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(917) 740-5287

PRACTICE POLICIES

Practice Expectations

Our clinicians try to be as flexible as they can in meeting you where you are at, and we do not dictate the treatment to you. We will work with you on your goals, working within your preferences for treatment strategy and frequency.
 
We want to be considerate of your time and money, while we also balance our need to provide high-quality care and monitoring. There are regular timeframes within which your clinician would want to see you, and that may change throughout the course of your treatment. Being a part of our community involves mutual investment in your health that includes timeliness, communication, and respectful interactions.

Rescheduled or Missed Sessions

Appointments must be cancelled or rescheduled with at least 48-hour notice, or you will be responsible for the FULL FEE of the appointment, regardless of the need for cancellation or lateness. You are paying for reserving the time of your scheduled sessions, regardless of whether you attend or not. Two missed, late cancelled, or late rescheduled appointments, even when paid in full, are grounds for discussing discharge from our practice. 

Financial Responsibility

Our session fees vary depending on the type of service and clinician whom you are seeing. Although we will be discussing session fees over the initial phone call, please see our website for a summary of our different rates.
 
Our session fees cover your scheduled session, clinician preparation and post-session documentation of visits, and brief communications with your or other members of your treatment team.
 
For other time spent outside of your session, you are charged ADDITIONAL fees (billed rounded to 15-minute increments proportionate to your session time and fee). This typically includes, but isn’t limited to: extended phone calls, special document work, intensive record review, and medication refills (requested outside of sessions/due to missed session).
By putting down the person that you note as the billing contact on this form, you and the billing contact are acknowledging that they are financially responsible for session fees. You are also acknowledging that the billing contact is aware in advance of any charges made to the billing contact’s credit/debit card.

Billing Procedures

We require a credit card or debit card to be on file that will be used to charge appointments, including missed appointments and late cancellations, or when additional services are provided.
 
The card on file will be charged on the day of your scheduled session, typically prior to your session. If your credit/debit card on file does not go through, we will reach out to you directly to get different card information. All sessions must be paid for on the day of the session.
 
If you have an outstanding balance, you may not schedule/attend sessions, unless you have spoken to our office about any financial accommodations.
 
To change your card information, please reach out to our office at 917-740-5287 or office@graymattersmd.com. 

Medication Policy

Medication refills should be requested during appointments. If your clinician has let you know that you do NOT need to make an appointment for a refill at this time, we still require a notice of at least 2 business days to send your refill.
 
Controlled medications, such as adderall or klonopin, are closely regulated, and we MUST be aware if you are receiving any controlled meds from any other clinician. Medications should only be taken as prescribed, and early refills are not possible. Any deviation from this could result in discharge from the practice. 
 
We do not take any refill requests from pharmacies, so please contact your clinician directly for refills. Pharmacies contact us constantly with requests that patients have not made so we communicate only with you about your refill. 
 
When you do pick up medication from your pharmacy, please ensure you are picking up the correct dose as the pharmacies sometimes will have older prescriptions from us on file and will “auto-refill” rather than giving you the most up-to-date prescription. 
 
Sometimes your insurance company may require prior authorizations for your medications, which may delay you receiving your medication. We will assist you, but we also ask that you help us by calling your insurance company or by filling out paperwork to help expedite your medication. 

Psychiatric Nurses

If availability exists and if you are interested, you may have the opportunity for a lower fee option by working with one of our psychiatric registered nurses, who are extensively supervised and guided by our clinicians. Psychiatric nurses are currently board-certified registered nurses obtaining clinical experience for completing their degree to become nurse practitioners and are not yet licensed prescribing clinicians.

When working with a nurse, all treatment recommendations/medications will be discussed with and approved by the supervising NP or MD. Working with a nurse is optional, and you are under no obligation to work with a nurse. However, if you do choose to work with a nurse, please note that your care may need to be transferred to a different nurse or clinician, as the nurses’ availability is dependent upon policies set by their program director outside of this practice. In general, we work with the same nurses for one full school year, so most clients who meet with nurses transfer their care to someone else once a year at the end of the school year.

Emergency Services

Our clinicians are not able to be available 24/7. If you are in crisis and need immediate assistance, please call 911 or go to your nearest emergency room. After you have done this, please also contact our main office AND your clinician so that we can get back to you as soon as we are able.
 
