Practice Policies & Notices
The following policies and notices govern administrative, clinical, billing, communication, and privacy practices at A New Hope Psychiatric Services.
Clients are encouraged to review these policies carefully.
These policies reflect the current operational and legal standards of A New Hope Psychiatric Services and may be updated periodically. The most current version is always available on this page
A New Hope Psychiatric Services
At A New Hope Psychiatric Services, we are committed to providing you with the best possible care. To ensure smooth operations and transparency regarding fees, insurance, and cancellations, please review the following information carefully.
This Financial Policy applies to all services provided by A New Hope Psychiatric Services. Policies, fees, and procedures may be updated periodically to maintain compliance with applicable laws and operational requirements. The most current version of this policy is always available on our website.
Payment Information
- A valid credit card on file is required to schedule and attend all appointments.
- Payment for services is required on the day of service.
- Charges will be automatically processed to the credit card on file within 1 hour after the appointment begins, in accordance with the signed Credit Card on File Consent Form.
- Accepted payment methods:
- Debit Cards
- Credit Cards (MasterCard, Visa)
Service Fees (Out-of-Pocket Pay)
Psychiatric Services
- Initial Psychiatric Evaluation (1 hour): $250.00
- Medication Management / Follow-Up Appointments (30 minutes): $125.00
- Medication Refills Only: $75.00
Therapy Services
- Therapist Visits (1 hour): $150.00
Psychological Evaluations
- Psychological Evaluations are cash-pay only and are not billable to insurance.
- Rate: $250 per 60 minutes.
- Minimum Time Requirement: Evaluations require a minimum of 2 hours, for a total minimum fee of $500.00, due at the time of service.
- Clients must acknowledge this policy in writing before scheduling.
- A Good Faith Estimate (GFE) will also be provided in compliance with the federal No Surprises Act.
Insurance & Reimbursement
- Insurance coverage depends on eligibility and verification completed before your appointment.
- Required paperwork must be submitted at least 48 business hours prior to confirming coverage.
- Insurance verification will determine whether you have a co-pay, co-insurance, deductible, or if services are covered at 100%.
- Clients are responsible for all costs not covered by insurance, including denied claims, deductibles, co-pays, and co-insurance.
- A New Hope Psychiatric Services submits claims as a courtesy, but final coverage decisions are made by your insurance carrier.
- We cannot waive client responsibility for insurance denials or unpaid balances.
- Self-pay rates must be elected prior to the date of service. Retroactive self-pay elections are not permitted once a claim has been submitted.
Outstanding Balances & Account Holds
- Accounts with an outstanding balance of $200.00 or more may be placed on account hold if the balance is not resolved.
- The practice will make reasonable attempts to contact the client regarding the outstanding balance.
- Clients will be provided up to seven (7) calendar days from initial notification to:
- Pay the balance in full,
- Establish a payment plan, or
- Resolve insurance or billing discrepancies.
- If the balance remains unresolved after seven (7) days, or if the client is unreachable, future non-emergent appointments may be canceled or suspended until the account is resolved.
- This policy does not apply to emergency situations. Clients experiencing urgent or emergent symptoms will be directed to appropriate emergency services.
- Administrative exceptions may be granted at the discretion of the practice and will be documented in the client’s chart.
- Account holds and appointment suspensions are administrative actions and are separate from the practice’s internal collections process or any referral to third-party collections, which may occur after additional notice and timeframes as outlined in applicable billing procedures.
Same-Day Appointment Fees
- New Appointments: $100.00 additional fee
- Follow-Up Appointments: $75.00 additional fee
(Applies regardless of insurance or self-pay status.)
Additional Fees
No-Show / Late Cancellation Fees
- Established Patients: $100.00
- New Patients: $150.00
One-Time Waiver Policy:
- A one-time waiver may be granted if the missed appointment is rescheduled within 7 days and the rescheduled appointment is kept.
- If the original provider is unavailable, patients may see another provider if available within 7 days.
