OFFICE POLICIES AND TREATMENT CONTRACT
Welcome to my practice. Please review the following so you are aware of the policies of my practice and contact me with any questions. Thank you and I look forward to working with you.
Confidentiality: Our sessions are confidential and what we discuss may not be revealed to anyone without your permission except where disclosure is required by law. Disclosure may be required where there is a reasonable concern of: 1) abuse or neglect of a child/elder, 2) danger of harm to yourself or others, 3) grave disability, or 4) in the case of a legal proceedings. I may find it helpful to consult other professionals about your case; however, neither your name nor any identifying information about you is revealed. In the case that another person (such as a family member or friend) is paying for your treatment, that person will not receive any confidential information about your care without your explicit written consent.
Unfortunately I do not allow video or audio recording of our sessions unless we discuss it ahead of time.
Initial Consultation/Intake: Our first visit will be either a 90 or 120 minute consultation for the purpose of evaluation. I require that intake paper work (different from the policies that you are signing here) via the IntakeQ patient portal be electronically completed 48 hours prior to our meeting so that I have proper time to review it. If it is not completed ahead of time, I will be covering in the intake a lot of the information that I gather ahead of time so it may take another session to fully complete. After evaluation, I will offer some first impressions of what our work might include, a treatment plan, and considerations regarding psychotherapy, medications, and holistic approaches. You may use this information—along with your own comfort in working with me—to make your decision as to whether you would like to pursue treatment. In addition, our initial meeting does not automatically result in the establishment of a patient-doctor relationship, nor does it guarantee treatment. If you do not feel comfortable working with me, or if I do not feel able to help you for any reason (such as needing different types of services or higher level of care), I will try to assist you with referral to others who may be able to meet your needs. After it is mutually determined that we would both like to begin treatment, then treatment and medication prescribing can begin.
Please note that if you are transferring care from another provider to me, I may not agree with their treatment plan and may not renew previous medications if I do not feel that they are appropriate for your treatment. You and I will work on achieving an appropriate treatment plan.
Follow Up Appointments: Regular follow up appointments are required in order to ensure good care. Follow up appointments are scheduled for either 50 minutes or 25 minutes depending on the complexity of the issue and whether we are setting aside time for psychotherapy. The appointment time is reserved for you, so it is important that you are on time. If you are late, your appointment will still conclude at the end of your scheduled appointment, or your appointment may have to be forfeited. If you miss or have to cancel an appointment, please reschedule within 30 days. If I do not hear from you within 90 days of a cancelled or missed appointment I will assume you are receiving your care elsewhere and administratively discharge you from my practice. Please be aware that once discharged, I may not be able to accept you back into my practice should you follow up with me in the future.
Patient Portal Sign Up: I do most of my scheduling, medication refills, patient communication, and billing via the electronic medical record (EMR) IntakeQ that I use. It is important and required that you sign up and become somewhat familiarized with it so you can communicate with me, reschedule appointments, request medication refills and have questions about billing/Superbills.
Scheduling Appointments: The initial intake consultation is scheduled with me during our 15 minute introductory phone call. Please contact me if it needs to be rescheduled. You and I will schedule our subsequent follow ups at the end of our appointments. If it is unable to be done during the appointment, you will schedule at a later time on the IntakeQ patient portal. If you need to cancel and/or reschedule an appointment, the preferred method is cancel and/or reschedule the appointment in the scheduling section of the IntakeQ patient portal. You also can send me a secure message via the IntakeQ patient portal and I can cancel it. You would then need to reschedule the appointment via the scheduling section of the IntakeQ patient portal at a later date.
If for some reason I have to cancel and reschedule our appointment due to being sick or last minute emergency, I will let you know at the earliest possible time. You will receive a message in your email advising you to this with a link to reschedule the appointment in the IntakeQ patient portal.
