About Roundtree Mental Health Group
Communication Policy
In order to communicate securely with our practice, you must download the Spruce app on your phone. Here is the spruce app link: https://spruce.care/roundtreemhg
This allows us to keep your medical information private and allows you to communicate with us easily – just send us a text through the app! This is the best method to send a message to your provider such as medication questions/concerns, appointment questions, or refill request!
In case of an emergency, you can access emergency assistance by calling the National Suicide Prevention Lifeline at 1-800-273-8255. Text HOME to 741741 from anywhere in the United States, anytime, about any type of crisis. Crisis Text Line serves anyone, in any type of crisis, providing access to free, 24/7 support and information via a medium people already use and trust: text. If either you or someone else is in danger of being harmed, dial 911 or go to your nearest emergency room.
No Show & Cancellation Policy
When you cancel or reschedule less than 48 hrs prior to your appointment, or do not show up for your appointment, you prevent someone else from seeking treatment. As a small practice, we can’t stay in business and provide care to our community, if patients repetitively reschedule at the last minute, or continuously cancel appointments. We hope that you understand why we have to put this policy in place. Multiple reminders, in different modalities (text/email), are sent to you to remind you of your upcoming appointment. If you must cancel or reschedule an appointment, we require at least 48-hour notice (weekends not included). If your appointment is on a Monday, the cancellation must be made by the same hour on the preceding Friday. We do offer video/online appointments. If you do not show up to your appointment, you will not get any refills until you see your provider.
In ONE calendar year – after the second less than 48-hour cancellation, less than 48-hour reschedule, or failure to show up to an appointment you will be placed on a waiting list. You will not be able to self-schedule for three visits. Within one calendar year – THREE (3) – less than 48 hr cancellations, less than 48 hr rescheduling of your appointment, or failure to show up to your appointment will be grounds for dismissal from the practice with a referral to another practitioner.
If you need to cancel an appointment for any reason, you must do so at least 48 hours in advance. To cancel your appointment, utilize the Spruce App or call/text our office at 931-288-4619 during our normal business hours (Tuesday through Friday, 9am-5pm). Not confirming an appointment reminder does not constitute canceling an appointment. If you do not reach the receptionist, please leave a message on our voicemail stating who the appointment is for, the date and time of the appointment, and that you would like to cancel. We will return your call to reschedule your appointment.
Refill Requests & Policies
Refill requests outside of scheduled appointments will be handled during regular business hours (9am-5pm CST) and require 48 business hours notice.
Request must include: NAME/DOB/MEDICATION & DOSAGE. Please submit only one request for medication refills within 48 hours to your SPRUCE PATIENT PORTAL.
If you haven’t already connected, connect here now: https://spruce.care/roundtreemhg
Messages without a pharmacy included will default to the most recent pharmacy used on file. If you include a new pharmacy, it must be the full address with zip code.
Often times you have refills on file at the pharmacy, please check your bottle to see if there are remaining refills on the label and request a refill from the pharmacy before requesting more medications.
Medication refills are generally addressed at each scheduled appointment. Refills on any medication outside of scheduled appointments will be prescribed at the discretion of the provider. The provider may refuse to prescribe a refill after a rescheduled or missed appointment. Please plan ahead for upcoming vacations or out of town trips so you do not run out of medications. We will always provide refills (as appropriate) so please don’t hesitate to reach out! We do not want you to run out of medications!
Controlled Substance Policy
The safety and care of our clients is our number one priority! Controlled substances are prescribed sparingly in this practice in an effort to keep you safe. They are also highly regulated by the Drug Enforcement Agency (DEA). Our prescribing of such medications is monitored, and providers are held accountable for prescribing practices. State laws require that additional measures be taken when prescribing controlled substances. We do not prescribe long term use of benzodiazepines. We do not prescribe multiple controlled substances together, or to anyone taking more than one controlled substance. Use of stimulant medications will be considered after a thorough evaluation and at the sole discretion of the provider, and there is no guarantee that our providers will continue a current medication or offer refills. We do not offer MAT/Suboxone/Subutex/Methadone/opiates.
