William V. Healey, M. D.

PSYCHIATRY 901 BOREN AVENUE SUITE 1910 SEATTLE, WASHINGTON 98104 TELEPHONE (206) 624-6987 FAX (206) 292-0236

OFFICE POLICIES
Conditions of treatment vary between mental health professionals. The following information outlines these conditions as they pertain to my office. Please feel free to ask questions and seek clarification at any time. APPOINTMENTS AND FEES: The fee for the initial evaluation is $450. These evaluations usually take one hour and include a report to the person who referred you to this office. In addition, this fee covers telephone follow-up as needed for medication management for a period lasting between 3 to 6 weeks. Two types of follow-up service are provided: 1.Psychotherapy sessions last 45 minutes and are charged $250. 2.Medication management appointments last 25 minutes. The charge is $150. Typically, the first follow-up appointment of this type occurs between 8 and 10 weeks after the initial evaluation. Subsequent medication management appointments are scheduled as necessary. FULL PAYMENT IS EXPECTED AT THE TIME OF SERVICE. All fees can be billed by my office directly to your insurance. You will receive a statement at the end of each month outlining your charges and balances. Special report preparation will incur a separate fee, $140 per half hour of preparation time. PAYMENT: You are responsible for paying your full fee or co-payment at the time of service. You should check with your insurance carrier about the exact nature of your mental health coverage including network coverage, co-pays, number of visits allowed and limitation on reimbursement. I AM NOT CONTRACTED WITH ANY INSURANCE CARRIERS, ALTHOUGH MANY CARRIERS ALLOW FOR OUT OF NETWORK BENEFITS. YOU SHOULD BE CLEAR ON THE EXTENT OF YOUR COVERAGE IN THIS AREA. A charge of 1% of the unpaid balance may be levied for payments that are 30 days or more overdue. CANCELLATION: Since your appointment time is reserved exclusively for you, you must cancel any appointment you are unable to keep. Full charge will be made for appointments cancelled less than 48 hours in advance, as well as for non-cancelled appointments. Insurance companies do not pay for missed appointments or late cancellation. MESSAGES and EMERGENCIES: You may reach my office by calling 206-624-6987 and leaving a message. During work hours, I check this machine frequently, and will return your call the same day. AFTER NORMAL BUSINESS HOURS YOU MUST MARK YOUR MESSAGE URGENT IN ORDER FOR THE SYSTEM TO NOTIFY ME. If I am out of town, coverage will be arranged with another psychiatrist and instructions will be found on my answering machine as to how to contact that doctor.

If you feel that you cannot wait for up to 4 hours for me to return your call, you should contact the nearest hospital emergency room or call 911, or call the Crisis Clinic in Seattle at 206-461-3222. You may also contact me by email: whealey3md@gmail.com CONFIDENTIALITY: I will hold as confidential information that we discuss, as well as the fact that you are my patient. I will not speak to any other person about your treatment without your permission. The following are exceptions where I am legally bound to provide information to another party: when you give me written consent for information to be released, I will do so; when a patient threatens to harm himself or others, it is my legal responsibility to warn the intended victim and/or contact appropriate authorities; or if I became aware of physical or sexual abuse of children or older adults, I must notify the appropriate protective service. If I receive a court order requiring that I relinquish your records, I must comply with that order. I would not do so before contacting you. Your confidentiality is of the utmost importance to me. I will not release any information about your care here, including to insurance companies, without your explicit permission. Typically, a summary report can be submitted in lieu of the full presentation of medical records to requesting agencies. HOSPITALIZATION: I do not currently provide in-patient psychiatric care. Should you need hospitalization, I will coordinate admission with a psychiatrist affiliated with a hospital. That psychiatrist will assume your care while you are in the hospital. I will be in contact with them and will be able to reassume your care when you are discharged from the hospital. MEDICATION REFILLS: Once you are an established patient, call your pharmacy and have them fax my office for medication refills. Most of the time, if you are out of refills, that indicates it is time for a medication management follow-up appointment. Some medications require a hard-copy prescription, and arrangements can be made to obtain that when needed.