Policies

Office Hours and emergencies:

Our office is open from Monday to Friday, between 8 AM – 8 PM, and Saturday 9 AM – 4 PM. Please note that our office remains closed on all major holidays. We do not offer emergency services, crisis support, or coverage during weekends and after hours. In the event of a life-threatening emergency, we strongly advise you to visit the nearest emergency room or dial 911.

Insurance:
Patient medical expenses are their responsibility, regardless of insurance coverage. While we verify benefits as a courtesy, the copay/coinsurance info provided is not a guarantee of payment. Patients must know their insurance policy and are responsible for payment if insurance fails to cover services. Please notify us of any insurance changes. Insurance plans pay Pinnacle Psychiatry directly. After your claim is processed and it is determined that the provider is out of network, the client is solely responsible for the entire visit payment. We also reserve the right to disclose medical information to your insurance for payment.

Medication refill policy:
At Pinnacle Psychiatry, we prioritize scheduling appointments for prescription refills. We do not provide refills without a virtual or in-person appointment with our providers. You must ensure you schedule a follow-up before your prescription runs out.

All medication refills and changes are addressed during or after your appointment with a provider. Missing appointments can disrupt your care and increase the risk of a relapse.

For patients on controlled substances, we reserve the right to withhold or delay prescription refills until the completion of a drug screening (UDS) as ordered by your provider. This ensures the responsible management of your medication.

Cancellations and missed appointments:
To ensure smooth scheduling, please provide a 24-hour business notice if you need to cancel or reschedule an appointment. If a missed or uncancelled appointment occurs without 24-hour business notice, a fee of $99 will be charged. Please note that missed appointment fees cannot be submitted to insurance, and you are solely responsible for this charge. After three missed appointments, services may be withheld until all outstanding fees are paid in full.

Medication Prior Authorization:
In order to assist you in making informed decisions about your prescribed medications and to prevent unexpected charges on your pharmacy benefits or policy, we highly recommend obtaining a copy of your formulary list before your visit. This will allow you to confirm whether your insurance company covers the prescribed medications and provide an opportunity to discuss alternative options. Taking this proactive step can help you navigate your medication coverage smoothly.

Scope of Services:
Our practice specializes in specific areas of psychiatry and does not offer forensic or occupational psychiatry services. We are not involved in worker’s compensation cases, divorce or child custody matters, assessments for fitness to work, disability evaluations, or legal proceedings such as providing testimony or reports for civil matters.

Additionally, we do not provide treatment for unstable, actively psychotic patients with schizophrenia or acute psychotic disorders. These patients typically require case managers and a higher level of care. Please note that we do not offer social services or case management as part of our services.

Paperwork:
To facilitate the processing of FMLA paperwork, your provider will charge $49-$149 for completion, based on complexity. Kindly submit your paperwork to the receptionist before your appointment. Any letters or forms requested from the patient will incur a preparation fee starting at $50. Completion of these documents is subject to the provider’s discretion. Please note that prepayment is mandatory for all paperwork and may take up to 14 business days to process.

Returned checks:
A fee of $50 will be incurred in the event of a returned check.

Medical records:
To obtain a copy of your medical record, we must provide our office with a signed authorization from the patient.

Labs:
In certain situations, we may require the ordering of laboratory tests. Kindly be aware that the cost of these labs is not included in your visit charges. You are responsible for inquiring about the cost of the labs directly from the lab facility. You have the freedom to select any lab of your preference.

Testifying in court:
In the event that legal actions arise and your physician is subpoenaed to provide testimony, such as in custody cases, it is your responsibility to cover the following expenses, even if the subpoena originates from the opposing party:

a) Travel expenses:

b) Hourly or per diem fees: Based on our existing rates, from when the physician departs the office until their return. Before the court appearance, we kindly request at least 50% of the estimated costs be paid in advance.

Communications:
We utilize phone, email, and text for communication. While we take precautions, we expect secure electronic communication on your end. If you’re uncomfortable or lack security, please refrain from scheduling with us.

Confidentiality:
At Pinnacle Psychiatry, we prioritize confidentiality within the boundaries permitted by Texas law. However, there are exceptions to this principle. Some common exceptions include:

Reporting any evidence of child abuse, whether it occurred in the past or is ongoing.
Reporting intentions of harm, danger, or criminal activities towards oneself or others to the appropriate authorities.
Reporting incidents of sexual improprieties by former therapists or psychiatrists as it is a criminal offense.
Complying with court orders or actions, such as custody cases, malpractice proceedings, or criminal investigations.
Addressing fee collection matters.

