Resources

Please find important documents below:

Office Policies

Office Policies

Virginia Gardner, MSN, PMHNP-BC is a board certified adult psychiatric mental health nurse practitioner with prescriptive privileges and is supervised by Dr. Laura Reynolds, MD. If you have any questions about the office policies below, please don’t hesitate to ask.

Appointments:

Patients are seen by appointment only. Gardner Wellness will make every effort to begin sessions on time. Patients are asked to please arrive on time—should you arrive late for your scheduled appointment, you can meet for the remainder of the scheduled time. Gardner Wellness prefers a brief email as the preferred method of contact, but you may also reach Virginia by phone. Gardner Wellness prefers to make all important clinical decisions during an appointment. If your message requests a medication change or a clinical decision, you will likely be asked to schedule an appointment to discuss it further so that it may be given it full attention. Because Gardner Wellness schedules only one patient per time slot and does not double book, missed appointments will be charged the full fee and must be paid prior to rescheduling. Should you find that you need to cancel an upcoming appointment, Gardner Wellness requests 72-hours’ notice in order to avoid the late cancellation fee. This late cancellation or no-show fee is not reimbursable by insurance. Appointments should be paid for at the time of service. New patient appointments require a $75 non-refundable deposit that will be applied towards your initial visit cost. Phone or internet-based video conference appointments are available, if appropriate, and they will be charged at the same rate as in-person appointments. When you make an initial appointment, Gardner Wellness asks that you commit to meeting a total of at least three times, after which the parties will check in and make sure that the therapeutic relationship is a good fit for both.

Telehealth:

For your convenience, Gardner Wellness offers telehealth visit options for all appointment types. To protect the confidentiality of our sessions, Gardner Wellness uses a telehealth platform which is HIPAA compliant and which does not record or store the contents of patient communications. The same rules of confidentiality and privacy protection apply to remote sessions as to in-person sessions. By agreeing to these office policies, you consent to the use of a third party video conferencing platform which will facilitate any telehealth visit. If you use a non-secure internet connection (such as public wifi) you may be taking on greater risk of the privacy of the session being breached. Gardner Wellness reserves the right to decide whether telehealth visits are appropriate for your care or whether in-person visits are necessary, in which case ongoing telehealth visits will not be offered.

Pricing:

· New patient appointment (90 minutes): $250

· Standard Follow up visit (25 minutes): $120

· Extended Follow up visit (55 minutes): $200

· Prescription Refills outside of an appointment: $30

· After hours calls: $100 per 10-minute increment

· Phone call (less than 10 mins): $60

· Phone call (11-30 mins): $120

· Paperwork not completed during session: $50-120 depending on amount of time needed

· Missed appointments or cancellations less than 72 hours in advance will be charged in full

Medication Refill Policy:

Gardner Wellness will make every effort to ensure that you have enough medication to cover you until your next scheduled appointment by prescribing an appropriate number of refills at your visit. If something is accidentally missed by Gardner Wellness and needs to be refilled between appointments, you will not be charged. However, if you run out of medication due to missing/cancelling an appointment or neglecting to reschedule, you will be billed for any refills that are requested between appointments. Gardner Wellness prefers that patients request their own refills (and she reserves the right to ignore pharmacy-generated requests as these are often sent in error). Please allow up to 48 hours for refill requests through Gardner Wellness. Please don’t wait until you are out of medication to request a refill. Controlled substances have specific regulations regarding their use and more frequent visits may be required.

Insurance: Gardner Wellness is not in network with any insurance companies. As such, you can choose to keep your information private and control who has access to your psychiatric record. Payment is due at the time of service, regardless of insurance. Upon your request, Gardner Wellness will provide you with a list of fees and billing codes. If you wish to file a claim with your insurance carrier, it is recommended that you contact your insurance carrier in advance to verify your benefits and find out how your insurance may reimburse you for Gardner Wellness visits (if at all). It is your responsibility to obtain all referrals/authorizations required by your insurance plan to file your claim with your insurance company. Upon request, you can be given a completed statement of service with all the codes necessary to file an out of network claim with your insurance carrier. It is your responsibility to contact your insurance carrier and request instructions for details about how to file your claim. Gardner Wellness cannot and does not guarantee insurance reimbursement of any kind. Gardner Wellness is not a Medicare, Medicaid, or TennCare provider. Patients who have Medicare insurance policies must sign the federally-mandated “Private Contract” in order to receive services.