It is the expectation of this practice that the controlled medication will be taken as prescribed and not self-adjusted. This means you will not increase or decrease your dose or stop taking it without talking to your prescribing provider. Self-adjusting prescribed psychiatric medications can be dangerous and can lead to seizures and/or death. Mixing these controlled medications with other substances such as alcohol, narcotics (pain pills), muscle relaxers, or other controlled substances can also lead to death. Self-adjusting controlled substances will be considered non-compliance. This type of non-compliance will result in discharge from our practice, as it places a huge liability on our ability to safely manage your care. If you come to our practice already on controlled substances from another provider, that does not mean that we will automatically assume these same or even similar medications. Our providers reserve the right to complete their own assessment and make treatment recommendations based on their professional judgment. Our practice does not prescribe exceedingly high doses of controlled substances and we are not obliged to assume such from other providers. If it is felt that such a medication could benefit you, you will be tapered down to a dose that is considered safe or placed on another alternative medication that may not be a controlled substance. Patients with stimulant prescriptions may be subjected to routine vitals/EKG/drug testing.
Telehealth Policy
When we provide phone/video appointments, a link for our secure and HIPAA-compliant platform will be emailed to you an hour before the scheduled appointment time. We expect that you are available at our scheduled time and are prepared, focused, and engaged in the session. You also need to be in a private location where you can speak openly without being overheard or interrupted by others to protect your own confidentiality. If you choose to be in a place where there are people or others who can hear you, we cannot be responsible for protecting your confidentiality. Please login at the time of your appointment and wait for your provider to join. We strive to maintain our schedule as closely as possible. However, as a medical office, unexpected emergencies can occur, which may occasionally cause telehealth appointments to start later than planned. We sincerely appreciate your patience and understanding in these situations. Telehealth services, much like traditional medical offices, require a structured process to ensure that each patient receives the appropriate care and attention. The virtual waiting room functions similarly to a physical waiting room in a medical office. It serves as a transitional space where patients can prepare for their consultation while the healthcare provider finishes with previous appointments or reviews the patient’s medical history. Therefore, while telehealth offers the convenience of remote access, it still requires patients to wait, ensuring that the quality and thoroughness of care are maintained.
Every effort MUST be made on your part to protect your own confidentiality. We suggest you wear a headset to increase confidentiality and also increase the sound quality of our sessions. Please know that we cannot guarantee the privacy or confidentiality of conversations held via phone, as phone conversations can be intercepted either accidentally or intentionally. Please assure you reduce all possibilities of interruptions for the duration of our scheduled appointment. Please know that per best practices and ethical guidelines, we can only practice in the state(s) we are licensed. That means wherever you permanently reside we must be licensed. You agree to inform us if your location has changed or if you have relocated your domicile to a different jurisdiction.
If we lose our connection during a video session, we will call you to troubleshoot the reason we lost connection. If we cannot reach you, we will remain available to you during the entire course of our scheduled session. Should you contact us back and there is time left in your session we will continue. If the reason for a connection loss i.e. technology, battery dying, bad reception, etc. occurs on your part, you will still be charged for the entire session. If the loss of connection is a result of something on our end, we can either complete our session via. alternative method, phone, or plan an alternate time to complete the remaining minutes of our session.
Benefits of Telehealth
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The ability to expand your choice of service provider.
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More convenient counseling options including location, time, no driving, etc.
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Reduces the overall cost and time of therapy due to not having to drive to and from an office.
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Ability to have real-time monitoring and reduces the wait time for scheduling office appointments.
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Increased availability of services to homebound clients. clients with limited mobility, and clients without convenient transportation options.
Limitations of Telehealth
It is important to note that there are limitations to Telehealth that can affect the quality of the session(s). These limitations include but are not limited to the following:
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Due to technology limitations we may not hear all of what you are saying and may need to ask you to repeat things.
