Patient Accounts: All prospective and current patients are required to sign up and create their own free individual patient account with my practice’s HIPAA compliant, cloud based electronic medical record vendor Therapy Notes.
All patients are required to maintain their own patient account in order to retrieve, complete, sign, and return all patient consent and intake forms. All patient intake and consent forms need to be reviewed before an initial appointment may be scheduled.
Appointments: The practice offers video appointments only. All telehealth appointments are conducted over a secure HIPAA compliant video platform. You understand that using telehealth conferencing technology does not provide in-person care and has limitations in assessing your physical status. You understand there are potential risks to using telehealth, including interruptions, unauthorized access, and technical difficulties. My practice does not record any appointments or phone calls. You are not permitted to audio or video record any appointments or phone calls with my practice.
Appointments will not be conducted in the event you are driving and if you are not physically located in the state of Massachusetts at the time of your appointment. If you are more than 10 minutes late for your appointment, your appointment will be cancelled and will need to be rescheduled. Arriving late to your appointment results in taking time away from providing you with a quality appointment and negatively impacts other patient appointments.
Appointments will not be conducted over the phone. Emails will not be used in place of an appointment.
The practice reserves the right to refer you to alternative psychiatric care at “any time” if it is clinically determined that “your psychiatric status and care needs have changed”, and it is determined that you require “a higher level of psychiatric care that is beyond the scope of my telehealth practice”. My practice can assist in transferring your psychiatric care to a local emergency room or to another outpatient psychiatric facility that would be able to provide you with a higher level of care.
Appointment Cancellations and No-Show Policies: My practice requires that all patients give at least 24 hours’ notice to cancel an appointment. You agree to give my practice at least 24 hours’ notice if you need to cancel your appointment. If you give less than 24 hours’ notice, you will be charged a Non-Refundable $50 Late Cancellation Fee. Late cancellations due to unexpected illness or other emergencies will be evaluated on an individual basis.
In the event you are not physically located in the state of MA, and/or if you are driving at the time of your appointment, my practice reserves the right to cancel your appointment, and you will be charged a Non-Refundable $50 Late Cancellation fee. If you Do Not Show for a scheduled appointment, you will be charged a Non-Refundable No Show Fee of $100. All Late Cancelation Fees and No Show Fees are the patient’s financial responsibility, and will not be billed to insurance.
Follow-Up Appointment Requirements: Upon starting a new prescribed medication, you will be required to have a follow-up appointment either bi-weekly or monthly depending on the type of medication. Follow-up appointments are required in order for my practice to clinically assess for medication safety, efficacy, and to provide time to answer questions. In the event you cancel your appointment, and do not return for a follow-up appointment, my practice reserves the right to decline refilling your medication(s) until you have a follow-p appointment. After a therapeutic dose is achieved, follow-up appointments may extend to 30 days, 45 days, 60 days, and may not extend more than 90 days due to Federal and State Drug Enforcement Agency (DEA) rules and regulations. If you do not return for a follow-up appointment within 90 days, you are required to be seen for a follow-up appointment before another medication refill may be sent.
For psychotherapy patients and coaching clients, bi-weekly or monthly follow-up appointments may be recommended depending on your individual goals. All patients are required to have a Primary Care Provider (PCP) manage and treat their medical care outside of my practice.
Telehealth Prescribing: My practice complies with all United States Federal and State of Massachusetts (MA) Drug Enforcement Agency (DEA) Laws and Regulations for telehealth care and prescribing. The DEA has extended the allowance for practitioners to continue Telehealth prescribing of medications, including controlled class medications (i.e., stimulant medications, sleep medications, anxiety medications) to new and/or existing patients who had established care and treatment through telehealth until
*December 31, 2026.
*Please note, that on or before December 31, 2026, the DEA may change these laws and regulations, and may require all patients to be seen via an in-office appointment(s) with their prescriber to be eligible to be prescribed a new and/or ongoing medication refill.
All Patients of A Compassionate Mind and Wellness, LLC Must Comply and Are Required To Attend All In-Office Appointments Mandated By All DEA Laws and Regulations. You understand the continuation of your care, and your eligibility for ongoing prescriptions are contingent upon your compliance and attendance to all appointments mandated by Federal and MA DEA Laws and Regulations.
Prescriptions: My practice reserves the right to clinically assess and determine whether a prescription(s) is clinically indicated for you. My practice reserves the right to decline prescribing medication(s) and reserves the right to decline refilling any prescription medication(s) that may have been prescribed to you by a provider outside of my practice.
Accepted Health Insurances: My practice does not accept any Medicare or Medicaid plans. My practice is an “In-Network Provider” with select Blue Cross Blue Shield of Massachusetts (BCBSMA) Commercial Health Insurance Plans: HMO Blue (Managed Care), Preferred Provider Organization (PPO), and Indemnity plans.
