Office Policies and Fees

Office Fees and Policies

A short video on “out-of-network” services and insurance reimbursement can be found here. 

Adult Patients: 18 Years + 

Nurse Practitioners: $175 Med Management / $275 45-Min family session / $350 60-Min Initial Consultation

Licensed Clinical Psychologists (PhD/Psy D): $205 -230 45-Min Therapy / $285-300 Initial 60-Min Consultation

* 90 Minute Initial adult visits (all providers) are 1.5 x hourly Initial Rate.

** Couples therapy rates approximately 20 dollars above quoted rates above.

***Dr. Pagnani has a separate fee schedule, call to discuss.

Children & Adolescents: Under 18 Years 

Administrative Requests (Children & Adults), Letters & Family phone discussions: $100/ hour. Includes any letter or form to a third party, summary of care, medical record requests and discussions about care with individuals besides the patient (with patient permission). The patient’s credit card on file is used for pre-payment. Please allow 14 days for such requests.

Appointments

Initial consultations are scheduled following a brief conversation by phone. A credit card is used to reserve your time. Evaluations are 60 or 90-Minutes in length (Neuropsychological evaluations excluded) and consist of an extensive medical and psychiatric history. Laboratory studies and a brief neurological examination may be part of your workup. With permission, your provider may request collateral information from medical providers, family or significant others, to aid in case formulation and diagnosis. The initial evaluation is considered a consultation, as it is an opportunity for both the patient and provider to decide whether they are a good fit for ongoing care (individuals are responsible for the consultation fee regardless). Should both agree to work together after this consultation, follow-up appointments are either “Medication Checks” (20-minutes in length) or 45-minute therapy/ family appointments. We will collaborate to develop a treatment plan that fits your individual needs, which may include therapy, medication management or both. If you have a therapist that you would like to continue working with, we will be happy to collaborate with that individual, provided that we can have open communication.  At a minimum, on-going patients are seen every three months.

Payment of Fees 

All fees are due at the time of service and payable by cash, check or credit card (Visa, MasterCard or Discover). Checks should be made payable to “Rittenhouse Psychiatric Associates” or “RPA.” Accounts that are delinquent may be sent to collections. All patients are required to keep an active credit card on file (used for missed appointments, phone appointments, late cancellations, administrative work, letters & family conferences). If a patient misses two appointments, they will be required to prepay via credit card when scheduling. There are no changes to these policies, when someone other than the patient is paying for visits. Additionally, paying for visits does not change confidentiality; a patient’s progress, medical record and any privileged information can still only be given with direct consent from the patient.  

Medical Insurance 

Rittenhouse Psychiatric Associates providers are out-of-network for all medical insurance companies. If you have out-of-network mental health benefits, we will be happy to assist you by supplying bills, diagnosis and other information that is requested by your carrier for reimbursement. Patients are responsible for submitting their own claims if they choose to do so.  Reimbursement is not guaranteed. Insurance companies do not always reimburse for virtual appointments (even if a patient has out-of-network benefits), and it is the patient’s responsibility to discuss this with their insurance company directly, prior to making an appointment. Rittenhouse Psychiatric Associates and its employees do not accept Medicare. Therefore, individuals with Medicare are agreeing that they will not submit receipts for visits to Medicare (doing so is fraud). 

Prescription of Controlled Medications

1. We take the prescription of controlled medications very seriously.
2. There should never be an expectation that a provider will write a patient for a controlled medication, even if the patient has previously taken a specific medication, or previously been given a diagnosis (like ADHD, Anxiety or Insomnia) by another provider.
3. If a patient has neuropsychological testing, medical records from another provider, or pharmacy records showing that they previously had a specific diagnosis or previously took a specific medication, we recommend that they bring that information to their first visit for their provider to review.
4. Even when our providers deem that a controlled medication may be appropriate, they often will wait until a patient’s second visit, to write it, so that they have time to call the patient’s previous pharmacies, review federal prescription databases, review records, and get additional information (like scales) completed by a patient (and often by family or significant others as well).
5. If a patient feels that they “need” a controlled medication urgently prescribed, we are not the right practice for them to schedule an appointment.
6. A provider disagreeing about a patient’s diagnosis or refusing to write for a controlled medication is NOT grounds for waiving the appointment fee.