On the Resources page of our website, we have included some outside crisis resources and hotlines that may be available 24/7.
On occasion, our clinicians may be able to reply to texts/emails/phone calls outside of typical office hours (Monday-Friday 10:00am-5:00pm EST) or their individual specific hours (ask your clinician or the office for these hours), but this is not always the case. Their response outside of these hours cannot be relied upon, especially in the event of emergencies.

Insurance

We are an out-of-network provider, which means we don’t take health insurance and you are responsible for paying your fees upfront and in full before your sessions. We don’t work with insurance directly as it would entail red tape and bureaucracy that would limit our ability to meet our standards of care.
 
However, you could still receive reimbursements and/or other benefits because some insurance plans still include out-of-network benefits. We encourage you to find out what your out-of-network benefits are so that we can help you make informed decisions about your treatment plan.
 
After you have paid your fee in full for a session, you can expect a statement/superbill from us within 7 days after your scheduled session – oftentimes, we will send it to you the day after your session! We want to send you these documents as soon as possible so that you can get reimbursed as soon as possible. If you would rather receive statements monthly instead of for every individual session, please reach out to us at 917-740-5287 or office@graymattersmd.com.
 
For each claim to your insurance, you will need a completed claim form as well as the statement(s) with the date(s) of service you are submitting for. Please keep in mind that you are responsible for submitting your claims to insurance so that you can be reimbursed directly. It can be a little confusing at first so if you need any help with how to submit claims, please let our office know.

Opt-in Communication

You will get emails that are automatically sent to you through our scheduling system as appointment confirmations, appointment reminders, and rescheduling/cancellation confirmations. You can opt out of these emails, but please note that if you choose to opt out of these emails, you will no longer receive emails that can be helpful in keeping track of your appointments.
 
You will also receive email newsletters and updates via Mailchimp, for the express purpose of facilitating communication of information that may be of interest. If you would not like your information to be shared with Mailchimp for email newsletters and updates, please let the office know by emailing office@graymattersmd.com. You can choose to unsubscribe at any point, but you will no longer receive emails that will keep you informed about what’s going on at the practice.

Secure Communication

The most secure ways to communicate electronically with your clinician and the office is through the following secure platforms:
 
•Spruce messaging app (upon request, you can receive an invite for this platform once you have been accepted into the practice as a client);
•Video chat using Google Meet;
•Shared cloud folder (for sending/sharing documents – please request).
 
You may choose to communicate electronically with graymatters through the following non-secure platforms:
 
•Texting;
•Email;
•Fax;
•Video chat using Skype, FaceTime, WhatsApp, and other platforms that are not Google Meet.
 
Please note that while texting, email, and faxes are secure and/or encrypted on our end, these forms of communication may not be secure on your end. Skype and FaceTime are not secure methods of video chat for both the sender and receiver, which is why the practice prefers to use Google Meet. Please understand the risks that come with choosing to communicate via text, email, fax, or non-secure video chat.
Communication via the above non-secure platforms may be used for administrative reasons, such as scheduling or billing. If you have personal topics you would like to discuss with your clinician, this should be done so via email or in your next session with them.
 
For any form of electronic communication that you choose, you are consenting to electronic communication with the understanding that the security of information delivered using technology carries risks to confidentiality, privacy, and security. During the course of your treatment, you may choose to communicate through these methods for your convenience; however, the only forms of communication that would be encrypted for both the sender and the receiver would be via Spruce, Google Meet, and a shared cloud folder.
If you need to send documents to your clinician, you may do so via secure fax or secure email. Our fax number is (888) 396-3996. If you wish to use secure email, please let your clinician know so that they can initiate a secure email thread.
If you do not wish to receive/send communication via the above non-secure methods, you can fill out the rest of this form but you must call (917) 740-5287 to notify us that you are choosing to opt-out of the above non-secure methods. If you do not call us to notify us, we may not be aware of your request. If you opt-in to non-secure methods now but decide at a later point that you no longer wish to receive/send communication via the above non-secure methods, please call (917) 740-5287.

Termination Guidelines

Your work with us can range from time limited or short-term to long-term work. You are always free to conclude your treatment at any point and for any reason. There may also be times when our practice chooses to conclude treatment, with some of the reasons being:

•A client having met goals as indicated by the client’s treatment plan and not actively working on any other goals with their clinician.

•The initial treatment plan decided upon by the clinician and client was time limited and has concluded.

