OFFICE PRACTICES & BILLING READING LIST
FORMS NOTICE OF PRIVACY PRACTICES CONTACT US
 
 
 

Zev S. Nathan, M.D., Ph.D.

OFFICE PRACTICES AND BILLING

 

Dear Clients:

I feel that I am better able to serve you if you are aware of my office practices. Please read over the following and then sign two copies, one of which you should keep.

EVALUATIONS: In order to develop a treatment plan that we can all agree upon, I have found it most productive to begin treatment of children and adolescents, and often adults, after an evaluation period.

CONFIDENTIALITY: All communications between adult patients and myself are kept strictly confidential. Communications between child patients and myself are kept relatively confidential as I explain to children and adolescents that I will have some contact with their parents. There are, however, two exceptions to confidentiality:

            If I am convinced that the patient will do harm to him or herself, or to someone else, I am required by law to take appropriate measures to assure the safety of the patient or the safety of anyone else who is threatened.

               If a patient reveals child abuse (sexual, physical, or emotional), I am required by law to report such matters to the Child Protective Services or the appropriate authorities.

EMERGENCY PROCEDURE:  If you are in crisis and need emergency assistance, contact me at 994-0898. If you are unable to reach me then call 911 or go to the nearest emergency room.

CANCELLATIONS: The appointment time has been reserved for the client. Subsequently, missed appointments and non-emergency last minute cancellations with less than 24 hours notice will be billed. Insurance companies will not pay for missed appointments.

COMMUNICATION:  Please contact Amy at amy@drzevnathan.com or 805-564-8861 for:

            Appointment changes

            Medication Refills (should be requested at least 24 hours in advance)

            Billing questions

            All forms, reports and paperwork requests

APPOINTMENTS AND FEES: The fee for the first one and a half hour consultation is $700. Ongoing fifty-minute psychotherapy sessions are billed at $400 per session. Eighty-minute psychotherapy sessions are $600 per session. Fifty-minute psychopharmacology sessions are billed at $400 per session. Twenty-five minute psychopharmacology sessions are billed at $275 per session. Phone calls longer than 10 minutes will be billed at a percentage of the hourly rate. Forms, insurance requests, disability reports and other paperwork that must be completed outside of appointment times may be billed depending upon the length of time required. Checks should be made out to Zev Nathan. Payments are to be made at the time of each session

VACATIONS: Unless previous arrangements have been made, I will not generally be answering texts, phone messages, or emails during vacations. I will respond to those messages upon my return. Please check my office voicemail for information on whether I am available or not if you do not hear back from me. I will always have a physician covering me for emergencies and medication refills while I am gone

INSURANCE: In some cases, health insurance plans will reimburse clients for a specified portion of the billed amount. I require that the client pay the entire bill and then be reimbursed by the insurance company. I will prepare a billing statement at the end of each month for you to attach to the insurance company claim form. I will, of course, be happy to help if necessary.

DELINQUENT ACCOUNT POLICY: Failure to pay your account in a timely manner will result in legal action or use of a collection agency. You will be charged for all costs incurred for this extra service.

CONTACT INFORMATION: Email address for patients is: zevnathan@gmail.com

Cellphone/text number for patients is 805.994.0898

Fax number for refills, prior authorizations, etc. is 805.966.5500

Post Office Box is PO Box 2037, Santa Barbara, CA 93120

Your signature below indicates that you have read the practice policies and procedures and agree to its terms and also serves as an acknowledgement that you have access to the Notice of Privacy Practices, which is located on my website, www.zevnathanmdphd.com or email at your request.

Please click here to print and sign

 
 

 
 

PRINTABLE FORM

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
copyright Zev Nathan, M.D., P.h.D