Contacting Me: I am available by phone or secure message during business hours. The preferred method for contacting me is via secure messaging via the IntakeQ patient portal. You can call and leave me a voicemail but my response rate is normally much faster with secure messaging as I am often checking them throughout the day. Voicemail is checked much less frequently. If you do call, please leave a voicemail with you name spelled out and your date of birth and phone number to be reached. Please speak slowly as sometimes voicemails can be difficult to understand.
Complex clinical questions should be discussed during appointments as opposed to over email. I will return messages in a timely fashion, typically within 24-48 hours. I do not receive emails after hours, on the weekends, or on vacation. In the case that I am on vacation, I will have a colleague provide coverage for me and they can answer questions that you might have. You will be alerted to my vacation times and who is providing coverage. If you need assistance more urgently, please go to your local urgent care. In case of an emergency, If you experience, please call 911 or go to your nearest emergency room. I am not available during evenings or the weekends.
Email Communication: Occasionally I am available to communicate via email but I prefer to electronically communicate with patients via the secure message feature in IntakeQ as 1) I am more likely to miss the message if sent via email (I receive lots of non patient related emails and also some go to spam) 2) I more diligent with checking my secure messages than email as this is where I expect to be communicating with patients, and 3) it is a more secure way of communicating with patients. With that being said, if for some reason the secure messaging is not working, you are struggling to figure it out, etc, I can be reached by email at Mark@ellestadpsychiatry.org. You must remember and be ok with the risk of using email. Messages can be addressed to the wrong person or accessed improperly while in storage or during transmission. I do not receive emails after hours, on the weekends, or on vacation. In the case that I am on vacation, I will have a colleague providing coverage for me.
Emergency Coverage: Unfortunately I do no offer crisis management, after hours access, or emergency medical/mental health services. If you find yourself in crisis (particularly if you are having thoughts of harming yourself or someone else), please call 911 or go to the nearest emergency department. You can also call the 24 hour King County Crisis Line at 211. If there is no immediate physical danger, you can call Crisis Connections at 206.461.3222. I have a list of other resources on my website at www.ellestadpsychiatry.com/faq and scroll to the bottom of the page to click on many different resources. I would, of course, like to be alerted to your emergency but do not wait to hear back from me as I do not check my messages frequently enough to appropriately respond to emergency needs.
General Medical Information: It is important that you have a primary care doctor while working with me. See primary care document for more details. It is important that you alert me to any new medical diagnoses or health issues that arise during the course of our treatment. It is important that you keep me up to date on any new medications, herbs or supplements that you might be taking to ensure that the medications do not interact in unsafe ways. I expect that I will be the only person prescribing psychiatric medications during our treatment unless discussed.
Medication Refills: Medication refills will be sent electronically via the electronic medical record IntakeQ to your pharmacy. I typically submit refills during scheduled appointments and provide enough refills until our next appointment. As long as you are coming for regularly scheduled appointments at the minimum of every three months, you typically will not need me to refill between appointments; however if that does arise, I can provide medication refills between appointments if deemed appropriate. It is best to send me a secure message in the patient portal so you can explain why you need the refill early. I then can put in the refill electronically and will let you know when it is complete. Please allow for a minimum of 3 business days for me to respond to refill requests. Do not leave these requests to the last minute as you might run out of the medication. If you have not been seen over the previous three months, you will need to schedule an appointment to obtain a refill. If you have been discharged from the practice, I will not be writing you medication prescriptions unless it is agreed upon.
Please be aware than when prescribing medications for my patients I will routinely check medication prescription history via available centralized platforms that show patients' medication prescriptions from different providers, in order to ensure good care.
