AGREEMENTS | Psychsynergy Practic

TELEHEALTH VISIT

REQUIRES:

Having access to a Scale and Blood Pressure-cuff machine for keeping accurate vital assessments (e.g., weight, blood pressure, heart rate).
Being in a quiet, safe, and secure location with reliant internet connection.
Being mentally and physically present for psychiatric visits meaning not driving, working, shopping, or other activities.
Telehealth visits are only available for Georgia residents.

Refills are sent at regularly scheduled visits. Any requests outside of visit is a $35 refill fee for non-controlled and $50 refill fee for controlled medications; and requests must be done via patient portal. Refill requests are completed within 24-48 business hours after payment received. Any requests for an increase in medication or change to a new medication can ONLY be done during scheduled visits.
Please schedule future appointments in a timely manner to ensure there is no lapse in medication coverage.

Accepted payment methods include major credit/debit (Visa, Mastercard, Discover) or HSA/FSA cards. An active card must be kept on file at the time of booking a new patient appointment and to continue treatment at PsychSynergy Practices. Your card will be pre-authorized in advance and then charged PRIOR to the start of appointment. The FULL payment of the scheduled visit-type is due at the time of service. If there are insufficient funds, then services will be held until full payment received.
Payment details are vaulted securely by our payment’s processor: it is not held directly.
For self-pay patients, a Good Faith Estimate of expected charges is available per a Federal law called the No Surprises Act. Information is available in a PDF document and at cms.gov/nosurprises.

The scheduled appointment time is reserved specifically for you (or your child) to offer you my full attention and care. Therefore, if you are unable to attend the appointment, then please be sure to cancel in advance at least 2 full business days (48 hours NOT including holidays and weekends) prior to appointment.
You can cancel your appointment by sending a patient portal message via Charm EHR or via automated reminder text messages.
There is a 50% charge of scheduled appointment-type in case of late cancellations within 24-48 hours; and a FULL charge within 24-hours, no-shows, or nonadherence to PsychSynergy Practices policies. Please note that insurance companies generally will not reimburse for missed appointments or late cancellations.
Patients might be discharged from the practice for violation of office policies as well as after 3-4 No-Show and/or Late cancellation appointments in 12 months, per the discretion of the practice.

The practice does NOT take insurance. Thus, Dr. Giles is considered an “out of network” provider. Patients are billed directly and will be provided with a receipt called a "superbill" that patients can submit directly to their insurance company for possible reimbursement. It contains details regarding diagnosis, treatment, and appointment billing codes.
It is the patient’s responsibility to contact their health insurance company to determine out-of-network benefits that may be eligible for reimbursement. To check if your plan provides such benefits, quote the following CPT codes to your insurance carrier:

- initial evaluations: 99204, 99205, 90833, 90836, 90838, 90792

- follow-ups: 99213, 99214, 99215, 90833, 90836

- phone-consults: 99441, 99442, 99443

Correspondence is done via your patient portal account in the Charm EHR system as it is HIPAA compliant and secure. You can ask questions about appointments, medications, side effects, and request refills in the portal as well as view your visit summaries and upcoming appointments.
Messaging is not a substitute for actual treatment. If there is any in-depth portal communication regarding a particular concern, messages become too frequent or complex, then you will be asked to schedule an appointment.
Email should not be used for medical advice, prescription requests, or emergencies.

We do not provide urgent, crisis, or emergency services. This is a solo practice with limited office hours and therefore, there is not any after-hours clinical care. For any non-emergent issues, you can send the concern via secure messaging in the patient portal and a response will be given the following business day.
If you require immediate assistance, are feeling unsafe, or are in an emergency or a crisis situation, please do not wait for me to return your call or message.
Please call 911, or go to your nearest emergency room for any life threatening medical emergency or mental health crisis.
For urgent but non-life threatening mental health issue or crisis, please call 988.
You may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or the Georgia Crisis and Access Line (GCAL) at 1-800-715-4225, which is available 24 hours a day, 7 days a week, 365 days a year.