Terms of Service

“Welcome to my practice! Below contains important information about my professional services and business policies. Please review it carefully. My goal is to help you feel better, realizing that no honest human being can predict the future or guarantee an outcome.”

"Finding the right provider is just like dating: you don't have to marry the first one you meet!" Whether it's a good therapist, PCP, or psychiatric provider, the "right fit" is of the utmost importance. The more comfort and confidence you have in your providers, the better your treatment outcome will be!

Before your first appointment you will be asked to fill out agreement forms. These forms include; Our Terms Of Service, Patient Information Sheet, Request For Confidential Information, Informed Consent Treatment and Telehealth services. Also if applicable; Informed Consent for Medications/ Medication Management Agreement.

 Fees and charges. Office visits are billed at a rate of $350.00 per hour. Sessions include therapy (25 minutes or 50 minutes), medication review (25-50 minutes), or comprehensive evaluations (50-80 minutes). All administrative tasks including medication refills, prior authorizations, any and all correspondence with third parties including insurance companies, and any other clinical or non-clinical tasks are billed at a rate of $350.00 per hour.

 Payment. I require payment in full, by cash, check, or credit card, at the time of service. I will provide you with a claim form or receipt for health insurance reimbursement upon request. Because payment is self-pay at the time of service, no claim will be sent by Jeffrey Barkin, MD, DFAPA to your insurance company or third-party payor. Please be aware of the extent of your coverage, including any cost sharing requirements (co-insurance, co-payments, and deductibles) or the need for prior authorization. You will be financially responsible for all services provided by Jeffrey Barkin, MD, DFAPA, even if all or some payment reimbursement is denied by your insurance carrier or other third party who is responsible for payment, or such charges are not covered benefits.

Balances older than 30 days are subject to interest charges of 1.5% per month and an administrative charge of $15 per month for paper billing and collection of unpaid charges. I also hold clients with overdue balances responsible for my costs of collection, including attorney’s fees and costs, if necessary. Checks returned for insufficient funds (“bounced checks”) will be charged a $50 administrative fee in addition to the original amount of the check.

 Good Faith Estimate. You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your medical care will cost. Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a GFE for the total expected cost of any non-emergency items or services. You can also ask me, and any other provider you choose, for a GFE before you schedule an item or service. If you receive a bill that is at least $400 more than your GFE, you can dispute the bill. For questions or more information about your right to a GFE, visit www.cms.gov/nosurprises or call 1-800-985-3059.

A good faith estimate will be based on how many visits you may need which will be determined in your first session. For example; If your agreement plan is to be scheduled for 6 sessions in one year, your yearly cost would be no more than $2,100. Some patients may need more sessions than others, we will not schedule or bill you for extra sessions unless you have agreed to do so.

 Cancellation of appointments. I require two (2) business days’ prior notice to cancel an appointment. Any other cancellation you will be charged full fee for the scheduled office visit.

 Medication Management Agreement. Sometimes controlled substance medication may be prescribed as part of treatment. Prior to, and as a condition of, receipt of any controlled substance medications in connection with treatment, you will need to agree to and sign a separate Medication Management Agreement.

 Prescription refills. I typically refill prescriptions during office visits. I will consider prescription refills or changes between appointments at my discretion. Please allow at least five (5) business days for prescription requests to be filled or refilled. Medications will not be refilled based upon email or phone request directly from a pharmacy. Please keep track of your medicines so, to the extent possible, refills are not required to be phoned in by on-call coverage, off-hours, Fridays, holidays, or weekends.

 Confidentiality of protected health information (PHI). My handling of your personal medical information, known as “protected health information” (PHI) is governed by state and federal health information privacy laws, including the HIPAA Privacy Rule and 22 M.R.S.A. §1711-C, described more specifically in the Notice of Privacy Practices available to you.