For your convenience, some of our current policies that you may have questions about can be found here. Please check back periodically for updates. For questions on policies not found here, please contact the office for more information.
Your patient records are confidential and no information concerning you as a
patient will be released without your written consent with few exceptions listed
in the HIPPA Notice of Privacy Practices. Disclosure of your medical information
to other providers, attorneys, family members or anyone else must be
requested and will require you to sign a release of information. Please refer the
HIPAA notice you signed for more detailed information regarding your medical records. By using your insurance, you consent to sharing medical information with your insurance company. This may include but is not limited to a DSM and/or ICD-10 diagnostic code, psychiatric evaluations and psychotherapy notes.
Insurance & Responsible Parties
It is your responsibility to confirm your mental health benefits with your insurance company. You are responsible for all co-payments, co-insurance, and deductibles at the time of service. You are responsible for all portions of fees that the insurance does not pay. Your copay will be charged to the card on file. Please notify the office of any changes in your insurance policy. Many insurance plans offer partial coverage for out-of-network providers and/or allow you to count your office visit fee towards your out-of-pocket maximum. Upon request, we will provide you with a “superbill” that you can submit to your insurance company for this type of reimbursement.
No Show & Late Cancellation Policy
Except in the case of emergencies, missed appointments that were not cancelled in advance with at least 24-hour notice will be subject to a fee. The fee for less than 24 hours' notice for the first no show/late cancellation of appointment is $100, additional no show/late cancellations will be charged at $150. Missed appointments of 3 or more may result in discharging from psychiatric treatment and services.
While electronic communication is convenient, please do not communicate personal related information via text messaging or email. These communications are not protected and cannot be guaranteed to maintain your privacy as there is a risk of third parties gaining access to your information. The most secure way to communicate with your provider is in person or through direct messaging in the patient portal.
Medication refills are handled during scheduled appointments. You are encouraged to keep your regularly scheduled appointments to avoid a $40 associated fee for medication requests handled outside of appointments. If you need a medication refill between appointments, please direct message your provider through the patient portal. Please allow a minimum of 3 business days for refill requests to be handled appropriately. We no longer accept fax requests for medication refills from your pharmacy as we receive numerous computer-generated requests that are not valid.
In the case that your appointment is conducted via telehealth, please follow appropriate guidelines:
1. Be in a private location. 2. Be sure you have a strong Wi-fi connection. 3. Be focused on your appointment. 4. Be in the state of Maryland.
Telehealth appointments will not be conducted while you are driving a vehicle or are not in a private location. It is your responsibility to be sure you have access and a good connection to your appointment prior to being seen. If you are unable to be seen for these reasons, you will need to be rescheduled and will be charged a NO SHOW/Late Cancellation Fee. Telehealth clients seen remotely are also required to have access to a scale and blood pressure cuff for monitoring vital signs to be reported at visits.
Good Faith Estimate
Right to Receive a Good Faith Estimate of Expected Charges - Under the “No Surprises Act”
Listed above are the services offered at Shine Behavioral Health, LLC, along with estimated rates, except when otherwise agreed upon with Shine Behavioral Health, LLC, or your provider. The fees above are listed in your consent forms, which you sign when you agree to treatment.
There is no pre-determined timeline for how long you will be in treatment. Our providers provide longterm and integrative treatments that are individualized to best serve the needs of each client.
The missed appointment/late-cancellation fee (less than 24 hours’ notice) is equivalent to a full session fee, and is not covered by insurance.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
• Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for services.
• You have the right to receive a Good Faith Estimate for the total expected cost of any nonemergency items or services.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your service. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
Disclaimer: The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for a service. The good faith estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the services from any of the providers or facilities identified in the good faith estimate. The estimate is based on information known at the time the estimate was created.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. There may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the good faith estimate. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. The information provided in the good faith estimate is only an estimate and that actual items, services, or charges may differ from the good faith estimate.
If you are billed substantially more than this Good Faith Estimate (at least $400 more than expected), you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care 539 Benfield Road, Suite 2, Severna Park, MD 21146 Ph: (410) 513-4513 Fax: (866) 697-4991 provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises.