Policies



We realize there is a lot of paperwork to be aware of.  But it realistically can be
reviewed and completed in the course of a few hours.   We believe in a
commitment to our patients and that commitment begins with an
understanding of how your treatment will progress and the rules we use to
implement it.  
Please familiarize yourself with who we are and how we treat patients.  
Below are some important policies in the manner in which we do business.  
You will be asked to review this paperwork prior to your appointment.  



PRIVACY POLICY

- Under pressure from government agencies to move to electronic health
records, we have decided to use Practice Fusion as our Electronic Health
Record Choice.  You may follow the link below to access the site and learn
more.


Practice Fussion for Psychiatric Practices


- As required under HIPPA, confidentiality and security standards will be
upheld.
- Confidentiality is waived if there is a real immediate threat to yourself or
someone else.
- Certain Diseases Must Be Reported to the Health Department
- A Court Order may Request these records.
- We are required to report cases of elder or child abuse.  
-Under most circumstances no records released without approval.

-Some private information is shared with insurance companies as required for
billing.
- Information will be shared with treating physicians in order improve quality
of care.
Regarding communication with family and other physicians.  In order to effect
psychiatric treatment, families and physicians need to be occasionally involved
when health is at stake.  Our staff will use judgment regarding what to disclose
regarding psychiatric treatment.  
An example of this policy would be if a family member called Dr. Grace stating
that the patient was acting in an unusual way, that sounded like hypomania.  If
the patient were on lithium for bipolar disease, Dr. Grace would likely stress
the importance of hydration with the medication the patient is on as well as
provide the family member techniques in dealing with a hypomanic person,
releasing the minimum required information to aid in the situation.
Patient safety is our FIRST priority.   


LATE CANCELLATIONS:   
Our office requires 24 hour notice for cancellation of appointments.  Failure to
provide will result in the patient being charged a fee of  $50.00. THIS NO-
SHOW POLICY NOW APPLIES TO ALL PATIENTS.  AS OF OCTOBER 2008,
PHYSICIANS ARE ALLOWED TO BILL MEDICARE PATIENTS FOR NO-
SHOW APPOINTMENTS.


BALANCE:    
Patients are expected to maintain a zero balance.  John W. Grace reserves the
right to charge a 1.5% finance charge for balances more than thirty days
overdue.  Please understand that filling out requested forms (such as disability
forms) and the full release of your medical records may be delayed by an
overdue balance.


INSURANCE BILLING:  
We file insurance as a courtesy to you using medicare guidelines for filling out
a HCFA-1500.  We do the best we can but it is YOUR responsibility to handle
YOUR insurance company if problems arise.  You can always take over your
billing at any time and simply pay at the time of your visit.    


PHYSICIAN EXTENDERS AND INSURANCE:  
OUR OFFICE UTILIZES BOTH LICENSED CLINICAL SOCIAL WORKERS
AND NURSE PRACTITIONERS IN THE IMPLEMENTATION OF CARE.  WE
ASK THAT YOU EXTEND THEM THE SAME COURTESY AS YOU WOULD
THE OTHER PROFESSIONAL MEMBERS OF THE TEAM.  
THEY WORK “WITH” THE DOCTOR.  THEY ARE NOT IN PLACE OF THE
DOCTOR AND THEY ARE PART OF A MULTIFACETED LEVEL OF CARE
SYSTEM.  THERE WILL BE TIMES DR. GRACE IS UNAVAILABLE.  WE ASK
YOU UTILIZE THIS SYSTEM AND GET THE MOST OUT OF OUR
PHYSICIAN EXTENDERS.  WE SUBMIT TO YOUR INSURANCE COMPANY
(AT YOUR REQUEST) BILLING INFORMATION IN STANDARD
MEDICARE HCFA1500 FORMAT.  IF YOUR INSURANCE REQUIRES A
DIFFERENT FORMAT OR FURTHER INFORMATION IT IS YOUR
RESPONSIBILITY TO LET US KNOW.   FAILURE TO DO SO MAY RESULT
IN LESS REIMBURSEMENT FROM YOUR INSURANCE COMPANY AND
GREATER COST TO YOU.  