Controlled Substances: In some cases I may prescribe controlled substances as part of your care. This list includes but is not limited to stimulants for ADHD such as Ritalin and Adderall, sedatives/hypnotics for insomnia such as Ambien, Sonata, and Lunesta, benzodiazepines/anxiolytics such as Ativan, Xanax, and Klonopin, and suboxone for opiate use disorder (please note, however, that i do not prescribe other opiates). It is important to take these medications as prescribed, and not to increase or change your dose without specifically discussing with me. In the case that you change your medication dose on your own and run out early, I will not provide an early refill and you may experience withdrawal symptoms. It is your responsibility to keep them safe. I recommend keeping them in a safe, secured location. Toxicology screens will be required on an annual basis for safety. Please note that i do not write for opioids such as oxycodone, oxycontin, or hydrocodone.
Due to DEA regulations and the Ryan Haight Act, in order for me to write a controlled substance, I must have seen you in person prior to writing any controlled substances. This does not preclude me from writing for controlled substances as I do have office space. I will not, however, be able to write for controlled substances until I have seen you in person. Following intakes, I plan to meet with all new patients in person so that should the need arise, I am able to write for controlled substances. My office is located at 3417 Evanston Ave, N #306 located in the Fremont neighborhood of Seattle. I will have in person office hours roughly 1x/month in Seattle.
Prior Authorizations: Most medications I prescribe are covered by insurance, but insurance companies sometimes require prior authorization for certain expensive or brand name medications. I can not guarantee a medication I prescribe will be covered by your insurance, but I will do what I can to make it as likely as possible by submitting medical justification to your insurance company. Because of the time involved with this process as sometimes it can take a considerable amount of time, I bill for it at the rates indicated below. I generally waive fees for prior authorizations for a single medication.
I use the service www.covermymeds.com to make it easier for you and your pharmacist. This will save me a lot of time (and therefore you money) if your pharmacy uses that service. If your pharmacy does not use that service, please obtain the prior authorization form from your pharmacy or the insurance’s website or ask them to fax it to me. Ask the pharmacy to fill out the form as much as possible. I will then complete the medical justification portion and send it to the insurance company for review. If your pharmacist tells you that “the doctor has to call the insurance company,” you should still convince them to either get you the form or obtain it directly from the insurance company.
Cancellations and Missed Appointments: Should you need to cancel, please do so at least 24 business hours in advance. Business days are considered weekdays, and exclude holidays. Cancellations made with less than 24 business hours notice, or missed appointments, are charged the full appointment fee. For example: an appointment scheduled for 12pm on Monday must be cancelled by 12pm on Friday to avoid incurring a fee. In addition, it is important to know that due to telehealth regulations, you must be in Washington state for our appointments and so if you are out of the state at the time of our scheduled appointment, it will be considered a missed appointment. If you are late for the appointment, I will be unable to extend the time of our appointment as it will interfere with the care of the next patient, and you will be charged for the full appointment.
Billing and Payment Policies: Prior to the first appointment, you will be required to provide your credit/debit/HSA card when you complete the Credit Card Authorization form and $1 will be charged to make sure that the card is working. Payment for all appointments is expected at the time the service is provided and will automatically be billed at the beginning of the appointment to the card that is on file.
Fees Structure:
Billing for appointments: The following indicate rates for scheduled appointments. For your initial consultation, you will be scheduled for either an Essential Psychiatric Assessment or an Integrative/Functional Assessment based on your individual case and requested treatment preferences.
Initial Consultation (90 minutes): $645
Initial Consultation (120 minutes): $845
Follow-Up Appointment (50 minutes): $420
*discounted to $380 (10% discount) for psychotherapy appointments scheduled, must be at least every 2 weeks
Follow-Up Appointment (25 minutes): $295
Follow Up Appointment after absence > 6 months (50 min): $520
Late cancellations and missed appointments billed at the rate of the scheduled appointment
Fees are subject to increase on an annual basis. You will be notified in advance of any fee increases.
If requested, I can provide you with a "Superbill" following each visit which is an available invoice that includes applicable billing codes for your visit which you may submit to your insurance for any available out-of-network benefits.
Medications and Supplements: During our appointments we will discuss medications and supplements. Depending on your insurance, most prescription medications will be covered by insurance with a copay. Supplements will normally need to be paid for out of pocket.
