The following are the office policies for Bethany Health Services, LLC, heretofore referred to as the Practice for the remainder of this document. Please read this document carefully. Your signature on this document indicates your understanding of each policy listed below. If you have any questions, please do not hesitate to ask your Provider before signing this form. Policies may be subject to change without advanced notice and every effort to notify clients of changes to these policies will be made, however it is your responsibility to stay informed of our policies, which will be updated accordingly on our website: bethanyhs.com

It is the PATIENT’S RESPONSIBILITY to know (if applicable) their health insurance plan including co-pay amounts, deductible amounts, and visit limitations when applicable. The Patient is expected to contact their insurance company BEFORE a first visit to determine this information. It is not the Provider’s responsibility to determine the level or the details of a Patient’s coverage.

At your first visit the Provider will conduct a detailed intake assessment. At the conclusion of this assessment, you and the Provider will determine if you and the practice are a “good fit”, and if being a client of the Practice would be beneficial for your specific health concerns. This visit will be 30-60 minutes in length. If for whatever reason, you or your Provider feels as though treatment here will not be therapeutic, the Practice will be happy to refer you to another Provider or therapist within the area. In order to help streamline this process, we ask that you provide accurate and detailed information upon your first meeting with our Provider.

The Practice does require clients to be fully engaged with treatment on a regular and consistent basis, as determined by you and your Provider. The frequency of these visits is individualized and will primarily depend on your treatment plan. In order to provide good quality care, as well as continuity to our clients, appointments with your Provider cannot exceed past 90 days. If a period of 90 days elapses, clients will be automatically discharged from the Practice. If this should occur, the Practice will be happy to refer you to another agency or mental health provider. In addition, medication refills will not be filled if 90 days pass without seeing your Provider.

Clients are expected to provide payment for services, which may include full payment for services, co-pays and/or deductibles if using their health insurance. Initial appointments are $300, and each subsequent appointment thereafter is at least $150. Currently the practice does accept PayPal/credit card and health care spending account cards. In the event of a personal check return, a fee of $25.00, as well as any applicable fees will also be applied to your bill. Please be aware that a fee of $100.00 will be applied to your bill in the event of a no show or cancellation less than 48 hours prior to your appointment. See the Schedule of Fees on the Practice’s website for updates and other fees. Clients will be required to keep a current credit card on file. See the Credit Card Acknowledgement and Policies section.

All appointment cancellations require a minimum of two business days (48 hours) notice. If you must cancel your appointment, you must notify your provider directly either through email or by voicemail. Cancellations can be made by email at info@bethanyhs.com. If you miss your appointment or cancel within less than two business days (48 hours), you will be charged $100.00 for the missed appointment. Please keep in mind insurance companies will typically not reimburse for missed or cancelled appointments. If you miss your appointment or late cancel two or more times within a 60-day time period, you may be terminated from the practice and referred to another provider or agency.

Missed appointments are defined as an unacceptable combination of no-show appointments, late cancellations, or multiple absences. Missed appointments may result in termination from the practice and referral to another provider or agency. If you are terminated from the practice, your medication will not be refilled.

Tardiness is defined as being more than fifteen minutes late for a scheduled appointment. If you are tardy for your appointment, you may still be seen at the sole discretion of the Provider. If you are thirty minutes or more late for an appointment, this will be considered a missed appointment and billed as outlined in the Cancellation section of this document.

The Practice does close for inclement weather per the discretion of the Provider. In the event of an inclement weather closure, the Practice will notify clients directly either through email or by phone. Bethany Health Services, LLC – Policies_Nov, 2021.

Medication refills will be addressed during scheduled appointments. Clients are responsible for notifying the Provider when their refills are due. As mentioned above, medication refills will not be granted if a client exceeds past 90 days without seeing their Provider.

An authorization form of request will need to be filled out in its entirety before the Practice will release any medical records to either yourself or to another provider. There is a fee of $50 plus twenty cents per page to print medical records. Upon request, processing copies of one’s medical record may take up to two to five business days.

It is your provider’s choice to prescribe or not to prescribe any kind of controlled substances or medications that may be addictive. Your provider will offer non addictive medications to target symptoms whenever clinically appropriate. If you do not agree with the Provider’s recommendation to use a non-addictive medication, you will be referred to another agency or provider. It is your provider’s sole discretion to initiate, continue or discontinue any medication based on your overall health and wellbeing. If the Provider feels as though a client is seeking a controlled substance and/or addictive medication, they will be terminated from the Practice and referred to another agency or provider.

At your first visit the Provider will conduct a detailed intake assessment. At the conclusion of this assessment, you and the Provider will determine if you and the practice are a “good fit”, and if being a client of the Practice would be beneficial for your specific health concerns. This visit will be 30-60 minutes in length. If for whatever reason, you or your Provider feels as though treatment here will not be therapeutic, the Practice will be happy to refer you to another Provider or therapist within the area. In order to help streamline this process, we ask that you provide accurate and detailed information upon your first meeting with our Provider.