Policies 

DISCLOSURE STATEMENT

 

Tangled Minds, PLLC (hereinafter noted as Tangled Minds) is available at:

 

19590 East main Street #206    Parker, CO. 80128

Phone: 720-383-7095  /  Fax: 970-573-6592

 

The mental health professionals located at Tangled Minds are:

Pamela Collins, MSN, APRN, PMHNP-BC

Laurie Andrews, MSN, MA, APRN, PMHNP-BC

Heeyae Lim, MSN, APRN, PMHNP-BC

 

 

CONSENT FOR TREATMENT

The undersigned patient or responsible party (i.e. parent or legal guardian) consents to, and authorizes services, by a licensed provider of Tangled Minds PLLC (i.e. the provider). These services may include psychotherapy, medication therapy, laboratory tests, diagnostic procedures and other appropriate therapies as deemed by the provider.

The undersigned understands that he/she has the right to:

1.  Be informed of and participate in the selection of treatment modalities.        

2.  Receive a copy of this consent.    

3.  Withdraw this consent at any time. Use paragraph blocks to write a description, set of instructions, or provide supplemental information for your patients to help complete the form.

 

Everyone fifteen (15) years and older must sign this disclosure statement. A parent or legal guardian with the authority to consent to mental health services for a minor child/ren in their custody must sign this disclosure statement on behalf of their minor child under the age of fourteen (14) years old. This disclosure statement contains the policies and procedures of Tangled Minds and is HIPAA compliant.  You may be asked to provide additional information such as divorce decree, parenting plan etc. in order to determine who is identified as an authorized person identified to sign releases.

 

Tangled Minds is a teaching practice and often has Nurse Practitioner (NP) students. At the beginning of an appointment, you may be asked if the NP student can be present and/or conduct the session. This is up to you and within your right to not have them be present and/or conduct your session.

 

No medical or psychotherapeutic information, or any other information related to your privacy, will be revealed without your permission unless mandated by Colorado law and Federal regulations (42 C.F.R. Part 2 and Title 25, Article 4, Part 14 and Title 25, Article 1, Part 1, CRS and the Health Insurance Portability and Accountability Act (HIPAA), 45 C.F.R. Parts 142, 160, 162 and 164).

 

COMMUNICATION POLICY

a.     Routine phone calls made during business hours will be returned within 72 business hours. Please be advised that this is for brief phone calls only (for example, a question concerning current medication). Tangled Minds and individual provider emails and voicemails will not be monitored during off-business hours.

 

b.     Our hours of operation are Monday, Tuesday, Wednesday, Thursday 9am-5pm. We are closed from 12-1p for lunch.  We are closed Fridays.

 

c.     In the case of an emergency or you are not safe at any time of day/night/weekend/holiday clients should  NOT REACH OUT TO TANGLED MINDS.  

Immediately: 

1) go to your Local Hospital Emergency Room, OR

2) call 911 or 988, OR 

3) call the Local 24 Hour Crisis Line at 1-844-493-TALK (8255) OR 

4) Go to your local Crisis stabilization Unit.

 

d.     For more extensive phone calls (10 minutes or more), please schedule a phone appointment with your Tangled Minds provider.  There will be a routine charge for these phone calls based on the time spent per call; please refer to the fee schedule for additional information. 

 

e.     Please note that insurance companies will not reimburse for phone consultation fees

 

 

PAYMENTS AND INVOICES

a.     Payment is expected at the time of service.  If payment cannot be made the visit will need to be rescheduled. Accepted methods of payment include, cash or credit card (i.e. MasterCard, Visa or American Express).  Checks are not accepted.  If other arrangements have been made and payment for services exceeds 30 days from the time of service your account will be turned over to a collection agency, an attorney, or small claims court and any necessary identifying information may be disclosed for collection of payment.  I understand that I will not be seen if my account is not current. 

 

b.     I authorize a provider from Tangled Minds, P-LLC (herein referred to as Tangled Minds) to charge the credit card noted on file when the patient does not give notice 24 hours in advance for a late-cancellation or no-show, as per the Practice Policies. I understand that if I do not want my credit card billed for this purpose, I am still responsible for these fees and will be billed accordingly.  This is not applicable to Medicaid clients. 

 

c.     If the fee is not paid prior to the next appointment, that no-show or late payment fee will be added to the next appointment fee.  I understand and agree that regardless of any insurance coverage, I am financially responsible for all charges generated for this patient. I understand that unpaid balances over 30 days past due may be referred to a collection agency and this may affect my ability to be seen.

 

d.     I understand that a balance equal to or exceeding $50.00 means that I will be unable to schedule any further appointments until this balance is paid off. Tangled Minds is willing and able to work with you.  I understand that I will need to communicate with Tangled Minds regarding financial payments and a failure to make payments, failure to communicate about fees and payments, or failure to meet promises made about payments will result in discharge from Tangled Minds.

 

e.     Tangled Minds accepts several different insurance carriers.  If we do not accept your insurance your visits with providers at Tangled Minds are considered “out of network” and may be reimbursement based on your insurance company’s policy.  Please check with your insurance company as to whether or not you would qualify for out-of-network benefits.  If needed, a detailed invoice can be provided for out of network billing purposes if permitted by your insurance provider. After payment is received, the receipt emailed to you will include the information needed for you to bill your insurance company. 

 

f.      All of our billing is completed by a private company.  All efforts will be made to determine benefits prior to your appointment. However, it is your responsibility to know your benefits. 

 

g.    Phone consultations will be charged at the hourly rate and are not covered by insurance, making them an out-of-pocket expense.

 

h.     We do not do paperwork for disability or service animals.  

 

i. Please note that additional legal services incurred on your behalf will be billed at a higher rate. This includes, but is not limited to, attorney fees for preparing and complying with the requested legal services, as well as matters related to testimony, such as case research, report writing, travel, depositions, actual testimony, cross-examination time, and courtroom waiting time. The higher fee is $375.00 per hour.

     

​

FEE SCHEDULE

$300   90-minute initial intake/comprehensive diagnostic interview

$150    30-minute medication management follow up 

$200    45-minute medication management with psychotherapy appointment 

$250    50-60 minute medication management follow up with psychotherapy

$100    60-minute group therapy session

$150    No-show or less than 24-hour cancellation charge

$175    Hourly rate

$50      Routine charge for phone calls longer than 10 minutes, billed at $50 per each additional 10 minutes. This is not covered by insurance.

$375    Legal service per hour

$25      Medical Records Processing Fee.  This is not covered by insurance.

All payments are due at time of service.

 

THERE IS A LATE FEE OF $30 PER MONTH AFTER S0 DAYS DELINQUENCY. PLEASE COMMUNICATE IF YOU HAVE ANY ISSUES WITH PAYMENTS. WE WILL WORK WITH YOU!

 

CREDIT CARD AUTHORIZATIONS

You  will be expected to keep an active Credit Card or HSA Card on file with Tangled Minds, LLC, to bill for professional services. Tangled Minds will do their best to assist with navigating copays, deductibles etc. ahead of time, however it is ultimately up to you the patient to know and understand your insurance policy.  

FEES FOR ALL SERVICES ARE DUE AT THE TIME OF SERVICE.