- If no appointments are available within 7 days, administrative approval is required for a waiver.
- If the rescheduled appointment is also missed, both appointments will be charged.
(Please see the separate “No Show, Contact, and Arrival Policy” for complete details.)
Forms & Administrative Fees
Medical Records Requests (Florida Statute §456.057):
- $1.00 per page for the first 25 pages
- $0.25 per page for each page after 25
- Applies to both printed and electronic records
Administrative Forms (FMLA, Disability, Complex Paperwork, etc.):
- $50.00 per page (front and back)
- Maximum fee of $200.00 for 8 or more pages
- Payment required before form completion
School/Work Notes:
- Free during appointments
- $25.00 per note if requested outside of an appointment
Cancellation Policy
- All cancellations must be made at least 48 business hours before the scheduled appointment.
- Late cancellations or no-shows will be charged according to the fees listed above.
Price Changes
- All prices and fees are subject to change with prior notice.
Good Faith Estimate (No Surprises Act Compliance)
If you are paying out of pocket or are uninsured, you have the right to receive a Good Faith Estimate (GFE) explaining how much your medical and mental health care will cost. You will receive this estimate in writing before services are rendered. For questions or more information, visit www.cms.gov/nosurprises
Client Acknowledgment
By receiving services at A New Hope Psychiatric Services, you acknowledge that you have reviewed and understand this Financial Policy and accept responsibility for all fees, charges, and terms described herein.
No Show, Contact, and Arrival Policy
A New Hope Psychiatric Services
At A New Hope Psychiatric Services, we value both new and established patients and strive to provide timely, efficient care. Please review this policy carefully so appointments can be managed effectively for all clients.
Arrival Time
- New Patients: Please arrive 15 minutes before your scheduled appointment.
- Established Patients: Please arrive 5 minutes before your scheduled appointment.
- Late Arrivals:
- Patients arriving more than 10 minutes late for psychiatric appointments (e.g., medication management, psychiatric evaluations) may need to be rescheduled at the provider’s discretion.
- Patients arriving more than 15 minutes late for therapy appointments will also need to be rescheduled.
- Missed or late appointments will be subject to the No Show / Late Cancellation Policy below.
Appointment Reminders
- Text message reminders are sent several days before appointments, giving clients ample time to cancel or reschedule if needed.
- Appointments must be canceled or rescheduled at least 48 business hours in advance to avoid fees.
- Reminders are provided as a courtesy and do not replace the client’s responsibility.
No Show / Late Cancellation / No Contact Policy
- Appointments canceled or rescheduled less than 48 business hours before the scheduled time, or appointments where the patient does not attend, will be charged as follows:
- Established Patients: $100.00
- New Patients: $150.00
- A one-time waiver may be granted if:
- The missed appointment is rescheduled within 7 days,
- The rescheduled appointment is kept, and
- The original provider has availability within 7 days.
- If the original provider is unavailable, patients may choose another provider only if an appointment is available within 7 days.
- If no appointments are available within 7 days, the one-time waiver may be granted only with administrative review and approval.
- If the rescheduled appointment is also missed, both the original and rescheduled appointments will be charged the applicable fees.
Definitions:
• No Show: Failure to appear for a scheduled appointment.
• Late Cancellation: Cancellation made less than 48 business hours before the scheduled appointment.
• No Contact: Failure to attend a scheduled appointment and failure to notify the practice before or after the appointment time.
Repeated Missed Appointments
After three (3) No Show / Late Cancellation / No Contact occurrences, A New Hope Psychiatric Services reserves the right to discharge the patient from the practice, in accordance with applicable laws and ethical standards, and with appropriate notice.
Medication and Treatment Disclaimer
- A New Hope Psychiatric Services is not responsible for adverse effects, health complications, medication lapses, or any negative outcomes resulting from missed appointments or failure to seek timely care.
- Missed appointments may delay medication refills, treatment adjustments, or the ability to discuss potential side effects with your provider.
