If you would like us to release your medical information to another medical provider, or to a family member or other designated person, please complete the Authorization for Release of Medical Information Form.

  • All payments and/or co-payments are payable on the day of service, prior to the appointment.
  • The patient is directly and fully responsible for charges not covered by his/her insurance company, such as co-payments, deductibles, and balances for non-covered services. Such payment is not contingent on any settlement, judgment, or insurance payment by which the patient might recover said fee. If the patient's insurance company fails to pay the balance in full, or there is no payment made within 60 days, it is the patients responsibility to pay for services rendered. If the patient fails to notify VBH of any changes to my insurance provider or policy prior to his/her next appointment, the patient will be responsible for any charges not covered by my insurance company.
  • If the patient uses a credit card for payment and is not the cardholder, he/she must supply a notarized statement from the cardholder.
  • There will be a $25 charge on all returned checks.

Non-covered services:

VBH will make every effort to make sure my treatment is authorized by your insurance company. However, in the event that your insurance company refuses, for any reason, to authorize services as medically necessary, the patient will be responsible for all charges associated with his/her care.

There will be a fee for these services, due at the time of the request, which is not billable to insurance, and for which the patient is responsible. These fees are compliant with Florida Statutes, and these services may require up to 10 business days to complete.

  • FMLA/Medical Leave/Disability - $50 per page
  • Narrative report - $100
  • Jury duty letter - $25
  • Medical records - $1 per page up to 25 pages, and $0.25 cents per page thereafter

The patient will be charged as below for a late cancellation (within 24 hours) or for a no-show. For Monday appointments, the patient should call to cancel by the preceding Friday, as our office is closed on weekends. This charge is not billable to insurance and the patient is solely and completely responsible for this payment. 

  • New Patient visit - $150
  • MD/ARNP follow up visit - $50
  • Psychotherapy visit - $120

VBH providers do not perform telephone refills, and that the patient must be present for a face-to-face visit in order to obtain a medication refill. It is the patient's responsibility to schedule a follow-up appointment with their provider prior to running out of medication. Auto-refills requested by the pharmacy will be denied, and any lost prescriptions for a controlled substance will not be replaced without a police report. VBH providers do not prescribe narcotic pain medications such as Lortab, Norco, OxyContin, Roxicodone, Vicodin. To replace lost prescriptions, there will be a charge of $10 each. You may authorize VBH to obtain your entire prescription history from Pharmacy Benefit Programs and Pharmacy fills.

For any emergencies, such as suicidal ideation, you should call 911 or go to the nearest ER. For urgent clinical issues such as side effects from a medication, you may reach the on-call clinician by following the prompts on the main office answering machine. For routing matters, you can leave a voicemail message that will be checked the following business day. 

To ensure adequate medical oversight and practice in accordance with the accepted standard of care, patients must be seen for a visit by their provider at least every 3 months. If you have not been seen in 4 months, your chart will be closed and will require a new patient appointment in order to re-open.

The law protects the relationship between a client and a psychiatric provider, and information cannot be disclosed without written permission.

Exceptions include:

  • Suspected child abuse or dependent adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
  • If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
  • If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to me by law in order to ensure their safety.

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