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Technology might fail before or during the telehealth session. Our second line of communication will be via telephone.
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Although every effort is made to reduce confidentiality breaches, breaches may occur for various reasons.
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To reduce the effect of these limitations, we may ask you to describe how you are feeling, thinking, and/or acting in more detail than we would during a face-to-face session. You may also feel that you need to describe your feelings, thoughts, and/or actions in more detail than you would during a face-to-face session.
Payment Policy
The card on file will be used to pay for co-pays, co-insurances, no-show fees, and any other balances due on the client’s account. There will not always be an invoice sent out prior to the card being charged. If the invoice sent to me prior to my appointment is not paid 24-hrs before my appointment, we will charge the amount due to your credit card on file. If there is a balance due after insurance pays for the visit, the credit card on file will be charged for that balance without prior notification. Balance due would be considered the patient responsibility noted on your Explanation of Benefits from your insurance company. All co-payments and deductibles must be paid at the time of service.
Insurance:
If you are insured by a plan we do business with, knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage. If you are not insured by an insurance plan we do business with, payment in full is expected at each visit.
Here is some basic information:
It is up to the patient using the insurance to have an understanding of the type of plan they have signed up for. We do not set the prices, your insurance tells us what to charge you when we log in to verify your benefits before your appointment.
Deductible:
The amount of money a patient pays before their insurance company begins to cover expenses. For example, if a plan has an annual deductible of $4,000, the patient would pay 100% of covered services until they reach that amount. Some plans waive their deductible amount for mental health services. You will be responsible for the entire amount of the visit that your insurance has set the price for until you hit your max out of pocket/deductible. For example, if you have a $1000 deductible, and your insurance charges you $200 for an intake appointment, you pay $200 and now your deductible is balanced at $800. This continues until you “pay it off.” This is subject to change depending on other doctor visits and other claims that process before ours gets processed. This is why all of our price quotes are done before the appointment and are ESTIMATES ONLY.
Copay:
A flat fee paid for certain services, such as doctor visits or prescriptions.
Coinsurance:
The percentage of the bill a patient pays after meeting their deductible. For example, if a plan has 50% coinsurance, the patient would pay 50% of the cost of a covered service, and their insurance company would pay the remaining 50%.
Most insurances have a patient portal you can log into and take a look at your mental health benefits. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. Please send us a picture of the front and back of your insurance card to 931-288-4619 or utilize our spruce app: https://spruce.care/roundtreemhg
Medical offices are legally required to collect these payments as part of the insurance agreement. Waiving or not collecting deductibles, copays, or co-insurance can be considered insurance fraud, as it violates the terms of the insurance contract and can lead to legal consequences for both the provider and the patient. By adhering to these requirements, medical offices ensure compliance with insurance policies and help maintain the integrity of the healthcare system. It’s important for patients to understand these terms to manage their healthcare expenses effectively.
It is your responsibility to:
You are responsible for all services rendered. If for any reason your insurance does not pay, the balance is your responsibility.
Charges will never be more than the amount you authorized at the time of service. If the amount you authorized does not cover the amount due, a statement will be emailed to you for the remaining amount.
If the insurance company denies your claim, stating you are not eligible or your coverage has terminated, your credit/debit card that was authorized at the time of service will be charged for the authorized amount. If you have new insurance, we will file your claim to your new insurance company. However, no refunds will be issued until payment is received by the insurance company. In the case of unpaid bills, a collection agency will be chosen to manage delinquent accounts. Once referred to collections, no assistance will be provided by our office. If your account is placed with a collection agency, you will be responsible for all collections and attorney fees necessary to collect this debt.
While we strive to verify insurance details, the information provided by the insurance company may not always accurately reflect your policy and coverage. It is important for patients to understand their plan and coverage.
