Office Policies & Procedures

This document summarizes important office, financial, medication, communication, telehealth, privacy, and safety policies for patients receiving care from KwikPsych. It is intended to work as a patient-facing office policy document and intake acknowledgment. It does not replace our separate HIPAA Notice of Privacy Practices, Telehealth Policy, Good Faith Estimate, Website Privacy Policy, or Terms of Use.

By receiving services from KwikPsych, and where required by signature or electronic acknowledgment, I understand and agree to the following:

1. Welcome to KwikPsych

Welcome to KwikPsych. We are committed to providing thoughtful, evidence-based mental health care through a collaborative, team-based model. Our clinicians and staff work together to deliver care that is individualized, respectful, and within our scope of practice.

2. Insurance Authorization, Assignment of Benefits, and Financial Responsibility

Authorization to Verify Benefits

I authorize KwikPsych to contact my health plan and use my information to verify eligibility, benefits, and coverage for services.

Assignment of Benefits and Release of Information

I authorize KwikPsych to release medical and billing information as reasonably necessary to my health plan, its agents, or other appropriate entities for benefit verification, prior authorization, claims submission, payment, utilization review, and other lawful health care operations. I authorize payment of insurance benefits directly to KwikPsych for covered services rendered.

Financial Responsibility

I understand that health insurance is a contract between me and my insurance plan, not between my insurance plan and KwikPsych. I am ultimately responsible for all charges related to my care, including:

• Copays
• Deductibles
• Coinsurance
• Non-covered services
• Denied claims
• Services not paid by my insurer for any reason
• Balances remaining after insurance processing

I understand that insurance verification is a courtesy and is not a guarantee of payment.

3. Payment Policy

Payment at Time of Service

Payment information and current insurance information must be provided before or at the time services are rendered. Copays and known self-pay balances are due on the date of service unless other arrangements have been made in advance.

Accepted Payment Methods

KwikPsych accepts cash, personal checks, and major credit or debit cards, including Visa, MasterCard, American Express, and Discover, unless otherwise posted or communicated.

Card on File Authorization

I authorize KwikPsych to securely store my credit or debit card and charge it for:

• Copays
• Deductibles
• Coinsurance
• Self-pay balances
• No-show or late cancellation fees
• Administrative fees disclosed in advance
• Outstanding balances remaining after insurance processing

I understand that I am responsible for maintaining a valid card on file.

Self-Pay Rates

If I do not have insurance, do not use insurance, or receive a service that is treated as self-pay, the current practice rates are:

• Initial psychiatric evaluation: $299
• Follow-up visit: $179

Additional services, extended visits, forms, or other non-routine services may carry separate charges if disclosed in advance.

Insurance Billing

If I choose to use insurance, KwikPsych may submit claims as a courtesy. I understand that:

• Claim submission does not guarantee payment
• Out-of-network reimbursement, if any, depends on my plan
• I remain responsible for all patient-responsibility amounts and any non-covered charges

Good Faith Estimate

If I am uninsured or choose not to use insurance, I understand that I may have the right to receive a Good Faith Estimate of expected charges before services are provided. Please see our separate Good Faith Estimate page for details.

Past-Due Accounts and Collections

Balances that remain unpaid after insurance processing and notice may become past due. KwikPsych may send statements, payment reminders, and follow-up notices regarding overdue balances. Accounts that remain unpaid after reasonable notice may be subject to late fees where permitted and may be referred for collection activity or outside billing support, as allowed by law.

This collections policy does not apply to any amount that is the subject of a pending federal patient-provider dispute resolution process under the No Surprises Act, to the extent prohibited by law.

4. Appointment Policies

Scheduling

Appointments should be scheduled in advance. New and established patients may be asked to confirm demographic, insurance, pharmacy, and payment information before the visit.

Identification and Insurance

Patients may be asked to present:

• A government-issued photo ID
• A current insurance card
• Updated demographic and contact information

Cancellation and No-Show Policy

We respectfully ask for at least 48 business hours’ notice for cancellations or rescheduling.

A $75 missed appointment / late cancellation fee may apply if:

• The appointment is missed, or
• The appointment is canceled with less than 48 business hours’ notice

This fee is not billable to insurance and may be charged to the card on file.

Repeated missed appointments or repeated late cancellations may affect continued scheduling and may lead to dismissal from the practice.

