Policies & Fees For Current
& Prospective Patients
Like every medical practice, we have policies that we ask our patients to follow and charges for many of the tasks we complete outside of a visit. These policies insure that we can be efficient in the delivery of psychiatric care and that we can keep the practice going. They serve to enable more patients to receive treatment. They also insure that our patients are seen promptly at their appointments. These policies also allow us to minimize the wait time for the many prospective patients currently on our waiting list. Last but not least, these policies enable us to stay in business.
The underlying foundation for our practice policies is simple: you must make your treatment a priority and be personally responsible for keeping your appointments, coming to those appointments on time, and promptly paying your charges AT EACH APPOINTMENT. If you do not make your treatment a priority, then you won't get better. If you are not personally responsible, then we cannot afford to treat you! Also, we are asked to perform other tasks outside of visits as discussed below. Insurance reimbursement has remained relatively static over the past 20 years. Frankly, we just can't afford to continue taking the financial hit any longer.
The following issues demonstrate whether or not your treatment is a priority for you and whether or not you are personally responsible. For the majority of our patients who come to their appointments on time and pay their copays and other charges on time, none of what follows will ever apply to them.
Arriving On Time for Your Appointments
Patients cheat themselves out of their full time with Dr. Kline when they arrive late for their appointments. Unlike the vast majority of medical practices, we actually do a pretty good job of staying on time. If you arrives late, your appointment will be shorter. If you arrive 20 minutes late for a 20 minute appointment, you will not be seen and will be charged for a No Show. We don't think it is fair for the next patient to wait because the patient before him arrived late. Patients with repeated late arrivals will be grounds for dismissal from the practice.
The reason that our patients seldom wait more than a couple of minutes to be seen is because we don't overbook. Other doctors overbook in part to compensate for the loss of revenue that results from Late Cancellations (cancellations less than 24 business hours before the appointment) and No Shows. We, in fact, hope you will arrive a few minutes early for your appointment. That way you can get a cup of coffee or a bottled water, pay your copay and other charges, and still get your full time with Dr. Kline. When you schedule an appointment, we expect you to show for it. Showing up is never optional.
The overhaul of the coding procedure system by which we bill insurance companies has brought with it a three-fold increase in the complexity and amount of documentation needed for office visits. For this reason, it is imperative that you arrive on time for your visits. Otherwise, most of your time will be spent answering questions and watching Dr. Kline feverishly filling out the notes of your visit! So, please come on time.
No Shows and Late-Cancellaltions
When you schedule an appointment, you are responsible for coming to that appointment. To Late Cancel an appointment, you should notify us 24 business hours prior to that appointment. We are closed on Monday, Thursday, and Friday. To cancel a Tuesday morning appointment, you should notify us on the Thursday before.
If you Late-Cancel an appointment, and we can fill that appointment, we will charge you nothing. If we are unable to fill that appointment or if you No Show, we will charge you the full fee for that appointment. This has always been the practice in Cincinnati, and those psychiatrists don’t try to fill the cancelled appointment. We do. If you Late-Cancel or No Show several times, then we cannot afford to keep seeing you and will close your case.
Along those same lines, we occasionally have a patient who decides "I feel fine. I'll just cancel my appointment." That is NOT okay. Dr. Kline schedules appointments based on what is an appropriate time interval between visits based on multiple factors such as did you just start a new medication, the number of overwhelming stressors in your life and your demonstrated ability to cope with them, and the natural history of your disorders. The bottom line is if you are going to make your own medical decisions, then you don't need us, and we will simply discharge you from the practice.
NOTE: Cancelling an appointment within the 24 hour period preceding the appointment is considered a Late Cancellation. The later you cancel an appointment, the greater chance that appointment will go unfilled and thereby result in the full charge for the appointment.
Refills Between Scheduled Appointments
We charge $12.00 for refills of medications between visits if you pick up the prescription from the office and $15.00 if we mail it to you or call it in to a pharmacy. Refill requests after-hours or on weekends will result in a charge of $25.00. We NEVER refill controlled medications early, after-hours, or on weekends.
