ask your pharmacy to fax the required information to our office 845-653-7301. It is ultimately up to your insurance carrier to determine coverage for medications. The processing time for prior authorizations varies; in some cases it may take up-to 1 to 2 weeks. Whenever possible we will provide samples of your medication until your insurance coverage is approved. If you have questions about your pharmacy benefits please contact your insurance carrier directly. Contacting our staff regarding a medication prior authorization must be done using our patient portal or by leaving a detailed message.
Phone Calls and Email:
If you have questions that were not covered during your visit and can not wait until your next visit, you may reach out to the nurse practitioner via email or leave a detailed message with the front office staff. If the issue is urgent you may call our office to schedule an urgent visit in the next available time slot. Please let the front desk staff know what you are experiencing so we can determine if the problem can be addressed over the phone. Issues regarding your care (non-emergency side effects of medications or requests for medication adjustments) should be discussed in person during face-to-face visits.
If your issue requires a call to our office or is an emergency, you will need to state the nature of the call / emergency for us to prioritize your issue and so your provider can be informed in a timely manner. For all non-emergency office issues, our staff will do its best to help meet your needs during business hours.
Your provider takes responsibility for each patient they care for. To do so, an evaluation must take place during certain intervals and at a minimum, you must be seen at least one time every 3 months. If a required follow up is not made at the 3-month period you will no longer be considered an active patient / client of State of Mind Health Psychiatry NP, PLLC / Nechama Keller-Sabel PMHNP and we will no longer accept responsibility for your care.
Please note that phone calls with the nurse practitioner are billed in 15 minute increments.
Prescriptions
You have been prescribed enough medication to last until you will need to be seen again for further evaluation. The Nurse Practitioner is required to monitor your response to medication and it is your responsibility to schedule an appointment prior to running out of medication. Our schedule fills up quickly and we strongly recommend booking your follow-up appointment at the conclusion of each visit. If the patient runs out of medication before their appointment they will receive a short supply until their next appointment and will be charged $35. Please note that if the patient requests their medication to be sent by mail they will be charged the cost of postage.
AUTHORIZATION FOR TREATMENT
I hereby authorize State of Mind Health Psychiatry NP, PLLC to perform any and all forms of treatment, medication, and therapy that are indicated and in accordance with the Standards of Psychiatric Care. I hereby authorize State of Mind Health Psychiatry NP, PLLC to furnish information to the insurance carriers concerning my illness and/or treatment and hereby assign to the nurse practitioner all payment for medical services rendered to myself, the patient. I understand that I am responsible for any amount not covered by insurance and agree to the above office policies and financial agreement. By signing, I authorize treatment by State of Mind Health Psychiatry NP, PLLC and indicate my understanding of the Financial Policies, Treatment Agreement and the Authorization for Treatment.
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Signature of Patient or Legal Guardian Date
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Patient Name: Print