Late Arrivals

Patients who arrive more than 15 minutes late may need to reschedule. If a late arrival cannot be safely or reasonably accommodated, the missed appointment / late cancellation fee may apply.

5. Medication and Prescription Policies

General Medication Management

Patients are responsible for keeping follow-up appointments and requesting follow-up care before prescriptions run out. Medication decisions are made at the provider’s clinical discretion and in accordance with applicable law.

Refill Requests

For non-controlled maintenance medications, refill requests should be submitted through the patient portal when available. Please allow 48 to 72 business hours for routine processing during normal business hours. Requests submitted after hours, on weekends, or on holidays will be addressed on the next business day.

Controlled Substances

Controlled substances are prescribed only when clinically appropriate and legally permitted. Patients receiving controlled substances may be required to:

• Maintain regular follow-up appointments
• Use one designated pharmacy unless otherwise approved
• Provide an accurate medication list and medical history
• Sign a controlled substance agreement
• Comply with monitoring requirements, including drug screening, pill counts, or pharmacy verification when clinically appropriate
• Present photo identification when requested

Early refills, replacement prescriptions, dosage changes, and requests involving lost or stolen controlled medications are not guaranteed and are handled only at the provider’s discretion and in accordance with law and clinic policy.

Prescription Monitoring and Safety

KwikPsych may review the Texas Prescription Monitoring Program, California reporting tools when applicable, pharmacy records, prior records, or other lawful sources of information when clinically appropriate and/or required by law.

Prior Authorizations and Non-Covered Medication Tasks

Prior authorizations, medication exception requests, and other non-covered administrative medication tasks may require additional processing time. Administrative fees may apply where permitted by law and payer contract, and if a fee applies, it will be disclosed in advance.

6. Telehealth Consent and Telehealth Use

KwikPsych offers telehealth services when clinically appropriate.

I understand that:

• Telehealth may be provided through secure video, audio, and other approved electronic platforms
• Telehealth may involve technical, privacy, or communication limitations despite reasonable safeguards
• I must be physically located in a state where my provider is licensed at the time of the appointment
• Telehealth services are generally billed at the same practice rate as in-person services unless otherwise stated
• Prescribing, including prescribing of controlled substances, is subject to current federal and state law and may change over time
• In an emergency or crisis situation, my provider may contact emergency services or my emergency contact if needed for safety

Please see our separate Telehealth Policy for full details.

7. AI-Assisted Documentation and Audio Processing Consent

KwikPsych may use secure, HIPAA-configured, AI-assisted documentation tools to support clinical note creation. With patient permission, these tools may process spoken information during a visit to help generate a transcript or draft documentation for clinician review.

I understand that:

• The purpose of these tools is to improve note accuracy and allow the clinician to focus more fully on the visit
• The clinician remains responsible for reviewing, editing, and signing the final note
• The final clinician-signed note becomes part of the medical record
• KwikPsych does not retain audio recordings of visits as part of the permanent record unless otherwise disclosed
• Draft transcription or processing data, if temporarily created, is used only for documentation purposes and handled in accordance with applicable privacy and security standards
• I may decline AI-assisted documentation without affecting my access to care

8. Communication Policies

Routine Business Communication

KwikPsych responds to routine phone calls, portal messages, billing questions, and administrative requests during regular business hours. Messages received after hours will generally be addressed by the end of the next business day.

Preferred Communication Methods

The patient portal is the preferred method for non-urgent clinical communication when available. Phone, email, and text may also be used for scheduling, billing, and care coordination as appropriate.

Electronic Communication Consent

I consent to receive communications from KwikPsych by phone, voicemail, patient portal, email, and text regarding appointments, billing, care coordination, and practice updates, unless I opt out where permitted.

I understand that standard email and text messaging may not always be fully secure. I understand that the patient portal is preferred for secure clinical communication and that electronic communication should not be used for emergencies.

9. Emergency and Crisis Policy

10. Administrative Services and Forms

Certain administrative services are not covered by insurance and may require advance payment.