- Continuation of treatment is contingent upon your ability to attend scheduled appointments as determined by your provider.
Important Note
For details regarding payment methods, insurance coverage, same-day fees, and other financial terms, please refer to the Financial Policy, available on our website and through the patient portal.
Credit Card on File & Automated Payment Policy
Purpose
To ensure timely payment, administrative efficiency, and transparency regarding billing practices, A New Hope Psychiatric Services requires all clients to maintain a valid credit card on file.
Policy Overview
All clients receiving services through A New Hope Psychiatric Services must authorize the secure storage of a credit card on file. This card may be used for charges related to services rendered, insurance balances, and applicable administrative fees in accordance with this policy.
Credit Card Storage & Security
- Credit card information is securely stored within the practice’s electronic systems in compliance with applicable security standards.
- Any payment method used at any time (in person, online, or by phone) may be securely stored on file and used for future charges unless authorization is revoked in writing.
Authorized Charges
The credit card on file may be charged for, but is not limited to:
- Co-pays, deductibles, and co-insurance
- Out-of-pocket service fees
- No-show fees
- Late cancellation fees
- Outstanding balances remaining after insurance processing
- Fees associated with declined or failed payment attempts
Timing of Charges
- Charges for scheduled services may be processed at the beginning of the appointment.
- No-show or late cancellation fees may be charged following the scheduled appointment time, including after any applicable grace period.
- If an invoice is issued prior to an appointment and remains unpaid 24 hours before the scheduled visit, the balance may be charged to the credit card on file.
- No invoice is required to be sent prior to processing authorized charges.
Insurance Processing & Balances
- If a balance remains after insurance adjudication, the card on file may be charged for the remaining patient responsibility without additional notice.
- Such charges are based on the Explanation of Benefits (EOB) issued by the insurance carrier and do not constitute balance billing.
Cardholder Responsibility
- Clients are responsible for maintaining accurate and current card information.
- If a card expires, is replaced, or is declined, the client must promptly update their information.
- Failure to maintain valid payment information may result in delayed services, appointment cancellation, or account hold.
- If the client is not the cardholder, the client confirms authorization from the cardholder to use the card for payments.
Multiple Cards on File
- If multiple cards are stored on an account, the client must designate a preferred card.
- If no preferred card is designated, A New Hope Psychiatric Services may use any card on file to process authorized charges.
Disputes & Chargebacks
- Clients agree to contact A New Hope Psychiatric Services directly regarding billing questions or disputes prior to initiating a chargeback.
- Charges made in accordance with this policy and related consents should not be disputed with the card issuer.
- In cases of fraudulent activity, the practice will cooperate with appropriate authorities.
Revocation of Authorization
- Authorization to store and charge a credit card remains in effect until revoked in writing by the client.
- Revocation does not eliminate responsibility for charges incurred prior to revocation.
- Services may be limited or suspended if a valid payment method is not maintained.
Policy Availability & Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Client Rights and Responsibilities Policy
Purpose
To outline the rights and responsibilities of clients receiving services at A New Hope Psychiatric Services and to promote respectful, ethical, and legally compliant care.
Client Rights
Clients receiving services at A New Hope Psychiatric Services have the right to:
Confidentiality in all matters related to treatment, programming, and services, except as otherwise required or permitted by law.
Actively participate in decisions regarding their care.
Be treated with dignity, courtesy, and respect.
Receive services free from discrimination based on race, color, religion, sex, age, national origin, disability, political beliefs, veteran status, or sexual orientation.
Know the name, role, and professional qualifications of their clinician.
Access their client records in accordance with applicable federal and state laws.
Receive clear information regarding fees for services.
Client Responsibilities
Clients receiving services at A New Hope Psychiatric Services are responsible for:
Providing accurate and complete information necessary for treatment and billing purposes.
Notifying the practice in advance if an appointment needs to be canceled or rescheduled, in accordance with the No Show, Contact, and Arrival Policy.
Refraining from verbal abuse, threats, or aggressive behavior toward staff or providers.
