Payment is due at each appointment. I do not currently accept insurance but am able to produce (paid) receipts which you submit to your insurance carrier for reimbursement. Late fees will accrue at a rate of $10 per month. Outside collections will be considered as a means of resolving all account balances with no payment activity after 90 days. It is the expectation we will complete all needed pre authorizations or paperwork together during office visits. If there is an urgent need for paperwork or pre-authorizations outside of an office visit with you, there will be fee of $50-$200 to be paid via electronic invoice prior to these commencement of services.
If a change to treatment is necessary, you will need to schedule an office visit by calling my office during normal business hours at (512) 687-3426. All questions ( e.g. medications) should be addressed during appointments so that I may have access to your patient file.
Cancellations and Missed Appointments
Please call to cancel or reschedule appointments at least two business days in advance. Appointments missed or cancelled less than 2 business day in advance will be billed at the full fee. PLEASE NOTE: Insurance Companies will NOT pay for missed visits.
All refills will be issued during your office visit. I do not, as a rule, phone or fax prescriptions. Please plan accordingly and call the office at (512) 687-3426 to come to an appointment before you run out of medication -generally the office will be able to schedule you within 3 to 4 days. Due to medical practice standards, if you are active patient, office visits will be required (at least) quarterly. Controlled substances (such as stimulants) require a paper prescription or electronic submission. Federal and state databases reporting controlled substance prescriptions are routinely monitored.
For established patients currently in treatment and needing to contact me urgently, you may reach me at the office (512) 687-3426 or by cell phone at 512-422-3565. Please note that I will not answer the phone when I am with a patient but will return your call as soon as possible. When leaving a message please include and repeat your full name and your phone number if you wish to be called back. Emergency calls are subject to emergency fees. In the event of a psychiatric or medical emergency, please call 911 or go to the nearest emergency department.
As more individuals utilize electronic communication methods it is important to realize diagnosis or treatment via email or text is not appropriate. These methods of communication are not secure. If you have a simple question of a general nature, which does not include private information, you may use my email at rmcinty,firstname.lastname@example.org. Please do not text me. More complex questions can only be considered during appointments.
I have read and agree to the above office policies
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application and the undersigned is also financially responsible for fees.