•A client failing to communicate with staff about an overdue balance even after attempts from the practice to open a dialogue about it.

•A client not responding to the clinician and/or the practice and not scheduling sessions.

•Even though your treatment plan is collaborative, a client not being able or willing to work with clinician in recommended treatment options in a way that we believe could be potentially harmful.

•The clinician feeling that the client and clinician are not a good fit.

•The client being unable, for any reason, to meet the expectations outlined in our practice policies.

HIPAA Compliance Privacy Notice

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Your Rights

You have the right to:
•Get a copy of your paper or electronic medical record.
•Correct your paper or electronic medical record.
•Request confidential communication.
•Ask us to limit the information we share.
•Get a list of those with whom we have shared your information.
•Get a copy of this Privacy Notice.
•Choose someone to act on your behalf.
•File a complaint if you believe your privacy rights have been violated.

Your Choices
You have some choices in the way we use and share information, if we:
•Tell family and friends about your condition.
•Share information in a disaster relief situation.
•Share information for marketing, sales, or fundraising purposes.

Our Uses and Disclosures
We may use and share your information as we:
•Treat you.
•Run our organization.
•Bill for your services.
•Help with public health and safety issues.
•Perform research.
•Comply with the law.
•Address workers’ compensation, law enforcement, and other government requests.
•Respond to lawsuits and legal actions.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your paper or electronic medical record.
•You can ask to see or receive a paper or electronic copy of your medical record and other health information we have about you. Ask us how to do this.
•We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Correct your paper or electronic medical record.
•You can ask us to correct your health information that you think is correct or incomplete. Ask us how to do this.
•We may deny your request, but we will tell you why in writing within 60 days.

Request confidential communication.
•You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
•We will agree to all reasonable requests.

Ask us to limit the information we share.
•You can ask us not to use or share certain parts of your health information for treatment, payment, or our operations.
•We are not required to agree to your request, and we may deny it if it would affect your care.
•If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree to your request, unless a law requires us to share that information.

Get a list of those with whom we have shared your information.
•You can ask for a list (”accounting”) of the times we have shared your health information for six years prior to the date you ask, with whom we shared this information, and why.
•We will include all the disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you requested us to make). We will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you request another within 12 months.

Get a copy of this Privacy Notice.
•You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act on your behalf.
•If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
•We will make sure the person has this authority and can act on your behalf before we take any action.

File a complaint if you believe your privacy rights have been violated.
•You can complain if you feel we have violated your rights by contacting us.
•You can file a complaint with the US Department of Health and Human Services Office for Civil Rights by sending a letter 200 Independence Avenue SW, Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
•We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:
•Share information with your family, close friends, or others involved in your care.
•Share information in a disaster relief situation.

In these cases, we never share your information unless you give us written permission:
•Marketing purposes.
•Sale of your information.
•Most sharing of psychotherapy notes.

Our Uses and Disclosures

How do we typically use or share your health information?

To treat you.
•We can use and share your health information with other professionals who are treating you.

To run our organization.
•We can use and share your health information to run our practice or improve your care, and contact you when necessary.

To bill for services.
•We can use and share your health information to bill and get payment from health plans or other entities.

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually to contribute to the public good, such as public health and research. We have to meet many legal conditions before we can share your information for these purposes. For more information, visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

To help with public health and safety issues.
•Preventing disease.
•Helping with product recalls.
•Reporting adverse reactions to medications.
•Reporting or suspecting abuse, neglect, or domestic violence.
•Preventing or reducing a serious threat to anyone’s health or safety.

To perform research.
•We can use your share your information for health records.

To comply with the law.
•We will share information about you if state or federal laws require it, including the Department of Health and Human Services, if it needs to confirm that we are complying with federal privacy law.

To address workers’ compensation, law enforcement, and other government requests.
•For workers’ compensation claims.
•For law enforcement purposes or with a law enforcement official.
•With health oversight agencies for activities authorized by law.
•For special government functions, such as military, national security, and presidential protective services.

To respond to lawsuits and legal actions.
•We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

•We are required by law to maintain the privacy and security of your protected health information.
•We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
•We must follow the duties and privacy practices detailed in this notice and give you a copy of it.
•We will not use or share your information other than as describd here, unless you give us written permission. If you give us permission, you may change your mind at any time. Let us know in writing if you change your mind. For more information, visit
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our website.