If you have any inquiries or concerns about these exceptions, please discuss them with your provider. They can also provide detailed information regarding your rights in such reporting situations.

You authorize your provider to take necessary action if, in their clinical judgment, they believe you pose a risk of harm to yourself or others. This may involve contacting your designated emergency contact or seeking assistance from another individual to help navigate through a crisis.

Right, to withdraw:
In a conflict between the client and the physician/provider, either party has the right to withdraw from the ongoing treatment. If the provider determines the need to withdraw from treatment, they will inform the client accordingly. Efforts will be made to provide appropriate referrals and ensure 30-day emergency care, if necessary.

HIPAA Notice of Privacy Practices

If you have any questions or concerns regarding ethical issues, you can direct them to the consumer hotline at 1-800-942-5540.

This Privacy Practices notice explains how your medical information may be used and disclosed and how you can access that information. Please review it carefully.

This notice describes how we may use and disclose your protected health information (PHI) for treatment, payment, and healthcare operations (TPO) and other purposes allowed or required by law. It also outlines your rights to access and control your protected health information. Protected health information includes demographic details that may identify you and are related to your past, present, or future physical or mental health, condition, and related services.

Uses and disclosures of protected health information:
Your physician, our office staff, and other individuals involved in your care and treatment may use and disclose your protected health information to provide healthcare services, handle the payment for services, support the operation of the physician’s practice, and fulfill legal requirements.

Treatment: We may use and disclose your protected health information to provide, coordinate, or manage your healthcare and related services. This includes sharing information with third-party entities involved in your care. For instance, we may provide relevant information to a referred physician to ensure accurate diagnosis and treatment.

Payment: Your protected health information may be used, as necessary, to facilitate payment for your healthcare services. This may involve disclosing pertinent information to your health plan to obtain approval for hospital stays or other necessary treatments.

Healthcare Operations: Your protected health information may be used or disclosed, as needed, to support the business activities of your physician’s practice. These activities include quality assessment, employee reviews, medical student training, licensing, and other necessary business operations. For instance, we may disclose your protected health information to medical students involved in patient care at our office.

Additionally, we may have a sign-in sheet at the registration desk where you will be asked to provide your name and indicate your physician. When your physician is ready to see you, we may also call you by name. Furthermore, we may contact you to remind you of your appointment, using your protected health information as necessary.

Certain situations allow for the use or disclosure of your protected health information without authorization. These situations include legal requirements, public health issues, communicable diseases, health oversight, cases of abuse or neglect, compliance with Food and Drug Administration regulations, involvement in legal proceedings, law enforcement purposes, matters involving coroners, funeral directors, and organ donation, research purposes, instances of criminal activity, military and national security activities, workers’ compensation cases, situations involving inmates, and other necessary uses and disclosures mandated by law. Additionally, under the law, we are obligated to disclose to you and cooperate with investigations by the Secretary of the Department of Health and Human Services to ensure compliance with the regulations outlined in Section 164.500.

Other Permitted and Required Uses and Disclosures Will be made only with your consent, authorization, or opportunity to object unless required by law.

You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken action in reliance on the use or disclosure indicated in the authorization.

Your Rights

The following statement outlines your rights concerning your protected health information:

You have the right to inspect and obtain a copy of your protected health information. However, certain records are exempt from this right under Federal law. These include psychotherapy notes, information prepared for or used in legal proceedings, and protected health information that is subject to laws prohibiting access.
You have the right to request restrictions on the use and disclosure of your protected health information. This means you can ask us not to use or disclose specific parts of your information for treatment, payment, or healthcare operations.
You may also request that certain information not be shared with family members, friends or for notification purposes, as explained in this Notice of Privacy Practices. Your request must clearly state the specific restriction and identify the individuals to whom it should apply.
Please note that your physician is not obligated to agree to your requested restriction. If your physician believes that it is in your best interest to allow the use and disclosure of your protected health information, they may deny the requested restriction. In such cases, you have the right to seek services from another healthcare professional.
You possess the right to request confidential communication from us through alternative means or at a different location. Additionally, upon request, you have the right to receive a paper copy of this notice from us, even if you have previously agreed to receive it electronically.
There is a possibility that you may have the right to request amendments to your protected health information from your physician. In the event that we deny your amendment request, you have the right to file a statement of disagreement, to which we may prepare a rebuttal. You will be provided with a copy of any such rebuttal.
You also have the right to obtain an accounting of certain disclosures, if any, that we have made of your protected health information.
Please be aware that we reserve the right to modify the terms of this notice. In such cases, we will notify you of any changes via mail. Subsequently, you have the right to object or withdraw as this notice outlines.