Paying any required fees for services in accordance with the Financial Policy.
Notifying the practice of any changes to behavioral or medical advance directives.
Respecting the confidentiality and privacy of treatment sessions. Audio or video recording of sessions is strictly prohibited unless explicitly authorized in writing by both the client and the provider. Unauthorized recording may result in termination of services and may also violate Florida law, including Florida Statute § 934.03.
Complying with A New Hope Psychiatric Services policies, procedures, and safety requirements necessary for the delivery of care.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Acknowledgment
By receiving services at A New Hope Psychiatric Services, clients acknowledge and agree to comply with this policy.
Patient Non-Discrimination Policy
Purpose
A New Hope Psychiatric Services is committed to providing high-quality psychiatric care in an environment that is free from discrimination, harassment, and bias. This policy affirms our commitment to treating all patients with dignity, respect, and compassion, in accordance with applicable federal, state, and local laws.
Policy Statement
A New Hope Psychiatric Services does not discriminate in the provision of services, treatment decisions, employment practices, or administrative operations on the basis of any legally protected characteristic.
Care is provided without regard to:
- Race
- Color
- Ethnicity
- National Origin
- Ancestry
- Religion
- Sex
- Gender
- Gender Identity or Expression
- Sexual Orientation
- Marital Status
- Disability
- Age
- Military or Veteran Status
- Genetic Information
- Any other characteristic protected under applicable federal, state, or local law
Clinical Decision-Making
All clinical decisions — including but not limited to psychiatric evaluations, diagnoses, medication prescribing, treatment planning, and recommendations for services — are based solely on:
- Medical necessity
- Clinical judgment
- Patient safety
- Applicable legal and ethical standards
- The best available medical evidence
Personal characteristics, beliefs, or protected statuses never influence clinical care decisions.
Workforce Compliance
All providers, employees, contractors, trainees, and staff members of A New Hope Psychiatric Services are required to comply with this Non-Discrimination Policy as a condition of their role within the practice.
Discrimination, harassment, or bias by or toward patients, staff, or providers will not be tolerated and may result in corrective action, up to and including termination of employment or contractual relationships.
Patient Conduct Expectations
Patients are expected to engage in care in a manner that is respectful, courteous, and professional toward providers, staff, and others.
A safe and therapeutic treatment environment depends on mutual respect, appropriate boundaries, and professionalism.
Behavior that is discriminatory, harassing, threatening, or abusive may result in limitations on services or discharge from the practice, in accordance with the Discharge and Termination from Practice Policy and applicable legal requirements, including appropriate notice and transition of care.
Concerns and Reporting
Patients who believe they have experienced discrimination are encouraged to notify the practice.
Concerns or complaints may be submitted in writing to the Administrative Office. All reports are reviewed promptly and addressed in accordance with applicable laws, professional standards, and internal procedures.
Legal Compliance
A New Hope Psychiatric Services complies with all applicable federal, state, and local non-discrimination laws and regulations, including but not limited to those enforced by the U.S. Department of Health and Human Services and the State of Florida.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Notice of Privacy Practices
Purpose
This Notice of Privacy Practices (“Notice”) describes how medical information about clients of A New Hope Psychiatric Services, LLC may be used and disclosed and how clients may access this information. This policy is maintained in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and applicable federal and state law.
Protected Health Information (PHI)
Protected Health Information (“PHI”) includes individually identifiable health information relating to a client’s past, present, or future physical or mental health condition, the provision of healthcare services, or payment for healthcare services.
This Notice explains how PHI may be used and disclosed and outlines the rights clients have with respect to their PHI.
Legal Duties of the Practice
A New Hope Psychiatric Services is required by law to:
- Maintain the privacy and security of PHI
- Provide notice of legal duties and privacy practices regarding PHI
- Abide by the terms of the Notice currently in effect
The practice reserves the right to change the terms of this Notice. Any revised Notice will apply to all PHI maintained by the practice. The most current version of this Notice is available on the practice website and upon request.