If you choose to use your BCBS of MA insurance, you give consent to my practice to release your personal information, including, but not limited to your psychiatric presentation, history, psychiatric evaluation and psychiatric diagnoses; all medications, along with your medical, social, educational, and occupational histories, along with your information about your family medical and psychiatric histories that is required to permit my practice to submit claim(s) in order to request payment(s) for your appointments. You agree and give consent to your BCBSMA plan to send all claim payment(s) for all your appointment(s) directly to the practice.
Payment Policies: The practice does not accept payment via cash, checks, or American Express Credit Card or Non-United States Currency.
All payments are required to be made online through Therapy Notes’ integrated PCI compliant credit card processing solution “Card Pointe”, which is owned and operated by Card Connect. My practice accepts online credit card payments from Visa, Mastercard, Discover, and Health Care Allowance Credit Cards.
Your appointment will not be conducted if your credit card is declined. The practice reserves the right to cancel your appointment, and you will need to reschedule for another date and time. If your appointment needs to be rescheduled more than Two (2) times due to your credit card being declined, or due to failure of processing your credit card payments, my practice reserves the right to decline scheduling future appointments to you and reserves the right to terminate care with you.
Payment Authorization Form: You are required to complete, sign, and return a card payment authorization form for the practice. By signing the practice’s payment authorization form, you give consent to my practice to charge your credit card for all appointment copays, any appointment fees not covered by your insurance, and for any outstanding balances. Your signature gives my practice permission to charge your card for any outstanding balances. Your signature gives my practice permission to charge your card before the start of all appointments.
*Please note, that the payment authorization form will encrypt your credit card information. The practice does not have access to your credit card information, and your credit card information is not stored within your patient record.
Insurance Copays, Deductibles, Patient Amounts, Late Cancellation, and No-Show Fees: You are responsible for obtaining information about your insurance plan, including if referrals are required, copay amounts, and deductible amounts. If you have not met your insurance deductibles, you will be held responsible for all appointment fees, and your signed payment authorization form gives your consent to my practice to charge your card for these charges until insurance deductibles are met.
Out-of-Network Care: If you would like to obtain “Out-of-Network Care” from the practice, you agree and give consent to the practice to charge your encrypted credit card the full appointment fee “prior to the start” of your appointment(s).
Superbills: Upon request, the practice can send you a “Superbill” that you may submit to your insurer or health care savings account to request reimbursement for your out-of-network care. The practice is not responsible for and does not submit Superbills. All patients are responsible for submitting their own Superbills. The practice is not able to guarantee that its out-of-network care services will be approved for reimbursement.
Private Pay Patients: The practice also offers care to patients who would like to obtain private pay care. For patients who would like to schedule private pay appointments, ADHD coaching, or Life coaching services, you agree and give consent to the practice to charge your encrypted credit card the full appointment fee “prior to the start” of your appointment(s).
*No Refund Policy: You understand the practice has a “No Refund Policy”. All appointment copays and fees, including Late Cancellation fees, and No-Show Fees are Non-Refundable. No refunds will be given for any psychiatric evaluations, appointments, psychotherapy appointments, ADHD coaching or Life Coaching sessions. No refunds will be given for any additional provider fees.
No Chargebacks: All patients agree not to issue any chargebacks to their credit card company for any practice appointments, services, or fees.
Unpaid Patient Balances: All patients are responsible for remitting full payment for all outstanding patient balances. Your signed payment authorization form gives your consent to my practice to charge your card for the full amount of your outstanding patient balance prior to the start of your next appointment.
Any outstanding patient balance that is Sixty (60) Days Past Due will be transferred to a collection agency. All unpaid patient balances will be charged an interest of 1.5% per month until all outstanding balances are paid in full and will be charged an interest of 18% per year until the balance is paid in full. You will be held responsible and liable to pay all fees and costs related to the collection of my unpaid patient balances, including all fees and costs related to collection agency services, and all attorney fees related to small claims court.
A Compassionate Mind and Wellness, LLC Privacy Policies:
The practice adheres to Federal and Massachusetts Laws to protect the privacy, confidentiality, and security of all its clients. The practice implements and maintain policies and procedures in compliance with the Federal law Health Insurance Portability and Accountability Act (HIPAA).
A Compassionate Mind and Wellness, LLC’s Non-Discrimination Policies:
A Compassionate Mind and Wellness, LLC comply with applicable federal civil rights laws and Massachusetts Civil Rights Act. Our practice is committed to provide compassionate and respectful care to all. Our practice does not discriminate or exclude any person, or treat any person differently based on a person’s race, color, creed, national of origin, citizenship or immigration status, religion, age, sex or sexual orientation, gender identity or expression, marital status or civil partnership, family or parental status, mental disability, intellectual or cognitive disability, physical disability, genetic information including family medical or psychiatric history, veteran or active military status, political beliefs or affiliation, and any other class of individuals protected from discrimination under federal and state laws.
A Compassionate Mind and Wellness, LLC’s Discharge and Termination of Care Policies:
You understand and agree that your care may be discontinued at any time by you or by the practice. You understand and agree that our practice reserves the right to terminate care with you at any time as defined in our practice’s Terms and Conditions and with your agreement and signed consent to our practice’s Terms and Conditions.