There is absolutely NO medical reason for prior authorizations of medications or visits. They are just insurance companies’ attempts to spend as little of your premium as possible so they can maximize their profits. The fee for prior authorizations is $12.00 each.
Disability Forms and Letters
Dr. Kline does NOT complete disability forms but rather sends progress notes. Letters are completed over the weekend and incur a substantial charge ($20.00 per each 5 minutes of preparation time with a minimum charge of $20.00 plus an additional $8.00 for staff time). The total charge is payable in full when you pickup the paperwork or letter or before we fax or mail it.
Alcohol and Drugs; Medication Misuse, Diversion or Abuse
Illicit drugs and alcohol usually worsen symptoms of any psychiatric disorder. If you use alcohol or other drugs while on controlled medications, you might die. House Bill 1 has mandated increased monitoring of patients prescribed controlled medications for which we will charge you $8.00 each quarter to defray the costs of obtaining KASPERS and reviewing them and any Tox Screens that have been ordered. These patients will be subject to random drug tests, pill counts, and KASPERs.
This practice has a zero tolerance policy for medication misuse, diversion, abuse, sale, or concurrent use of substances of abuse while taking controlled medications. Evidence of any of the above activities will result in immediate dismissal from our practice.
The following will result in discontinuation of all controlled medications and/or termination of services:
· Failure to comply with monitoring or failure to obtain required drug screens;
· Jumping from pharmacy to pharmacy;
· Repeatedly filling those prescriptions early or requesting early refills;
· Any evidence that you are misusing, abusing, selling, or not taking the controlled medication;
· Evidence that you are using illicit drugs;
· Going to another physician to obtain prescriptions for the same controlled medication; OR
· Failure to pay monitoring charge when due.
What You Should Know About Anxiety
Anxiety is a normal part of life. We all experience anxiety, and no one can escape occasional periods of anxiety. Anxiety always increases when we encounter stressful life situations. In healthy adults, anxiety is a signal that we much change something that will reduce the anxiety that we experience. If an individual cannot cope with anxiety, then intensive psychotherapy is required, because that individual has inadequate coping mechanisms. Psychotherapy can bolster an individual’s resilience to and successful response to stress.
Antianxiety medication is indicated for specific diagnoses such as Panic Disorder, Generalized Anxiety Disorder, and Post Traumatic Stress Disorder. Anxiety due to inadequate coping mechanisms is better treated by intensive psychotherapy. The use of controlled antianxiety agents is NOT the most appropriate treatment of anxiety that results from inadequate coping mechanisms or poor choices in life!
It is inappropriate to expect to feel calm every moment of the day. Moreover, with the increase in substance abuse of prescribed medications, red flags go up when you keep asking for increases in your Klonopin, Ativan, Valium or Xanax. House Bill 1 has sharpened every physician’s suspiciousness of such patients, mandated increased monitoring, and threatened physicians with sanctions if they continue to prescribe to patients they suspect of misuse or abuse or other illegal activities.
“High Maintenance Patients”
These are patients who move from one crisis to another, or who have frequent requests for additional service such as early refills, cancelling or rescheduling of appointments, or endless requests for completion of disability forms.
Recurrent crises suggest inadequate or self-defeating coping mechanisms that require concurrent intensive psychotherapy – NOT recurrent increases in antianxiety medication. Patients who require more effort often can be accommodated in this practice, but only if they are in psychotherapy. We do not believe in “magic bullet” treatment (treatment that relies soley on antianxiety medication for anxiety in patients with inadequate or self-defeating coping mechanisms).
Emergencies and After-Hours Calls
Serious suicidal thoughts, drug reactions that causes your face or throat to swell, your neck to twist, or that causes you to be short of breath are life-threatening emergencies. Call 911 or have someone take you to an E.R. immediately. If a medication gives you a rash, stop taking it and call the next business day. Only use the Emergency Line for serious concerns that cannot wait until the next business day. After-hours calls for refills and non-emergent issues will result in a charge of $25.00 per call.