Permitted Uses and Disclosures of PHI
Treatment
PHI may be used and disclosed to provide, coordinate, or manage healthcare treatment and related services. This includes consultation with other healthcare providers, clinical supervisors, or members of a treatment team involved in a client’s care, as permitted by law.
Payment
PHI may be used and disclosed for billing and payment activities, including eligibility determinations, claims processing, medical necessity review, utilization review, and collection activities. Only the minimum necessary PHI will be disclosed for these purposes.
Health Care Operations
PHI may be used or disclosed for healthcare operations such as quality assessment, licensing, accreditation, training, compliance activities, and general business management. PHI may be shared with business associates who are contractually obligated to protect the confidentiality and security of PHI.
Appointment Reminders and Care Coordination
PHI may be used to contact clients regarding appointments, treatment alternatives, or other health-related services.
As Required by Law
PHI may be disclosed when required by federal or state law, including mandatory reporting requirements and government audits.
Serious Threat to Health or Safety
PHI may be disclosed when necessary to prevent or lessen a serious and imminent threat to the health or safety of a client or others, consistent with applicable law and ethical standards.
With Verbal Permission
PHI may be disclosed to family members or others involved in a client’s care with the client’s verbal permission, when appropriate.
With Written Authorization
Uses and disclosures not otherwise permitted by law will be made only with written authorization. Authorizations may be revoked in writing, except to the extent that action has already been taken in reliance on the authorization.
Client Rights Regarding PHI
Clients have the following rights regarding their PHI:
- Right to Access and Copy: Clients may inspect or obtain a copy of their PHI, subject to limited exceptions permitted by law. A reasonable, cost-based fee may apply.
- Right to Amend: Clients may request an amendment to their PHI if they believe it is incorrect or incomplete. Requests may be denied as permitted by law.
- Right to an Accounting of Disclosures: Clients may request an accounting of certain disclosures of PHI. A reasonable fee may apply for multiple requests within a 12-month period.
- Right to Request Restrictions: Clients may request restrictions on certain uses or disclosures of PHI; the practice is not required to agree to all requests.
- Right to Request Confidential Communications: Clients may request communications in a specific manner or at a specific location.
- Right to Be Notified of a Breach: Clients have the right to be notified following a breach of unsecured PHI that may compromise the privacy or security of their information.
- Right to a Paper Copy: Clients may request a paper copy of this Notice at any time.
Complaints
Clients who believe their privacy rights have been violated may file a complaint with A New Hope Psychiatric Services or with the U.S. Department of Health and Human Services. Clients will not be retaliated against for filing a complaint.
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Phone: (202) 619-0257
Privacy-related questions or concerns may also be directed to the practice’s Privacy Officer.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Telehealth Services Policy
Purpose
This policy establishes standards for the provision of telehealth services at A New Hope Psychiatric Services in compliance with Florida law, federal regulations, and professional standards of care. Telehealth is used to improve access to care while maintaining patient safety, confidentiality, and clinical appropriateness.
Definition of Telehealth
Telehealth refers to the delivery of healthcare services through secure, interactive audio and/or video communication technology when the provider and client are in different physical locations. Telehealth may be used for psychiatric evaluations, medication management, psychotherapy, care coordination, and related services when clinically appropriate.
Telehealth does not include emergency services and is not suitable for all clinical situations.
Clinical Appropriateness
Telehealth services are provided only when:
- Clinically appropriate based on the provider’s judgment
- Consistent with applicable laws and professional standards
- The client has provided informed consent for telehealth services
Providers may determine at any time that telehealth is not appropriate and may recommend in-person care or referral to a higher level of care.
Licensure and Jurisdiction
Telehealth services are provided only by licensed clinicians acting within the scope of their professional licensure and in compliance with Florida law. Providers must ensure that telehealth services are delivered in jurisdictions where they are legally authorized to practice.
Privacy and Security
Telehealth services are conducted using platforms that meet applicable privacy and security standards. Reasonable administrative, technical, and physical safeguards are used to protect protected health information (PHI).
