Punctuality: if you find you are running late, I will assume you are on your way and after 15 minutes I will give you a courtesy call to alert you to the missed appointment and the need to reschedule. I tend to run on time with appointments, so please be a few minutes early so you can settle in before we meet.
Cancellation Policy I have a 48 hour cancellation policy. Prior to 48 hours, there is no cancellation fee; however, if an appointment is missed or cancelled at the last minute, cancellations fees are as follows:
Less than 24 hours notice $100
Less than 48 hours notice $60
In pandemic times and for the future, I am able to offer telemedicine services. I use a premium Zoom.us, doxy.me or FaceTime platforms. I am able to offer in-office visits on Thursdays.
Care Coordination: I endeavor to coordinate with your health care providers, especially if there are medical complications, ongoing serious health concerns or changes in your treatment plan that can effect other aspects of your care. Please complete the Care Coordination form so I might be able to communicate on your behalf re: your mental health care.
Communication: It is important that you know how to reach me when I am not in the office. My preferred method of communication is email. Please understand that while email is not a secure form of communication, I recognize the convenience of using it in today’s environment. In the instance where I must communicate with you via email, I will take every precaution to limit personal health information. More secure options for communicating with me are within the messaging options in this website. I make a practice of checking e-mail and voice mail frequently during the weekdays and once daily on weekends. If you do not hear from me within a reasonable period of time, please send me a message again.
Complexity and Referral: Treatment can adapt and change in response to each persons evolving needs. I continuously pay attention to the need for treatment adjustments as well as the original issues presented. If your condition worsens for any reason, I will help you manage it. If you require a higher level of care, I can provide valuable assistance in accessing higher levels of care. If the problems extend to beyond my scope of practice, I may refer you to another provider. I have extensive knowledge of the treatment network the Boston and surrounding areas. My goal is to get you the right care, in the right amount and at the right time.
I will occasionally be required to have written communication with your insurance company when medication prior authorizations are needed.
Medication Management Services: Medication management is best if therapy providers are also part of the treatment experience. If patients are in-between therapy or have challenges finding new providers, medication management can be sustaining but decisions to provide ONLY medication services are made on a case by case basis. I provide that service with a number of caveats:
- Complex care requires that I be in contact with your therapist and/or primary care providers
- I prescribe benzodiazepines judiciously and avoid long term prescriptions or higher than normal dosing, Treatment goals should be directed towards lowering and tapering off long term benzodiazepine medications.
- Telemedicine sessions are available for established patients however, I reserve the right to request in-person sessions should I judge that telemedicine sessions are inappropriate.
Overview of Prescription Policies:
Taking Medication Safely
While I have access to electronic prescribing and reliable resources to check for medication interactions and side effects, it does not substitute for your own efforts to be vigilant in taking medication safely. Please learn about your medication, its uses, dosage and side effects. It is important to know what the tablets look like and to check the information on your bottle for accuracy. It is important to limit alcohol and other drug use as serious interactions can occur.
FDA Approved, Non-Approved and Non-Pharma Treatments
The Federal Drug Administration (FDA) provides basic guidelines as to the intended uses of medication, however medications are often approved for a narrow range of indications. I may prescribe medication for non-approved uses (“off-label”) in an effort to individualize your care. In that instance, I will fully inform you of the reasons for recommending a medication for a non-approved indication and will explain why. I adhere to principles of judicious use, sensible dosing schedules and often will recommend non-pharma options (such as CBT, mindfulness meditation, or psychotherapy, etc.) as part of your treatment.
Controlled Substances (Medications)
While all prescribed medications are controlled, some are more controlled then others. Certain medications are under strict quantity and refill limits that vary from state to state. Current pharmacy laws are requiring that many prescriptions be written electronically so as to avoid fraud, diversion and other problems associated with paper prescriptions. Most pharmacies have converted to e-prescribing and allow limited inter-state prescribing in most states should you need medications called in for travel or relocation services.
Pharmacy and Pharmacy Benefit Plans
Most insurance companies provides you with a PBM (Pharmacy Benefits Manager). Common PBM’s are: Medco, ExpressScripts, CareMark, etc. These are often large services that are located in other states and provide prescription fulfillment services by mail. They will mail medication quantities as specified on your prescription for either 30, 60 or 90 day increments. In addition, your local pharmacy can fulfill your prescriptions but usually for only 30 or 60 days at a time. Both mail order and local pharmacy providers are instructed to follow the Medication Formulary adopted by your health insurance. That is why some medications I may prescribe will either require a “Prior Authorization” to get it approved, or have a higher co-pay compared to a generic medication. Where possible, I will prescribe generic medications, offer alternatives or seek a prior authorization for the medications I am recommending as part of your treatment plan.
Alcohol
It is important to avoid excess alcohol while taking psychoactive medications. Interactions with psychotropic medications and alcohol have been known to cause “blackouts”, seizures and overdose deaths. Even the “usual amounts” of ingested alcohol can interact dangerously if you haven’t eaten, gotten enough sleep or are dehydrated in any way. Please discuss your patterns of alcohol use while in treatment.
Interactions, Herbs, Supplements, Over the Counter Medicines
Herbs, supplements and over the counter medications can present risks by interfering with the adequate absorption of prescribed medications or increase the blood levels of medications. Please bring a list of herbs, supplements and over the counter medicines to your appointments.