Medical Records 

Our providers generally do not release patient evaluations, progress notes or therapy notes. A summary of care will be provided to patients and/or third parties when medical records are requested. The above administrative rates apply to such requests and the card on file will be used for this service. 

Discharge/Closing Charts 

Our providers may “close” or inactivate a patient’s chart for a number of reasons including but not limited to: a patient terminating care voluntarily (as when moving or finding a new provider), a patient violating a controlled substance agreement, a patient not following a provider’s treatment recommendations, a patient’s condition requiring a higher level of care than we are able to provide (as assessed by the provider), a provider assessing that they do not have the skillset required to adequately treat a patient or their condition, a patient not following up at intervals specified by the provider and a patient missing or late cancelling 2 appointments within a year.

If a patient is not seen for 3+ months (appointments are required at a minimum of every 3 months to remain an active patient), providers will mail or e-mail a letter stating that their chart will be closed unless the patient contacts their provider within a specified period of time. When a patient’s chart is “closed,” we are no longer able to prescribe that patient medications, schedule them for appointments, or assist them if they are in crisis. You are responsible for ensuring that you have office visits every 3 months or less (exact timing determined by your provider, exceptions made on a case-by-case basis) and for keeping your address & e-mail updated with our office. We are not responsible for letters not reaching their intended destination if you move or get a new e-mail and do not update us. If a patient’s chart is closed, and they would like additional information on resources in the community or finding a new provider, we will be happy to assist (call our office staff at 267- 358-6155 x 1 or email Scheduling@RittenhousePA.com to receive our referral list). Additional information on finding a new provider is listed on our website here. Your provider will also be happy to assist you directly. If your chart is closed, and you would like to restart care, we cannot guarantee availability or that we can see you back as a patient. It will be based on provider availability and discretion, and you may be required to have an initial 60-minute visit (above fees apply).

Transferring Between Providers in Our Practice

If a patient is an active patient of one of our providers, and wishes to transfer to another provider within the practice, they are to discuss this directly with their active provider after filling out a transfer request form (by discussing with our admin: scheduling@rittenhousepa.com or 267-358-6155 x 1). A transfer is dependent on BOTH the active provider confirming appropriateness to stay in the practice and the new provider agreeing to accept the patient, after reviewing the case with the active provider. A patient can transfer within the practice one time only. If a patient’s chart was closed with the practice, or their care was terminated by their provider (for example, for breaching a controlled medication contract or if a provider deemed that they did not have the skillset or resources to safely care for that patient), they may NOT re-open their chart with a new provider within the practice.

Automatic (Robotic) Text Message Appointment Reminders 

Our office utilizes an Automatic (Robotic) text message appointment reminder system. You will be provided an “opt-in” form at your initial visit, if you would like to participate in this service (standard text charges through your carrier will apply). If you decide to opt-out, our provider will exclude you from this service.

 You can also cancel this service by replying [STOP] to any automatic message from our office. 

 Missed Appointments/Weather Policy/Cancelations 

If you are unable to keep an appointment, please give 48 business hours advanced notice (with business hours being Monday thru Friday 9AM – 5PM, and they exclude holidays), otherwise you will be charged in full for the time that was reserved for you (for example, if your appointment is on a Tuesday at noon, you must cancel by the previous Friday at noon or you will be responsible for the full appointment fee). Insurance companies do not reimburse for missed appointment charges. You may cancel your appointment by calling or emailing your provider, or calling scheduling. If you are late for an appointment, you will be seen for the remainder of your reserved time. You will be responsible for the full session fee (this includes initial visits).  We do not close due to weather, unless it is a State of Emergency. If you miss a visit and we are unable to reach you by phone, your provider will run your credit card on file. Signing this form gives permission to do so. If a patient misses or late cancels for 2 appointments within a year (12 consecutive months) the provider reserves the right to discharge them from the practice and close their chart. 