To help determine your benefits for psychiatry services, we recommend asking your insurance provider the following questions regarding your benefits for psychiatry services:
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Health care providers need to give patients who don’t have insurance or who are not using insurance, an estimate of the bill for medical items and services. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For more information, please go to https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance
Privacy Policy
Notice of Privacy Practices
EFFECTIVE DATE: March 1, 2024
WHEN IT COMES TO YOUR HEALTH INFORMATION, YOU HAVE CERTAIN RIGHTS. THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Each time you receive health care services from Roundtree Mental Health Group a record of your treatment is made. This record contains demographic information about your mental health symptoms, examinations, test results, medications you take, and the plan for your care. It is an essential part of the healthcare we provide for you. Your health record contains personal health information (“PHI”) and there are state and federal laws to protect the privacy of your health information. This notice is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).
This document contains important information about federal law, the Health Information Portability and Accountability Act (HIPAA), which provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) used for treatment, payment, and health care operations.
HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for the use and disclosure of PHI for treatment, payment, and healthcare operations. The Notice explains HIPAA and its application to your PHI in greater detail.
The law requires that we obtain your signature acknowledging that we have provided you with this. If you have any questions, it is your right and obligation to ask so we can have a further discussion before signing this document. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding unless we have taken action in reliance on it.
Use and Disclosure of Protected Health Information:
- For Treatment – We use and disclose your health information internally in the course of your treatment. If we wish to provide information outside of our practice for your treatment by another healthcare provider, we will have you sign an authorization for the release of information. Furthermore, authorization is required for most uses and disclosures of psychotherapy notes.
- For Payment – We may use and disclose your health information to obtain payment for services provided to you.
- For Operations – We may use and disclose your health information as part of our internal operations. For example, this could mean a review of records to assure quality. We may also use your information to tell you about services, educational activities, and programs that we feel might be of interest to you.
For HIV Disclosure- Under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, public health authorities are authorized to collect and receive private health information “for the purpose of preventing or controlling disease” and in the “conduct of public health surveillance…” without patient or provider consent or authorization other than state or local public health law. This clause authorizes providers to report HIV/AIDS cases to the HIV Epidemiology Program without obtaining patient consent and it authorizes health department personnel to review medical records and any other source of information needed to report the case.
Any other disclosure of HIV-related information must be made on the “HIPAA- Compliant Authorization for Release of Medical Information and Confidential HIV-Related Information”. State law prohibits any further disclosure of HIV-related private health information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.
Client Rights:
- Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category.
- Right to Confidentiality – You have the right to have your health care information protected. 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 payment or our operations with your health insurer. We will agree to such unless a law requires us to share that information.
- Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
- Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and the release of information must be completed. Furthermore, there may be a copying fee (see Practice Fee Schedule for cost). Please make your request well in advance and allow 2 weeks to receive the copies. If we refuse your request for access to your records, you have a right to review them, which we will discuss with you upon request.
- Right to Amend – If you believe the information in your records is incorrect and/or missing important information, you can ask us to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and we will decide if it is and if we refuse to do so, we will tell you why within 60 days.
- Right to a Copy of This Notice – If you received the paperwork electronically, you have a copy in your email. If you completed this paperwork in the office at your first session a copy will be provided to you per your request or at any time.
- Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. At your request, we will discuss with you the details of the accounting process.
- Right to Choose Someone to Act for You – 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 for you before we take any action.
- Right to Choose – You have the right to decide not to receive services with us. If you wish, we will provide you with the names of other qualified professionals.
- Right to Terminate – You have the right to terminate services with us at any time without any legal or financial obligations other than those already accrued. We ask that you discuss your decision with us in session before terminating or at least contact must be made by phone letting us know you are terminating services.
- Right to Release Information with Written Consent – With your written consent, any part of your record can be released to any person or agency you designate. Together, we will discuss whether or not we think releasing the information in question to that person or agency might be harmful to you.
Clinician Duties:
- We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices concerning PHI. We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect. If we revise our policies and procedures, we will provide you with a revised notice in the office during our session.
This Notice of Privacy Practices applies to the following organizations:
ROUNDTREE MENTAL HEALTH Group
365 S Hartmann Dr Suite 102, Lebanon, TN 37087