Clients are encouraged to participate in telehealth sessions from a private location and to take reasonable steps to protect their own privacy.
Emergency and Crisis Limitations
Telehealth services are not intended for emergency or crisis situations.
- Clients experiencing emergencies are instructed to call 911 or seek emergency medical care.
- Providers do not deliver emergency services through telehealth.
- Providers may require verification of the client’s physical location at the start of telehealth sessions.
- Providers may redirect care or terminate telehealth sessions when patient safety cannot be ensured.
Documentation and Records
Telehealth encounters are documented in the client’s medical record in the same manner as in-person services. Records are maintained in accordance with HIPAA and applicable state and federal laws.
Billing and Financial Practices
Telehealth services are billed in accordance with the practice’s Financial Policy and applicable payer requirements. Coverage varies by payer and plan. Clients are responsible for applicable copayments, deductibles, and non-covered services.
Consent Requirements
Clients must complete a Telehealth Services Informed Consent prior to receiving telehealth services. Consent may be withdrawn at any time without affecting the client’s right to future care, though in-person services may be required if telehealth is declined.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Electronic Communication & SMS Policy
Purpose
This policy governs the use of electronic communications, including SMS text messaging, email, and patient portal messaging, to ensure compliance with HIPAA, the Telephone Consumer Protection Act (TCPA), and applicable federal and state laws.
Scope of Electronic Communications
Electronic communications may be used for:
- Appointment reminders
- Scheduling and administrative communication
- Billing and payment notifications
- Practice-related information
Electronic communication is not used for emergency or crisis care.
Privacy and Security Considerations
Electronic communications carry inherent privacy risks, including unauthorized access to devices or accounts. The practice takes reasonable steps to safeguard PHI but cannot guarantee absolute security.
Clients are informed of these risks prior to consenting to electronic communication.
SMS Text Messaging
SMS text messaging is used only with client consent and is limited to non-marketing, care-related communication. Mobile numbers are not sold or shared for marketing purposes.
Clients may opt out of SMS messaging at any time by replying “STOP” or by notifying the practice.
SMS consent is voluntary and not a condition of receiving treatment.
Email and Patient Portal Communication
Email and portal messaging may be used for non-urgent communication. Clients are responsible for monitoring messages sent through these channels. Providers do not guarantee immediate responses to electronic messages.
Consent and Revocation
Clients must complete an Electronic Communication & SMS Consent prior to receiving electronic communications. Consent may be revoked at any time verbally or in writing.
Revocation of electronic communication consent does not affect a client’s right to receive care.
Workforce Responsibilities
All workforce members must comply with this policy and use electronic communication only in accordance with practice procedures and applicable law. Unauthorized or inappropriate use of electronic communication may result in corrective action.
Policy Availability and Updates
This policy applies to all electronic communications conducted by A New Hope Psychiatric Services and may be updated periodically.
Session Recording Policy
Purpose
A New Hope Psychiatric Services is committed to protecting the privacy, confidentiality, and therapeutic integrity of all clinical services. This policy establishes clear restrictions regarding the recording of sessions to safeguard clients, staff, and providers and to ensure compliance with applicable federal and Florida law.
Scope
This policy applies to all sessions and communications, including but not limited to:
- In-person sessions
- Telehealth sessions
- Telephone-based clinical encounters
This policy applies to all clients, providers, staff, contractors, and any individuals participating in services with A New Hope Psychiatric Services.
Prohibition on Recording
Audio, video, or digital recording of any session or clinical interaction is strictly prohibited unless explicitly authorized in writing by both the provider and the client.
Unauthorized recording includes, but is not limited to, recordings made via:
- smartphones
- computers
- tablets
- wearable devices
- third-party applications
- hidden or passive recording tools
Florida Law Compliance
Florida is an all-party consent state under Florida Statute § 934.03. Recording a private communication without the consent of all parties is unlawful and may expose the individual making the recording to civil and/or criminal liability, including damages and attorney’s fees.
