Some medications have an addiction potential. These medications are classified as controlled substances by the Drug Enforcement Agency (DEA). We are required, by law, to verify that you are, in fact, our patient before issuing your prescription(s) for controlled medications to your pharmacy.
There are significant concerns regarding the long-term use of controlled medications. Please take a moment to familiarize yourself with the controlled medication contract, which goes into further detail regarding points of concern and nuances associated with the prescribing and use of controlled medications.
Benzodiazepines and sedative/hypnotics can be prescribed by a nurse practitioner with a maximum of three refills per prescription
Stimulants, such as those used to treat ADHD, can only be prescribed by nurse practitioners as separate, 30-day prescriptions—with a maximum of three, 30-day prescriptions being issued at one time, per dose.
Pharmacies will not fill/release-controlled medications less than 28-30 days from the prior fill.
Pharmacies do not auto-fill controlled medications.
It is the patient’s responsibility to contact their pharmacy to request the next fill/prescription on file. For stimulants, patients should call their pharmacy and request that the prescription on file/hold be filled.
If a patient needs an early fill of a controlled medication, regardless of reason, this is subject to the provider’s and pharmacist’s discretion, and only available in rare situations.
Unlike non-controlled medications, controlled medications cannot be transferred between pharmacies.
If a controlled medication is not available at a pharmacy or the patient prefers to fill at an alternate pharmacy, the provider must call the pharmacy where the original prescription(s) was issued, void the prescription(s) on file, and then submit new prescriptions to the alternate pharmacy. This is a work-intensive process.
Reissuing controlled scripts, for any reason, is at the discretion of the patient’s specific psychiatric provider; and may incur additional expense/patient liability that is not covered by insurance.
Some medications will require a prior authorization in order to use prescription benefits from the pharmacy. Please be ready to send your prescription benefits to us if we ask. It is a courtesy for our patients that we complete these authorizations which can sometimes be difficult.
Per DEA guidelines, psychiatric providers are also limited in our use of telepsychiatry for prescribing controlled medications.
DEA guidelines emphasize that a provider must be able to visualize the patient in the context of an appointment.
It is essential for patients to maintain their follow-up appointments in order to receive on-going treatment.
If you are in need of a medication refill, please leave one message on the Barnabas medication line or via the Barnabas patient portal.
Calling or messaging your provider repeatedly, will not expedite the process.
Leaving multiple phone or portal messages creates a backlog that prevents the administrative staff and nurse practitioners from being able to address patient concerns efficiently.
Please track medications and allot for 72 hours for providers to respond to messages and/or issue medication refills
Each of our providers can be grouped into a provider level for billing purposes. There is a Doctor level, a Mid level and a Masters level. Each of these levels have two basic charges, the new patient charge and the established patient charge. There are also charges that can apply outside of the standard care such as legal testimony, physician consultations, etc.
A new patient for a medical visit from a midlevel provider would not be the same charge as a follow up brief counseling session from a masters level.
If you are a portal user, we can send your statement electronically. Other statements will be sent through the mail. A statement is only accurate at the time it was generated and will only show you the portion of your balance that you are responsible for. It will not show you what your insurance is still processing. For this reason, its import that you understand that your statement may not reflect each claim as of today.
During the billing process there is a cycle of responsibility of the charges between the insurance company and the patient. Once you have completed your visit there is a charge generated by your provider that's applied to the insurance balance. The claim is sent to the insurance company for processing and they send us back a payment with an explanation of how they applied the charge based on the allowable amount (see DEDUCTIBLE, COINSURANCE & COPAYS, AND ALLOWABLE RATES ).
The payment explanation is then applied to your account according to what your insurance has outlined. In some cases the entire allowable rate is applied to your deductible. In other cases the insurance company will pay all but your copay. The insurance company also can deny the payment or reject the claim for various reasons according to your specific plan. These charges are then applied to the patient which will reflect in the patient balance.
The main reason your patient balance changes is based on where the charge is in the billing cycle. It is either insurance or patient responsible. Some insurance companies will process a claim faster than others which can result in a lag in payment. For example, if your insurance takes two weeks to process a claim, its not unheard of for a patient to have a visit with for medication and several counseling appointments. Our office will not schedule a patient with a balance, but if the balance has not yet applied to the patient it creates a situation where you may have several claims processing prior to your next visit.
As a private practice we do not have the resources that state run or community based practices enjoy. We recognize that you have choices for your care and we are committed to excellence, but we are not a free clinic.
We have options for payment plans as well as providers not yet independently licensed that work at a reduced rate. We can also help refer you to another provider.
We recognize that financial situations can change for a multitude of reasons. We do offer payment plans on a case by case basis. If you need a payment plan, please be prepared to propose a plan that will cover your past due balance as well as future visits as they are needed.
We can offer reduced rates on a needs base for in certain situations.
We offer self pay rates for our patients without insurance.
NEW PATIENTS SELF PAY- (Must be paid to be scheduled initially)
ESTABLISHED PATIENTS- (Due prior to visit)
We do our best to return phone calls, answer portal messages and non care specific emails as quickly as we can. Please remember, we are not an acute care facility and our providers are not available outside of office hours. Please allow us 72 hours to respond to portal messages or phone calls before resending your request. We understand that there are emergencies and will do our best to accommodate your circumstance, but we will not tolerate rude or threatening language or overly repeated calls to our front desk staff.
Although the current COVID 19 crisis has relaxed certain HIPAA standards for patient communication, we will not be communicating about your confidential information through standard email.
We do receive your emails through the email@example.com address, however our providers will not reply via email.
