DMV MEDICAL GROUP

PRACTICE POLICY UPDATES

Payment:

-Payment is due at the time of service (Co-pays, deductibles, co-insurance)

-Our office does not make a practice of completing patient forms; however, we will review requests for form completion on a case-by-case basis. Forms may take 5 to 10 business days to complete. Completion of forms may require a fee of $175. Cash and credit cards are accepted; however, we do not accept checks.

-Our office requires a credit/debit card on file in our EHR system as well as our third-party billing system “Headway”. If a card is not on file the day prior to your appointment DMV Medical Group reserves the right to cancel your appointment without notice.

Fees:

-Our fee for initial therapy sessions is $300, medication management is $225, Talk therapy is $250, and $375 for medication management and talk therapy sessions.

Please be aware that insurance carriers will not cover cancelation charges. Unless we make another explicit arrangement, you are responsible for filing insurance claims for your visit. I can provide you with a superbill you can provide to your insurance company.

Late Arrivals:

I understand if I arrive 10 minutes late to my appointment I may not be seen, will be subject to a no-show fee, and must reschedule.

Appointment Cancellations:

-Once you have scheduled an appointment, you may cancel it without incurring a charge only if you provide notice at least forty-eight (48) hours in advance at the above phone number. If you do not provide timely notice, you will be charged $225.

No-Shows/cancellations/late arrivals:

-A "no-show" is someone who misses an appointment without canceling it in the proper manner. A failure to be present at the time of the scheduled appointment will be recorded in your medical record as a "no-show". If you are a no-show for your first appointment with our provider(s), you will be charged $300. A credit card or debit card is required prior to your first appointment. Please fill out the credit card information attached to these forms.

-For each no-show, cancelation, or late arrival will be charged $225. All no-show fees must be paid prior to your next appointment.

-If you have two (2) or more "no-shows" you may be discharged from the practice.

Appointment Rescheduling:

We at DMV Medical Group understand that things happen. However, in order for us to adequately serve our clients we have implemented a rescheduling fee of $225 to deter last-minute appointment reschedules (less than 48 hours in advance of your appointment).

Communication Policy

To enhance the security and efficiency of our patient interactions, all communications will be conducted exclusively through your patient portal email/text or via telephone. You are also able to reach us via text message by replying to any message sent you directly from Tebra such as “Please confirm your appointment”.

The patient portal is a user-friendly platform that enables you to:

1. Access your medical records

2. Request appointments

3. Communicate with our healthcare team

4. Receive important updates and test results

This transition to the patient portal is designed to safeguard your personal health information and streamline the communication process. It ensures that all messages are stored securely and allows us to provide you with a more efficient and timely response.

We want to emphasize the importance of leaving a message when you call us. In order for us to provide you with the best care and assistance, you must leave a message. Without a message we will not be able to confirm that you called. Additionally, we may not be able to address your needs effectively and return your call. Be sure not to leave any sensitive information but your name and a brief description of your questions, concerns, or requests.

If you do not have access to the patient portal, please let us know at your earliest convenience. Until you have access, we kindly ask that you refrain from sending communication or requests via any other means, as we will not be able to respond to them outside of the portal.

Your health and well-being are our top priorities, and we believe that this transition will help us provide you with the best care possible. If you have any questions or require assistance in setting up your portal account, please contact our support office at 240-669-7496, via responding to a previous text message from Tebra, and/or email us at info@dmvmedgroup.com.

Thank you for your cooperation and understanding as we make this important change. We look forward to continuing to serve you and provide you with the highest quality of care through our secure patient portal.

Emergencies/ After Hours:

During normal business hours call 240-669-7496, and the receptionist will set up an emergency appointment for you.

-For after-hours emergencies, Call 911 or go to the nearest emergency room

-Call Montgomery County Mobile Crisis Team: 240-777-4000 or in person at 1301 Piccard Drive in Rockville (no appointment needed).

-Call Washington DC Helpline: 1 (888)7WE-HELP or 1-888-793-4357 

Confidentiality:

DMV Medical Group will only release your confidential information if there is:

1. Written consent from the patient

2. An indication that clear and immediate danger exists to self or others

3. A court order directing the release of information

4. Disclosure of sexual abuse, physical abuse, or neglect of a child under the age of 18

5. Information necessary for your insurance carrier to insure that your treatment is medically necessary and appropriate.

Physician Contact

Physical and psychological symptoms often interact with prescribed psychotropic medications. I encourage you to seek medical consultation if warranted. In some cases, it may benefit your treatment for me to speak to your primary care provider, in which case I will ask for your permission first.

Freedom to Withdraw from Treatment

You have the right to end therapy and/or medication management at any time. Please also know that our practice reserves the right to end therapy and/or medication management at any time for failure to multiple missed appointments and/or cancellations and failure to adhere to a treatment plan, etc.

Patient Testimonial/ Review:

By signing this notice, I understand and acknowledge that if I voluntarily share a testimonial/review on the company website about your services, it will be distributed to Kareo, Google, and possibly other social media pages. Any personal information I choose to disclose is not protected. DMV Medical Group, LLC, is not responsible for any personal information being released when distributed voluntarily.

Notice of Privacy Policies:

You have been provided with a copy of our Notice of Private Policies and consent before signing this Acknowledgment You have the right to revoke your consent at any time by notifying us in writing. The revocation will not affect any actions taken prior to the time you revoke it. You have the right to restrict the use of your health care information; however, we are not required to agree to any restrictions. If any restrictions are agreed upon, the agreement is binding on use.