Practice Enforcement
Violation of this policy may result in corrective action, up to and including termination of services, in accordance with the Discharge and Termination from Practice Policy.
Any unauthorized recording may not be:
- used
- disclosed
- published
- transmitted
- distributed
Unauthorized recording may also compromise the confidentiality of other clients, providers, or staff and may be addressed through appropriate legal or administrative channels.
Permitted Recording – AI Scribe Technology Only
The only exception to this policy is the practice’s approved AI scribe technology, which may be used solely with the client’s separate written consent.
Client-initiated recordings, whether for personal, legal, or third-party use, remain strictly prohibited under this policy.
Policy Availability and Updates
This policy applies to all services and sessions provided by A New Hope Psychiatric Services and may be updated periodically.
Good Faith Estimate (GFE) Policy
Purpose
The purpose of this policy is to ensure compliance with the No Surprises Act and applicable federal regulations by outlining the procedures for providing Good Faith Estimates (GFEs) to uninsured and self-pay clients. This policy supports transparency, protects clients from unexpected medical bills, and establishes consistent internal practices for documentation and delivery.
Policy Statement
A New Hope Psychiatric Services provides a Good Faith Estimate (GFE) to all uninsured or self-pay clients for non-emergency services when required by law.
The GFE outlines the expected out-of-pocket charges for scheduled services based on information available at the time of scheduling.
Applicability
This policy applies to:
- Uninsured clients
- Clients who elect self-pay and decline use of insurance
- Non-emergency psychiatric, psychotherapy, and psychological services
This policy does not apply to:
- Clients using insurance for services
- Emergency services
- Walk-in encounters where no scheduling occurs
Timing of GFE Delivery
A Good Faith Estimate will be provided:
- At the time a self-pay or uninsured client schedules services, or
- Upon request by the client
GFEs are delivered prior to services being rendered, in accordance with federal requirements.
Content Requirements
Each Good Faith Estimate must include:
- Practice name and identifying information
- Patient name
- Date the estimate is provided
- Payment status (Self-Pay / Uninsured)
- Description of expected services
- Itemized expected charges
- Required No Surprises Act disclosures, including:
- Statement that the GFE is not a contract
- Explanation of the $400 dispute threshold
- Information on how to dispute a bill
Flat-Fee Pricing Model
A New Hope Psychiatric Services operates under a flat-fee pricing model for self-pay services. GFEs reflect the current standard out-of-pocket rates, including but not limited to:
- Initial Psychiatric Evaluation
- Psychiatric Follow-Up / Medication Management
- Psychotherapy Services
- Psychological Evaluations
If services change materially, an updated GFE will be provided when required.
Acknowledgment of Receipt
Client acknowledgment of receipt of a GFE:
- Is optional
- Is not required for compliance
- Does not constitute acceptance, consent for treatment, or financial obligation
Optional acknowledgment may be documented electronically when available.
Documentation and Recordkeeping
- A copy of each GFE is maintained in the client’s medical record
- Delivery of the GFE is logged via the practice’s intake or scheduling system
- GFEs are retained in accordance with federal and state record retention requirements
Workforce Responsibilities
All administrative and clinical staff involved in scheduling, intake, or billing are responsible for:
- Identifying uninsured or self-pay clients
- Ensuring timely delivery of GFEs when required
- Documenting delivery appropriately
- Referring questions regarding GFEs to the Privacy Officer or Clinical Director as needed
Failure to follow this policy may result in corrective action.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
DISCHARGE / TERMINATION FROM PRACTICE POLICY
Purpose
A New Hope Psychiatric Services is committed to providing safe, ethical, and clinically appropriate mental health care. This policy establishes the circumstances under which a client may be discharged or terminated from specific services or from the practice and outlines the procedures used to ensure compliance with applicable federal and Florida law, professional standards, and patient safety requirements.
Discharge decisions are made to protect patient safety, provider integrity, staff safety, and the therapeutic environment.
