FEES AND BILLING
Full payment is required at the beginning of each session so that we can fully utilize the allocated session time to focus on your therapy. Methods of payment accepted include:
New patient appointment (with review of past records/coordination of care), $ 350
Please complete required forms before the appointment
Established patients have the choice of:
15-minute brief medication management appointment (for simple, stable meds): $150
25-minute typical medication management +/- brief therapy: $200
45-minute typical medication management +/- brief therapy: $275
60-minute therapy +/- medications: $300
Telephone / Video Appointments same as above
Complex prior authorization or documentation completion, such as letters, forms completion requiring greater then 15 minutes of time will incur a $50.00 fees
Missed appointments or late cancellation, with less then 2 business days notice will incur a $75.00 fee
Sending Medical Records Handling Fees $ 35.00 for first 50 pages and 10 cents for each additional page thereafter
I am currently an out-of-network provider for all insurance plans. Thus, the full fee for each session is due at the time of service. However I am happy to provide you with a statement that you can submit to your insurance company for reimbursement.
If you choose to collect from your insurance, it’s important that you find out your out-of-network benefits. We suggest you contact them before setting up your first appointment. Some of our clients have received as much as 90% coverage, and others as little as 0% coverage. Beware that if you do submit a statement to the insurance company to access Out-of-Network benefits, insurance may request a copy of your medical records.
Your privacy is very important to me and that is the main reason why I do not bill insurance. By deciding to submit a statement for mental health services to your insurance company, a mental health diagnosis will become part of your medical records permanently and this may affect your ability to obtain life insurance, or jobs which require no prior history of mental health diagnosis.
Of course if there are financial constraints and you must submit a statement of mental health services to your insurance I will support you in every way possible by providing all necessary documentation to fulfill whatever needs you may have.
I understand that taking the first step to seek help for mental health and/ or substance use disorders might be difficult as these are poorly understood by those who do not suffer from them. I promise to be your partner through this journey no matter what challenges may come your way.
Please Note: I have chosen not to process claims with ANY insurance including Oregon Health Plan, Washington Medicaid or Medicare. Patients seen for services at this clinic are aware that this provider does NOT see patients with Medicare coverage and they should not submit reimbursement requests to Medicare /Medicaid.
CHEMICAL DEPENDENCY SERVICES
When considering office based treatment for opioid or alcohol dependence, it is important to be aware of the related costs of treatment. These include medications, urine drug screening, and in certain cases, blood work. PLEASE NOTE: these charges are separate and distinct from the fees billed for office visits.
Medications: Fees for Suboxone®, Vivitrol® and other medications are paid directly to pharmacies; prospective patients should contact their pharmacy or the drug manufacturer for details regarding pricing. Most insurance companies will cover these medications, and the co-pay amount may be reduced or eliminated by the drug manufacturers. These medications may or may not not be covered; prospective patients are encouraged to contact their plans for details.
Laboratory Tests: Harmony Mental Health Services of NW requires patients undergoing substance treatment to have random urine drug testing. Although many plans will cover this cost, the outside lab may bill the patient for any amounts not covered by insurance. For those individuals without insurance, the outside lab will charge a fee billed directly to the patient. In my experience urine toxicology screens are around $60 out-of-pocket.
Appointments: You can request an appointment by sending us a confidential email using the appointment request form, or by leaving a message on our confidential voicemail at (360) 773-6340. Appointments start promptly at the scheduled time. Time spent in the waiting area is minimal.
Late arrivals may lose appointment times and will either need to reschedule or be seen after other patients. Punctual arrivals have priority.
Cancellation Policy: Because appointment times are reserved in advance, it is necessary to call to cancel an appointment that cannot be attended. Cancellations made at least 24 hours prior to the appointment time will not be billed. Missed appointments and appointments canceled with less than 24 hours notice will be billed at full fee. These fees are generally not reimbursed by insurance.
Termination of Service: Multiple late cancellations, no-shows and other forms of noncompliance with treatment may result in termination of services.
Medication Refills: Please contact your pharmacy and have them call Dr. Gonzalez-Rodriguez to request a medication refill.
Patients not seen in the past 3 months may be asked to schedule an office appointment prior to a medication being refilled.
We take our patients' confidentiality seriously and try our best to protect it beyond what is required by state and federal law and by the ethics code of the medical profession. We will not release information about you or your treatment without your written permission. However, under the following circumstances, the law authorizes and/or requires disclosure of protected health information:
- suspected abuse of a child, developmentally disabled person, elder or other dependent adult
- imminent or planned harm to yourself or others
- required by a court of law (see HIPAA disclosure document).
- if you choose to use your insurance for our visits, I will be required to disclose information regarding your diagnosis and treatment plan to the insurance company
We may also ask your permission to allow contact with your primary care physician or others whose care may interact critically with our work. It is of course your choice whether to permit such contact or not. If you wish to permit it, please download and complete the Consent to Receive/Release Confidential Information form.
If you are interested in learning more about your legal rights to privacy in the healthcare system, please visit www.hhs.gov/ocr/hipaa.
E-mail can be used for scheduling but we recommend patients to communicate about most other matters by leaving a message on the office voice mail. If e-mail is used for a clinical matter, please keep in mind that our email is not encrypted and even with reasonable security measures, it cannot be guaranteed as entirely private and confidential. E-mails about clinical matters will be included as part of your medical record. If you wish to communicate with us via email, please complete the E-mail Communication Consent form.
Due to our work schedule, we are often not immediately available by telephone. When we are unavailable, the telephone is answered by voice mail that is monitored frequently. We will make every effort to return your call on the same day you make it, with the exception of late evening, weekends and holidays.
If there is a life threatening emergency or you are unable to wait for our return call, please call 911 or go to your nearest emergency room. You may also call the Southwest Washington Crisis Line at (800) 626-8137. When we are out of town, another psychiatrist may be covering for us. In this event, our voicemail will provide instructions for contacting the covering psychiatrist.
Unless we explicitly agree otherwise at the beginning of the treatment, we do not provide evaluations nor complete paperwork for legal purposes, for disability or for work-related claims. If we work together, we will not agree to talk with lawyers, guardians-ad-litem, or other parties not directly involved in your treatment. We generally feel these services interfere with the therapeutic relationship and should be contracted separately.