Laboratory Services & Fees:
Specific lab testing is discussed during our sessions and ordered as clinically indicated based on your symptoms and goals.
Basic lab work: Cost of lab testing — billed to insurance (copay may apply), Lab Review Fee — $75
Genomic Testing: Cost of lab test — billed to insurance (copay may apply), Lab Review Fee — $150
Functional Lab Testing: (includes both cost of lab test (billed by lab directly) + Review Fee) (Integrative/Functional Treatment Track only)
Functional Nutritional Testing: $650
GI gut testing: $650
Comprehensive Allergy & Immunology Testing (includes testing for sensitivities to foods and mold): $650
Salivary Adrenocortex Profile (cortisol testing): $260
Salivary Melatonin Profile: $190
Billing for services between appointments: Clinically-related services provided between scheduled appointments are billed at the rates listed below. Non-clinical phone, email, or text contact (such as scheduling or billing questions) are not charged for. For brief or limited services between appointments I generally waive the below fees.
Paperwork such as letters, forms, or prior authorization paperwork. Time spent preparing medical records to transfer between providers. (Please be aware that you have a right to request a copy of your medical records at any time; there is no additional administrative fee to release records to you, although I require we set up a follow up appointment to review and discuss your records prior to releasing them to you): $75 per letter or form OR $75 per 10 minute increment for more time-involved forms.
Phone calls with family members or other providers such as therapists or primary care doctors. Clinical questions answered over email (billed based on the time it takes me to respond to the question): $75 per 10 minute increment.
Insurance Coverage: I am not in-network for any insurance panels and am considered an “out of network provider” for PPO plans. While I do not contract with insurance companies, I do assist my patients by providing the paperwork necessary to submit into their insurance carriers for reimbursement (a “superbill”). I am not able to negotiate or submit claims with insurance companies. Please be aware that your insurance provider may not reimburse you for any, or may only reimburse you for a part of, the charges for my services. Insurance companies generally do not reimburse for administrative services or missed appointments.
Termination Policy: You are under no obligation to continue services if you decide to terminate. To assist you in the next steps such as medication refills and possible future referrals, it is helpful to make me aware of this and we have a termination session.
I may encourage you to seek treatment with a different provider if you require different expertise, a different treatment setting, or if you do not seem to be benefiting from treatment with me. I reserve the right to discharge you from my practice at my discretion when appropriate, included but not limited to: failure to go to my recommended appointments, misuse of your treatment, not having a primary care provider, failure to follow through on treatment recommendations (psychotherapy homework, seeing specialists, obtaining appropriate lab work, abstaining from elicit substances, etc), not paying bills, engaging in unprofessional, intimidating or threatening behavior, seeing a psychiatrist/physician for same related condition and not notifying me (I do welcome you seeing other providers but I request that I am made aware and am able to communicate with them if necessary), receiving psychotropic medications from another provider without my knowledge, you require a high level of care or different treatment that I am unable to provide, misuse of medications or obtain duplicate prescriptions (particularly for controlled substances) from other providers.
Limits of Service:
I do not provide disability evaluations, worker's compensation (labor and industry) evaluations, forensic evaluations, emotional support animal evaluations, ability to work/own a weapon/drive vehicle assessments or provide legal services or testimony. Should you require legal testimony at some point during our treatment together, you will need to retain an independent forensic psychiatrist. I also do not provide court ordered treatment or treatment under the Washington Involuntary Treatment Act.
I also do not provide Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), suboxone or intranasal/intramuscular(IM)/intravenous(IV) ketamine treatment (I can prescribe low dose ketamine during certain types of therapy). Although I do find these types of treatments can be very helpful for patients, I cannot provide them safely in a telehealth setting. Your wanting to engage in these treatments does not necessarily preclude you from working with me. I can provide you with referrals that can provide the service and our work together can complement these treatments.