Forms and Paperwork

• FMLA, disability, and medical forms: $40 per form completion
• Forms should be submitted through the patient portal or brought to an appointment whenever possible
• Completion is based on provider discretion, medical necessity, and available information
• Please allow 7 to 10 business days for routine completion
• Outside deadlines do not guarantee expedited completion

Additional Administrative Requests

Letters, medication forms, return-to-work or school notes, prior authorizations, and other administrative requests may require additional time and may carry a separate fee if disclosed in advance and permitted.

11. Medical Records

Medical records requests must be submitted in writing and, when required, accompanied by a valid authorization.

KwikPsych will generally process valid records requests within 15 business days.

Copy fees, if applicable, are charged in accordance with applicable law. For Texas records requests, current limits generally allow:

• Paper records: up to $25 for the first 20 pages and $0.50 per page thereafter
• Electronic records: up to $25 for 500 pages or fewer and $50 for more than 500 pages

No fee is charged for medical or mental health records requested for a disability benefits or assistance claim, where applicable.

Records may be released to:

• The patient
• A legal guardian or personal representative
• Another provider
• Another authorized recipient with a valid written authorization

KwikPsych may require verification of identity and legal authority before releasing records.

12. Privacy and Confidentiality

KwikPsych follows applicable privacy laws, including HIPAA, and maintains a separate Notice of Privacy Practices describing how protected health information may be used and disclosed.

Confidentiality is important, but it may be limited, and disclosures may be permitted or required by law in circumstances such as:

• Risk of serious harm to self or others
• Suspected abuse, neglect, or exploitation where reporting is required
• Court orders, subpoenas, or other lawful process
• Insurance billing, utilization review, or payment activities
• Health care operations such as supervision, consultation, quality improvement, compliance, and credentialing
• Collection activities allowed by law
• Medical emergencies or situations involving immediate safety concerns

In the event of a breach involving protected health information, KwikPsych will provide notice as required by applicable law.

13. Team-Based Care / APRN and PA Services

KwikPsych uses a collaborative, team-based approach to care.

As part of that model, patients may be evaluated or treated by:

• A psychiatrist
• An Advanced Practice Registered Nurse (APRN), including a Nurse Practitioner
• A Physician Assistant (PA)

Care is provided within applicable supervision, collaboration, licensure, and scope-of-practice requirements. By receiving services at KwikPsych, I understand and consent to care being delivered by an appropriate member of the treatment team.

14. Practice Standards, Safety, and Patient Conduct

KwikPsych is committed to maintaining a safe, respectful, and professional environment for patients, clinicians, staff, and visitors.

Patients are expected to treat staff and others with courtesy and respect. Behavior that may result in warning, removal, dismissal, or contact with law enforcement includes:

• Threats or intimidation
• Verbal abuse or harassment
• Physical violence or threats of violence
• Sexual harassment or sexual misconduct
• Discriminatory or hateful conduct
• Intoxication during appointments that prevents safe care
• Disruptive conduct that interferes with care or clinic operations
• Damage to clinic property
• Stalking, harassment, or threatening conduct toward staff in or outside the workplace

KwikPsych recognizes that mental health symptoms can affect behavior. When appropriate and safe, reasonable efforts may be made to de-escalate and accommodate disability-related behaviors. Safety remains the priority.

15. Patient Dismissal Policy

KwikPsych may dismiss a patient from the practice for reasons including, but not limited to:

• Repeated missed appointments or repeated late cancellations
• Failure to meet financial obligations after reasonable notice
• Abusive, threatening, or unsafe behavior
• Repeated violation of clinic policies
• Noncompliance that compromises safety or treatment integrity
• Seeking inappropriate medications or services outside the provider’s clinical judgment or scope of practice
• Providing false or misleading information regarding identity, insurance, or medical history
• Criminal conduct on clinic premises or in connection with the practice

Dismissal Process

When appropriate, dismissal will be communicated in writing to the patient’s last known address or other approved contact method.

When clinically appropriate and legally permitted, KwikPsych may offer limited bridge care for up to 30 days to allow time for transition to another provider. Bridge care is not guaranteed and may be limited by safety concerns, legal restrictions, or clinical judgment.

Medication refills during a transition period, if any, are provided only at the provider’s discretion. Controlled substances may be limited, tapered, or declined based on safety and legal requirements.

Records Transfer After Dismissal

Medical records may be sent to a new provider or authorized recipient upon receipt of a valid authorization and any lawful copying fees that apply.

16. Contact Information

17. Emergency Information