Our care portal is designed to send secure messages to our office. Its HIPAA compliant and allows us to send your messages marked "private" directly to the intended receiver. It is not email although it's similar. The main difference that sometimes confuses our patients is that your provider can only see your message when they are logged in to our EMR system. It's not a text message that beeps their phone or a popup for email.
As mentioned previously, please allow 72 hours for a response.
Telehealth visits and remote office work is a new ball game for us and most likely for you too.
Traditional visits allowed us to give our patients a clip board and a pen once they arrived at our office. We could make a quick copy of your insurance card, ask a few questions and send you back to meet with your provider face to face.
Our online registration tool is our way of ensuring that we have a full picture of you and your needs, accurate insurance information, current medications, allergies, contact information, test scores, referring physician, etc. This also allows us to communicate with you through our portal once you create your account.
To become one of our patients, you will need to fill out our intake paper work. Once you have completed your forms, we will be able to schedule your visit. If you have been referred to our office and have an email address on file, you will receive an email with a link to complete your online questions. You can also fill out our paper work by going to our portal and clicking on the "click here to fill forms" link and entering our Clinic ID P1727442 .
If your forms were submitted and they were completely filled out, you will be able to schedule an appointment. Please be aware scheduling is based on the availability of our providers. Some providers will have a longer waiting list than others.
It is ok to call the office once your paperwork is complete and inquire about scheduling, but we cannot schedule patients without the completed intake.
Another issue that can hinder your scheduling could be that your forms were received but were only partially complete. Please look at the completion percentage to ensure you have answered all of our questions.
Even though you have filled out your insurance information through our online tool, we know from experience that it is easy to enter an incorrect ID number or pick the wrong insurance. We recommend sending us a copy.
For the most part we are able to send your prescriptions electronically to your pharmacy. This is especially useful while we are conducting virtual visits! Some medications can have addiction potential (which are called controlled substances) and we must verify that you in fact our patient before sending your prescription. This verification can be done through your virtual appointment if you are able to connect with video or by bringing your photo ID by our office.
If you are going to run out of medication, don't wait until the last minute to let us know!!! We are not an acute care facility and we don't have staff working 24/7. Medication can react differently for different people and its our job to make sure your treatment is working properly...which means, you will need to keep your follow up appointments.
We check our medication refill phone messages several times per day. If you have left a voice mail, we will get to it. You always have a the option to send note through the patient portal. Please keep in mind our office hours and provider availability are not 24/7. If you are having a life threatening emergency, please go to your nearest emergency department.
Please be aware of how long your prescription will last and schedule your follow up appointment prior that time.
None of our providers take Medicaid plans, ALL of our providers are credentialed with Medicare, Blue Cross, Aenta and Cigna.
Tricare, Humana, Magellan and United Healthcare/Optum are only taken by SOME of the providers.
Here is the tricky part, with only some of our providers taking Optum, if your Blue Cross policy sends their mental health claims to Optum, its possible that you may have to pay out of network. Bottom line, its best practice for you to call and speak with your insurance company to determine what your mental health benefits are and if your appointment will be covered. Remember, we are happy to file your visit to your insurance company, however you are ultimately responsible for your bill.
Insurance billing can be difficult and navigating all the different plans can sometimes leave us scratching our heads! For the most part we try to contract with insurance companies as a group (which would apply to all the providers under our Barnabas Behavioral Healthcare name), however some plans do not give us this option which leaves us contracting our providers individually.
The best advice we can offer you is to check with your insurance provider to make sure you understand what your costs will be.
Allowable Rates: How much your provider and your insurance company have agreed for payment.
Deductible: How much you have to spend for covered health services before your insurance company pays anything
Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible.
In mental health, like other specialty practices, some insurance plans will opt to send their claims to a third party. Even though your insurance card may say Blue Cross on the front of the card, your mental health benefits may be processed by another plan or another address. Another situation that can occur is when we send claims with a medical component (which we do for our medication visits) with our psychological codes (as a specialty group). The insurance company may assign the responsibility for payment to you. We can sometimes correct this for some payers (we have a pretty good working knowledge of which payers are the culprits) however, ultimately we file insurance for you as a courtesy. Long story short, please make sure we have the right information on file for you!
We are able to both email and text your access code for your visit. You will receive a code with a link that you can follow to enter your visit. We have found that some cell phones/tablets seem to connect better by downloading the app from Apple or Google.
If you have not received your code or are having other issues that downloading the app cannot resolve, please call our office. We ask that you try to download the app first (which we have seen resolves a lot of problems).
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Our office is a non-acute care facility which means that we are not open 24/7 and do not provide the same level of care as an inpatient hospital or similar. There may be times when our office is closed or perhaps your therapist is unavailable. In the event of a crisis we recommend the following.
If it is during office hours and you cannot get through to the front desk and you are not in immediate danger, please continue to try our office through phone, email or the patient care portal. We will do our best to reach your provider and notify them of your situation.
If you are in immediate harm or intend on hurting yourself or someone else, please go directly to the nearest emergency department. Let us know what's going on and we will communicate your situation with your provider.
ARE YOU FEELING SUICIDAL?
*Call 911 or be transported to the nearest emergency department
*Prisma Behavioral Health 803-296-8765
*Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)
*Three Rivers Behavioral Health 803-796-9911
Effective September 1, 2021; We have been awarded new rates with Blue Cross. Your deductible will not be affected nor will any Co Pays, however out of courtesy to our patients, plans with a percentage co payment will be paying the same percent based on a higher dollar amount per service.