General Policy Statement
Discharge or termination is not automatic and is determined on a case-by-case basis using clinical judgment, patient safety considerations, adherence to treatment, legal requirements, and operational considerations.
This list of reasons for discharge is not exhaustive. A New Hope Psychiatric Services reserves the right to discharge or terminate services when continuation of care is no longer clinically appropriate, safe, feasible, or legally permissible.
Discharge decisions are not based on retaliation for protected activity and are made solely in accordance with this policy and applicable law.
Grounds for Discharge or Termination
Clients may be discharged or terminated from services, including psychiatric, psychotherapy, and/or psychological evaluation services, for reasons including but not limited to:
- An ongoing pattern of missed, late, or canceled appointments, including three (3) missed, late, or canceled appointments, as defined in the Attendance Policy
- Financial non-compliance, including failure to pay required fees, in accordance with the Financial Policy
- Failure to follow recommended treatment plans, medical instructions, or safety requirements
- Non-adherence to medication management requirements, including failure to attend required follow-up appointments
- Clinical determination that the provider cannot safely or effectively meet the client’s treatment needs
- Inappropriate use, misuse, diversion, or non-adherence involving prescribed medications
- Prescription Drug Monitoring Program (PDMP) findings, including but not limited to provider shopping, multiple pharmacies, overlapping prescriptions, undisclosed controlled substance use, or other findings that interfere with safe prescribing
- Abuse, threats, harassment, or unsafe behavior directed toward providers, staff, or other clients
- Conduct that compromises the safety, integrity, or functioning of the practice
- Provider relocation, licensure limitations, or changes in scope of practice
- Administrative or operational circumstances that make continuation of services unsafe or infeasible
Service-Specific Discharge
Discharge may apply to specific services rather than the entire practice.
- If a client is discharged from psychiatric services, they will not be eligible to receive psychiatric services from any psychiatric provider within the practice
- If a client is discharged from psychotherapy services, they will not be eligible to receive psychotherapy services within the practice
- If a client is discharged from psychological evaluation services, those services will no longer be provided
Clients may continue receiving other services within the practice only if not discharged from those services and only with clinical and administrative approval.
Discharge from one service does not automatically result in discharge from all services unless clinically or administratively indicated.
Medication Management During Discharge
When clinically appropriate and legally permissible, medication continuity may be provided as follows:
- Up to ninety (90) days of non-controlled medications
- Up to thirty (30) days of controlled substances only when all of the following conditions are met:
- The client has attended recent follow-up appointments
- No safety concerns are present
- No concerning PDMP findings exist
- No evidence of misuse, diversion, or non-adherence
- Continued prescribing is clinically appropriate and lawful
Medication continuation is not guaranteed and may be limited or withheld when patient safety cannot be ensured.
Emergency and Safety Situations
In situations involving immediate safety concerns, threats, unlawful behavior, or risk of harm, discharge may be effective immediately.
In such cases, emergency resources will be provided, and appropriate documentation will be completed.
Notification Process
Clients will be notified of discharge or termination in writing.
Notification may be delivered via:
- Patient portal
- Email on file
- USPS mail to the last known address
Notice is considered delivered when sent using any of the above methods.
The notice will include:
- The reason for discharge (when appropriate)
- The effective date of discharge
- Information regarding medication transition (if applicable)
- Referral resources and emergency contact information (e.g., 988, 911)
Continuity of Care and Referrals
When appropriate, clients will be provided with:
- A reasonable transition period
- Referral resources for psychiatric providers, therapists, psychological services, or higher levels of care
- Emergency and crisis resources
A New Hope Psychiatric Services does not guarantee availability of external providers.
Policy Availability and Updates
This policy applies to all services provided by A New Hope Psychiatric Services and may be updated periodically.
Acknowledgment
By receiving services at A New Hope Psychiatric Services, clients acknowledge that they have been informed of the Discharge / Termination from Practice Policy and agree to comply with its terms.