Advance Directive for Medical Health Treatment:

Maryland law states that you have the right to make decisions in advance, including mental health treatment decisions, through a process called an advance directive. An advanced directive can be used to state your treatment choice or can be used to name a healthcare agent, who is someone that will make healthcare decisions for you. Please notify us to provide you with a copy of the Advance Directive for Mental Health Treatment.

Pharmacy:

-We require your pharmacy of choice upon your initial evaluation appointment. If you require a change of pharmacy we will allow a one-tme pharmacy change per year at no additional cost to you. If you require a change of pharmacy more than once per year a fee of $75 will be charged to your card on file.

Prescription Refills: 

-All prescriptions are sent to the pharmacy of your choice by using encrypted technology via the internet. On certain occasions, we can also call in certain prescriptions.

-Schedule and keep the appointments recommended by your provider to keep your medications current. It is your responsibility to attend all scheduled appointments before your medications run out. -If you miss an appointment or run out of medications before your next appointment, contact our office to discuss your medication needs. Medication refills, without an appointment, occur at a minimum charge of $200 and are reviewed on a case-by-case basis.

-Please allow 48 hours for medication refills and prior authorizations. Refills primarily are taken care of at appointments during business hours. Please understand that regular follow-up appointments are very important so that your medical and emotional status can be assessed. Also, appropriate recommendations and education regarding medications are made during follow-up appointments. Failure to attend follow-up appointments as discussed in your treatment plan puts you at risk of not receiving refills of your prescriptions and possible termination from our practice for continued care. 

However, if a refill is needed, please contact us via your patient portal or call us at 240-669-7496 at least 2 days in advance of your prescription ending. If you call, please leave a voicemail for your provider with the following information: Patient name, date of birth, medication name and dose, pharmacy, and pharmacy phone number. Refills are not submitted after hours or during weekends. Understand, it may take as long as 48 hours to complete your refill request.

Controlled Substances: Please understand that beginning April 1, 2023, any evaluation that may result in the prescription of a controlled substance (such as stimulants) will require an in-person initial evaluation. It is also important to understand that we may choose not to prescribe controlled substances during an initial appointment because these medications require the utmost attention to detail. In some cases, we will request your previous treatment records to ensure that we are providing you with the highest quality care. We also utilize a review of the MD, VA, and DC Controlled Substances Database(s) to ensure your safety.

COVID-19 Public Health Emergency Ending Soon!

As you may or may not know as of May 11th, the COVID-19 Public Health Emergency is ending. During the Emergency, some requirements about prescribing controlled substances were temporarily waived, including the Ryan Haight Act of 2008 which places strict regulations on medications prescribed via telehealth appointments.

If you are a patient of DMV Medical Group and live in the state of Maryland who currently has a prescription for a controlled substance medication*, and you have not been seen in person by your provider in the past 6 months, you will need to be seen in person by your provider soon to continue receiving prescription refills for the medication. Those who live in DC and VA will need to continue to be seen in person for ALL controlled substance refills.

Please discuss this new change and schedule an in-person visit during your next appointment with your provider. Failure to comply with these legal requirements by seeing your provider for an in-person visit will preclude your provider’s ability to refill your controlled substance prescription.

We appreciate your understanding as we do our part to comply with the change in legal requirements. Please contact us with any questions or concerns at (240) 669-7496. We are here to support you through the transition. 

*Some common controlled substances include:

• Adderall (amphetamine/dextroamphetamine)

• Ambien (zolpidem)

• Concerta (methylphenidate)

• Focalin (dexmethylphenidate)

• Klonipin (clonazepam)

• Ritalin (methylphenidate)

• Xanax (alprazolam)

• Vyvanse (lisdexamfetamine)

This list is not all-inclusive. If you are not sure whether your medication is a controlled substance, please contact your provider.

Refill Fee: Beginning April 1, 2023, if you request a medication refill and have missed (or no-show) your follow-up appointment this will incur a minimum $200 out-of-pocket refill charge. Only one month of the medication will be called in (or less for controlled substances), and the missed appointment will need to be rescheduled for continuity of care.

Prior Authorization:  Generally, we are automatically notified by your pharmacy when prior authorization is required.  However, there are times prior authorization is required to receive your medication with some policies, at a lower-tier cost.  We strive to submit prior authorization information in a timely manner, as we do not want anyone to be without their medication.  

Typically:

1.  Our office is notified by the pharmacy that prior authorization is needed and we submit the necessary information as per the authorization.

2. Sometimes responses are instant at other times the pharmacy receives approval or denial from the insurance company. If approved, the prescription will be filled.  Please note that while we do our best to help ensure approval, ultimately the decision is up to your insurance company based on your current benefits. 

3. Most pharmacies will send you an automatic message that your medication is ready to pick up, be mailed, etc. or they will let you know if there is an issue with the prescription.  If there is an issue please contact your pharmacy to determine what the issue is, as we are generally not informed, or receive the approval/disapproval information later than the pharmacy.  We will do all that we can to quickly resolve the issue with the pharmacy and or provide education about other medication options.  

4. If the pharmacy notifies you about an authorization needing to be completed, please call our office and we will alert your prescriber, because our office may not have received your request.  We prefer that you contact us through your patient portal.

TIPS:

If you have not heard that your prescribed medication is ready from your pharmacy:

1. Contact your pharmacy to find out more information

2. Please only contact us through your patient portal if the pharmacy has not received the prescription or if authorization is needed or the authorization has not been received.