PRIOR AUTHORIZATIONS FOR MEDICATIONS:  
WE ARE FINDING OURSELVES INUNDATED WITH MORE AND MORE
FRIVOLOUS REQUESTS FOR PRIOR AUTHORIZATIONS FROM
INSURANCE COMPANIES, (INCLUDING REQUESTS WHICH TAKE UP TO
A HALF AN HOUR OF TIME FOR A GENERIC MEDICATION WHICH
COSTS UNDER $10.00).
WE HAVE A STANDARDIZED LETTER THAT WE MAIL OUT FOR PRIOR
AUTHORIZATION OF MEDICATION.  WE WILL ALSO BE HAPPY TO FAX
YOUR PROGRESS NOTES WHICH WILL DICTATE OUR RATIONALE FOR
THE PRESCRIPTION YOU RECEIVE IF YOU REQUEST IT.
ANY ADDITIONAL EFFORT ON YOUR BEHALF WHICH YOU REQUEST
MAY RESULT IN AN ADDITIONAL CHARGE TO YOU.  
PLEASE  CHOOSE YOUR INSURANCE COMPANY CAREFULLY AND BE
WARY WHEN THEY SAY THINGS SUCH AS, “ALL YOUR DOCTOR HAS TO
DO IS GIVE US A QUICK PHONE CALL AND THAT MEDICATION WILL BE
APPROVED.”  WE GENERALLY DO NOT MAKE PHONE CALLS FOR
AUTHORIZATIONS.  


ADDITIONAL PAPERWORK:
OCCASIONALLY WE ARE ASKED TO FILL OUT PAPERWORK
REGARDING DISABILITY OR OTHER ISSUES.  THERE MAY BE AN
ADDITIONAL CHARGE TO FILL OUT THIS PAPERWORK IF THE TIME
REQUIRED IS SUBSTANTIAL.  PLEASE CONTACT US ON A CASE BY CASE
ISSUE.  


LONG PHONE CALLS INVOLVING PSYCHOTHERAPY:        
Most insurances do not reimburse for telephone psychotherapy.  They
consider these part of the other services which physicians bill for.  
In psychiatry, talking is part of our treatment and the reality is that we can
provide substantial treatment over the phone if need be the case.  We are able
to reinforce many of the things we state in therapy in real-world situations.  Or
we are able to continue therapy issues if people travel to other places and need
an urgent session.
If these services are utilized we will attempt to bill your insurance but they
likely will not pay for such services and you will be responsible for them.  
You will not be charged for brief conversations lasting less than a few minutes
or to confirm medication requests.          
We consider phone-based psychotherapy to be an integral part of treatment in
this day and age and we would like to be able to provide this to you if it is
necessary for instance if you are traveling and need a session.  
Medicare patients will need to sign a waiver in order to receive this treatment if
necessary.  


RISKS OF PSYCHIATRIC MEDICATIONS
Unfortunately most of the treatments we use in medicine carry substantial
risks.  Albeit small, in most cases, we feel that patients need to be aware that
things can, and do go wrong.  Here at our office we make every effort to expose
the patient to the least amount of risk for their benefit and believe that this
needs to be an ongoing process.  
Psychiatric illnesses carry substantial risks as well.  Schizophrenic patients
appear to have shorter life expectancy than normal patients.  Major
Depression, Panic Disorder, Bipolar Illness, and Substance abuse all have
much higher rates of suicide than the general populations.  There is also
considerable and lasting impact on relationships, employment, and quality of
life from these illnesses.
In summary, having psychiatric illness places patients at risk.  We hope to
lower risks by using medications and therapy.   But nothing can remove it
completely.