Medication Requests and Prescription Refills 

Patients may call or email their provider and leave a message for prescription refills. Refills are called in Monday through Friday only, during normal business hours. Please allow 48 business hours for all requests. If you have not had an appointment within the last 3 months, there will be an associated 25-dollar fee (charged to your credit card on file). Our office takes the prescription of controlled medications very seriously. An initial face-to-face appointment AND an in-office visit every 90 days may be required by your provider, the DEA and/or the state where you reside. We will not make exceptions to local or federal regulations. If you are prescribed a controlled substance, appointments will be required for refills. Lost or stolen controlled substance prescriptions will not be replaced under any circumstances. If patients are having withdrawal symptoms due to lost or stolen controlled prescriptions, they are responsible for going immediately to the ER or calling 911 to seek immediate medical attention (i.e. we will not break our controlled medication policies because a patient states that they are having withdrawal). 

 Contacting Your Provider

Patients have access to their provider’s business phone and e-mail address. E-mail is used for scheduling and cancelling appointments, prescription requests and administrative requests only. E-mails are added to the official medical record at Rittenhouse Psychiatric Associates’ discretion. We can typically return calls and e-mails within 48 business hours Monday through Friday, 9AM-5PM. When patients call with questions that can be answered quickly, a fee will not be charged. If questions require a lengthy discussion (for example, any medication change), patients will be asked if they would like to schedule an office or virtual appointment (above rates apply). You will never be charged for a phone call, without your provider discussing it first. If a patient is abusing access to their provider’s phone or e-mail address, this may result in termination of care, at the provider’s discretion. Social media is not an acceptable form of communication for current or former patients (no exceptions).  Patients CAN “follow” our business accounts, but they are not to use Social Media for communication. Texting is never an appropriate form of communication and business lines may not accept texts. Furthermore, your provider is not responsible for responding to any information sent via text.   

Office Coverage  

If your provider is out of the office, they will leave the covering provider’s information on their answering machine and in an automatic e-mail reply. For non-emergent issues, you may call the covering provider or leave a message for your provider’s return. Prescription refills will be called in Monday through Friday 9AM-5PM. He/she will be able to respond to calls within 48 business hours. Covering providers do not refill controlled substances. Patients are responsible for keeping their appointments and re-scheduling (if they cancel or miss an appointment) several weeks prior to running out of controlled substances. We are not responsible for adverse events due to failure to do so.

Emergencies 

If you have an emergency (such as an allergic reaction to medicine, suicidal thoughts with plan to act, homicidal ideation, or a suicide attempt) you must call 911 or go to your nearest emergency room. This is a requirement, as we are not able to be available at all times and emergencies require immediate attention. After doing so, call your provider’s emergency number listed below & share it with any providers assisting you (in the ER or Crisis Center etc.).   

Emergency Lines:  These lines may not accept texts, and we are not responsible for any information texted to them. Patients must go to the ER, nearest crisis center, or call 911 before calling these numbers:

We are not always available even when calling these numbers (this is why it is vital that you call 911 or go to your nearest emergency room first). If you have any concerns about this policy, you are required to discuss with your provider (at the initial evaluation or if you develop concerns during your course of treatment). Our providers do not have admitting privileges at local hospitals, a dedicated emergency line, or support staff answering phones during evenings, holidays and weekends. We have the resources to treat patients with moderate levels of mental illness, and to be available within 48 business hours for patient needs. When calling to schedule, our office staff will ask about any history of suicide attempts, inpatient psychiatric admissions and psychosis, and patients may be referred out of our practice, if we assess that we do not have the resources to safely care for an individual. 

If a provider assesses throughout treatment with a patient, that they do not have the resources or skillset to safely care for that patient, they will discuss it directly, and provide resources to the individual to find a new provider outside of our practice, within a reasonable amount of time (for example, 90 days). Safety is extremely important to us, and it is incredibly important that we are transparent about our capabilities, resources and competencies, and practice within them.

Policies are subject to change

Contact Rittenhouse Psychiatric Associates to Schedule

Call: 267-358-6155 x 1

Scheduling@RittenhousePA.com

Or Inquire Directly through our Contact Page