STATEMENT OF POLICY:
Psychiatric Associates (PA) is
a mental health clinic providing a variety of clinical services. Each Clinician is certified or licensed by the State of Michigan
in his/her professional field. Our services are of the highest quality. If you have any questions about your treatment or
PA policies and procedures, please contact your Clinician or any of the office staff.
client confidentiality at all times. All involvement with PA is confidential. However, ethical and legal standards require
that the Clinician report information in cases of suspected child abuse, in cases where an individual demonstrates a clear
potential for self-harm or harm to others, and in cases where a Court subpoenas a client's records. In all other cases, communication
with other people or agencies will take place only after authorization has been obtained from the client, parent, or legal
Each session will start at the scheduled time. A 24-hour notice is expected
for any appointment cancellation. You will be billed for all missed appointments that are not cancelled. Insurance does not
cover this expense. Parents/legal guardians are financially responsible for their children's missed appointments. If one appointment is missed, you'll receive a letter of notification and be charged
a fee of $50 or more which must be paid within 30 days of the missed appointment. If two
appointments are missed, you'll receive a certified letter stating that two appointments have been missed and that your case
will be closed. You'll be provided with up to thirty (30) days of urgent care while securing a new provider. After thirty
(30) days you will no longer be considered an active patient at Psychiatric Associates. No further treatment (appointments,
phone calls, prescription refills, etc.) will be provided.
Your basic fee will be established at the time of your initial appointment. You are
expected to pay the fee at the time of each session unless other arrangements are made. If you have health insurance which
covers all or a portion of the fees, you are expected to provide the insurance card and authorization forms, if necessary,
and pay any copay due. You are also responsible for informing our office whenever your insurance information changes. Additional
fees may be charged for services such as telephone calls; calling in a prescription; crisis intervention; psychological testing;
written statements; reports to attorneys, Courts, schools, or insurance companies; and Court testimony.
statements will be send monthly. You are expected to pay this balance each month. If you have any questions about your statement
please call our office or the billing office number listed on your statement.
In an emergency situation,
call 911, proceed to the nearest hospital emergency room, or call Community Mental Health's Emergency Services unit at (517)
- You have the right to have information about you or your family kept confidential unless you
have given your written consent or unless otherwise required by law. You must sign a Release of Information if you wish to
have your Clinicial talk to or send a report to someone else.
- You have the right to review
your case record or file in the presence of your Clinician.
- You have the right to obtain information
on the relationship of your Clinician to other healthcare professionals and facilities involved in your case.
- You have the right to file a formal complaint or grievance if you have a concern about your care or services provided
- You have the right to receive a clear explanation of any treatment or services
provided or recommended to you, including any medication prescribed and its possible side effects. You have the right to refuse
any treatment, services, or medication provided or recommended to you.
- You have the right to
review your Clinician's fee schedule and to request and receive an explanation of your bill.
have the right to be treated with dignity and respect during your treatment. No photographs or videotapes will be made without
your written consent. Once your treatment is completed, any photos or videotapes to which you gave your consent will be given
to you or othewise disposed of as specified in the Consent Form.
- You have the right not to be
discriminated against on the basis of color, race, sex, age, marital status, sexual orientation, or disability status.
- You are expected to keep appointments and to arrive on time. If
you are unable to keep the appointment, you are expected to provide notice at least 24 hours in advance. Failure to arrive
on time may result in your appointment having to be rescheduled.
- You are responsible for providing
clear and accurate information about yourself and for following your treatment plan. Please let the staff know of any changes
in your address or phone number so that your record can be kept current.
- You are responsible
for all charges accrued as a result of your treatment. You are expected to pay for services at the time that they are provided,
unless otherwise agreed upon with your Clinician in advance.
- All or part of your costs may
be covered or reimbursable depending upon your health insurance or other applicable benefits. Failure to provide updated,
accurate insurance information may result in billing complications, unnecessary delays in reimbursement, or personal responsibility
- Other clients and staff also have the right to the same respect, privacy, and confidentiality
accorded to you. You are expected to maintain the confidentiality of others while you are receiving treatment.
- As a provider clinic, we have the right to expect that our clients will conduct themselves in a manner which does
not pose a danger to themselves or others. Dangerous or inappropriate behavior or substance abuse may result in a request
that you leave the office and/or may result in termination of your treatment. Both staff and clients are expected to use courtesy
in their interactions.
You have the
right to present complaints to the staff of Psychiatric Associates either verbally or in writing. The Chief Executive Officer
or Chief Operations Officer will oversee the complaint process. You also have the right to receive a copy of Psychiatric Associates'
Office Policy Agreement at the time that you provide a complaint.
MAKE A COMPLAINT:
1. First discuss your concern with your
Clinician. If you aren't satisfied with the outcome, contact:
The Chief Executive Officer -- Susan Michalowski, NP, BC
The Chief Operations Officer -- Lisa Whitehead, ACSW
2. Psychiatric Associates
will receive, investigate, and respond to your complaint in writing, within ten (10) working days. Psychiatric Associates
will notify your Clinician of your complaint and discuss any action that should be taken. For complaints, please contact the
office at the phone number or address listed below.
4084 OKEMOS ROAD
OKEMOS, MI 48864
Telephone: (517) 347-4848
Fax: (517) 347-4844