Calling the Office
If you call and leave a message with staff or on voicemail, Dr. Kline will call you back within one business day. Please do not call back that day to see if Dr. Kline received your message. He has. Dr. Kline makes return calls as late as 7 PM. Calls received after 3 pm will be returned on that day only as time allows with the most serious having top priority. All other calls received after 3 pm will be returned on the following business day. The office is closed on Monday, Tuesday, Friday, Saturday and Sunday.
Deductibles, Copays, and Outstanding Balances
Please pay your copays and other charges at each visit. We cannot afford to carry balances, especially as we are reducing office hours. Plan ahead and expect to pay the full fee for your visit if your deductible has not been met, especially during the first few months of each year when deductibles are in force.
If you receive a statement from us, please pay off the balance due before the end of that month if you wish to remain a patient in this practice. If you need a little more time, please call and discuss your temporary situation with us. If you do not pay off your balance in full, we will assume that you no longer wish to remain a patient in this practice UNLESS you call to discuss your temporary situation.
If you cannot afford to pay your copays, deductibles, and other charges, then you cannot afford private psychiatric treatment, and you will be referred to Catholic Charities or NorthKey. We simply cannot afford to treat patients who cannot or do not pay the copays and additional charges required for their treatment.
Medications and Pregnancy
Because some medications can produce congenital anomalies (birth defects) and other unwanted effects in the developing fetus or newborn infant, it is important to use an effective form of birth control while taking psychiatric medications. The “pill” is the most effective. Abstinence is the least. If you would like to become pregnant, please inform Dr. Kline and your OB/GYN BEFORE you begin trying. If you discontinue your birth control measure, contact Dr. Kline immediately
Antipsychotics are powerful medications that can cause a variety of potentially serious side effects. Always inform Dr. Kline if you begin to experience any abnormal movement while on these medications (Risperdal, Geodon, Abilify, Seroquel, Zyprexa, to name a few). Fortunately, such side effects are relatively rare in the antipsychotics used in this practice. Of more frequent concern is weight gain. Always report weight gain associated with the use of these or any other psychiatric medications.
The Bottom Line
We cannot treat everyone. Some patients simply need a psychiatrist that hospitalizes patients frequently. “High-maintenance patients” such as those requiring frequent telephone calls, those who are in frequent crisis, and those who frequently cancel appointments cannot be accommodated in a private practice setting unless they are engaged also in psychotherapy.
Likewise, we must be able to afford to treat you. Patients delinquent in paying for services will not continue to receive services in this practice. These policies are essential. Not enforcing them would jeopardize our practice and our ability to continue providing our other patients with the highest quality outpatient psychiatric care available in Northern Kentucky and the surrounding counties.
So, who can we treat? The answer is simple. We look forward to treating responsible, motivated adults who come to their scheduled appointments, rarely cancel appointments, take their medication appropriately, and who typically pay their fees and additional charges promptly. Most of our patients easily fulfill these criteria. We appreciate them and thank them for choosing this practice for their psychiatric care.
Summary of Additional Fees
Late Cancellation, Short Visit, Unfilled $100.00
Late Cancellation, Long Visit, Unfilled $135.00
No Show, Short Visit $115.00
No Show, Long Visit $150.00
Refills between appointments, Picked Up $ 12.00
Refills between appointments, Mailed $ 12.00
Refills between appointments, Called in $ 15.00
Prior Authorizations $ 12.00
Form Completion, Proofing and Faxing Records $ 12.00 + copay
Letters (Composition) $ 20.00 ea 5 min prep time
Letters (Admin Fee) $ 8.00
House Bill 1 Controlled Medication Monitoring Fee $ 8.00 (Due Quarterly)
If any of these policies don't make sense to you, we encourage
you to discuss them with us at your next visit!
* * * Please Note: We are no longer accepting patients with
Medicaid, Medicare, Aetna, UHC/UMR, or Suboxone patients. * * *