Services Provided: Gardner Wellness treats adults with mood disorders, including depression, bipolar, anxiety, OCD, panic disorder, social anxiety, and PTSD. She also treats ADHD. Her services are not best suited for those battling a current drug and alcohol addiction. She does not treat sex offenders nor does she provide forensic services or disability determinations. Gardner Wellness provides medication management with a focus on the whole person—taking into account biological, genetic, physical, psychological, social and spiritual factors. Time-limited cognitive behavioral therapy and CBT-I (cognitive behavioral therapy for insomnia) sessions are also available. Gardner Wellness reserves the right to end any treatment relationship, with or without cause, in accordance with and as permitted by applicable ethical laws and guidelines.

Confidentiality: Confidentiality is important to Gardner Wellness. Applicable laws, including HIPAA, dictate that confidential information is controlled by the patient or by the patient’s legal representative with some exceptions. No information will be released to a third party without your specific authorization except as required or permitted by law. Reports of child or elder abuse must be reported to the Department of Human Services. In case of an emergency, or when there is imminent danger to the patient or to other persons, the mental health provider may be required to make a report to a third party without violating any duty of confidentiality. It is possible that a judge may require that certain information be released to the court. If a medical provider or other professional refers you to this clinic, Gardner Wellness may communicate with that professional unless you instruct otherwise. If you choose to submit your out of network insurance claim, the information on your statement of service will be released to the insurance company. Gardner Wellness may provide additional information to that insurance company as required. Typically, this can include diagnosis, billing codes and dates seen. If you would like Gardner Wellness to communicate with a family member, medical provider, or therapist about your care, a written release will be required.

Emergency Calls: If you have an emergency, you should call 911 or go to your nearest emergency room. If you urgently need to speak to Gardner Wellness about your care outside of normal business hours, you will be billed at a rate of $100 per 10-minute increment for telephone calls. Email is not appropriate for emergencies. Gardner Wellness does not guarantee an immediate response to email, voicemail or texts.

Privacy Policy. By signing below, you represent that you have read and understood the Gardner Wellness Privacy Policy as it may be amended from time to time.

I have read and understood these office policies and agree to these terms:

__________________________________________________ (Signature)

__________________________________________________ (Date)

Notice of Privacy Practices

GARDNER WELLNESS - PRIVACY POLICY

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Contact us with any questions.

Our Uses and Disclosures

We may use and share your information as we:

• Treat you

• Run our organization

• Bill for your services

• Help with public health and safety issues

• Do research

• Comply with the law

• Address workers’ compensation, law enforcement, and other government requests

• Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to:

• Get a copy of your paper or electronic medical record

• Correct your paper or electronic medical record

• Request confidential communication

• Ask us to limit the information we share

• Get a list of those with whom we’ve shared your information

• Get a copy of this privacy notice

• Choose someone to act for you, like a guardian

• File a complaint if you believe your privacy rights have been violated

Here are some additional details regarding your rights to:

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care

• Share information in a disaster relief situation

• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we NEVER share your information unless you give us written permission:

• Marketing purposes (under no circumstances will we sell your health information for marketing purposes)

• Sale of your information

• Most sharing of psychotherapy notes

Explanation of Uses and Disclosures

Here are additional details about how we typically use or share your health information:

1) Treating you

We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

2) Running our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

3) Billing for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

4) Helping with public health and safety issues

We can share health information about you for certain situations such as:

• Preventing disease

• Helping with product recalls

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

5) Doing research

We can use or share your information for health research.

6) Complying with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

7) Addressing workers’ compensation, law enforcement, and other government requests

We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, or for special government functions such as military, national security, and presidential protective services.

8) Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other Instructions

• This Notice shall be effective beginning on March 1, 2020 and thereafter during the term of your treatment at Gardner Wellness;

Virginia Gardner serves as privacy officer for Gardner Wellness and can be reached regarding any of the terms of this Notice.

• Gardner Wellness will never share any substance abuse treatment records without your written permission.