Practice Policies & Administrative Agreement
Introduction
Welcome to Vijapura Psychiatry. This page outlines all current practice policies and serves as our full Administrative Agreement. By applying as a new patient and signing our intake agreement, you acknowledge that you have reviewed, understood, and agreed to these policies.
1. Billing & Insurance
All patients must keep a credit card on file. Beginning January 1, 2026, Vijapura Psychiatry will use PracticeQ, a HIPAA-compliant electronic health record and billing platform, to securely tokenize your card information. This means your full card number is never stored or visible to our staff — only an encrypted token is retained by PracticeQ’s PCI-certified payment processor.
If a HSA/FSA is chosen, a secondary credit card must also provided for non-eligible charges or insufficient funds.
All patient responsibility—including copays, deductibles, coinsurance, and self-pay fees—is due and will be charged to the card on file on the day of service. For telehealth visits, the card may be processed at the time of check-in or immediately following the appointment.
A $25 Declined Payment Fee applies to failed or expired cards.
Your card may be charged for:
Copays, deductibles, and coinsurance
Non-covered services
Form and letter requests
Prescription refill requests
Late cancellations and no-shows
Declined cards must be updated within 7 days. If an invoice is more than 7 days past due, any upcoming appointments will be cancelled. Repeated payment issues may require you to prepay for all future visits. Patients are responsible for any charges denied by insurance.
Insurance Eligibility & Benefits Disclaimer
As a courtesy, Vijapura Psychiatry verifies insurance eligibility using the information provided at scheduling. This verification is not a guarantee of coverage or payment. Final determination is made only after your insurer processes your claim.
Patients remain financially responsible for:
• Non-covered services
• Denied claims
• Differences between quoted benefits and final Explanation of Benefits (EOB)
We strongly recommend contacting your insurance company directly to confirm:
• Whether Vijapura Behavioral Health is in-network with your plan
• Your mental health visit copay and deductible status
• Telehealth coverage
• Coverage for CPT add-on codes (e.g., 90833)
Scheduling an appointment signifies acceptance of this policy.
2. GOOD FAITH ESTIMATE (NO SURPRISES ACT)
• Federal law requires us to provide a Good Faith Estimate (GFE) of treatment costs.
• Because psychiatric treatment varies for each individual, estimates may change over time.
• Our current estimate is available here: Good Faith Estimate.
3. Non-Covered Services
If insurance denies coverage for any reason, patients are financially responsible for the cost of care.
3A. Self-Pay (out-of-network) Rates
Board Certified Psychiatrist
Initial Evaluation: $600
Follow-up Visit: $225
Extended Follow-up (25 min): $300
Advanced Practice Practitioner (NP/PA)
Initial Evaluation: $425
Follow-up Visit: $175
Extended Follow-up (25 min): $250
4. Appointments & Cancellations
Appointments must be canceled by phone or email/sms message at least 48 hours in advance.
No-Show Fees (not billable to insurance):
New patient visit: $200
Follow-up visit: $100
Repeated late cancellations or missed appointments may result in limited scheduling availability or discontinuation of care.
5. Medical Records
Processing time: up to 7 business days.
Fees:
Electronic records (via secure email or portal): $14 administrative fee
Paper copies: $1.00 per page for the first 25 pages, $0.25 per page thereafter, in accordance with Florida Statute §456.057.
Fees cover verification, staff time, and secure preparation.
6. Communication
Appointment reminders: Sent as a courtesy via text/email. Patients remain responsible for canceling or attending appointments.
Secure Patient Portal (view only): The patient portal is used to view prescriptions, appointments, pending forms, shared documents, and payment information. The portal cannot be used for messaging.
Spruce Secure Messaging: Spruce is the preferred and recommended platform for all communication with our office. Patients are strongly encouraged to download the free Spruce app for HIPAA-secure encrypted messaging. Spruce allows secure communication for clinical questions, medication concerns, administrative requests, and document sharing. Messages are reviewed during business hours.
If a patient chooses not to use the Spruce app, communication will occur through standard SMS/text messaging. SMS is not fully HIPAA-secure on your personal device. By choosing SMS instead of Spruce, you acknowledge and accept the privacy risks associated with unencrypted communication.
Standard SMS Text Messaging: SMS is available for convenience (e.g., scheduling issues, reminders, insurance or payment updates). SMS is not fully HIPAA-secure on your personal device. By choosing to use SMS instead of Spruce, you accept the privacy risks associated with unencrypted communication.
Secure Email: The practice sends encrypted outbound email using a HIPAA-compliant system. Your personal email inbox may not be fully secure. By communicating through email, you accept this risk.
Marketing & updates: Patients may receive newsletters or practice announcements and may unsubscribe at any time.
7. Telepsychiatry Consent
Telepsychiatry is available to Florida residents only.
Benefits: Convenience, reduced wait times.
Risks: Technical issues, limited physical examination, small privacy risk.
Consent may be withdrawn at any time.
Full details are available in our Telepsychiatry Policy.
8. MEDICATION Policy
Medication refills require a scheduled appointment — no phone refills.
Patients are responsible for maintaining an adequate supply.
Auto-refill requests from pharmacies are denied.
Controlled substances must be prescribed by one provider and filled at one pharmacy.
Lost controlled medication prescriptions require a police report for replacement.
Prior Authorizations
Some medications require insurer approval. A $25 administrative fee applies per request.
Prescription Monitoring
We review prescription history through Surescripts and the Florida PDMP to ensure safety and regulatory compliance.
9. Emergencies & After Hours
Emergencies: Call 911 or go to the nearest ER.
Urgent issues: Call the office and follow the on-call instructions
Routine needs: Leave a voicemail during business hours.
10. Continuity of Care
Follow-up visits are required at least every 3 months.
Patients not seen within 4 months may have charts closed and require a new intake to resume care.
Integrated Care (Epic Community Care Network)
We participate in a secure health information exchange used by Baptist Health and Mayo Clinic.
This allows our team to review relevant labs and medical records to ensure coordinated, whole-person care.
11. Termination of Care
Either the patient or Vijapura Psychiatry may end the treatment relationship at any time.
Reasons for provider-initiated termination may include:
Repeated no-shows
Nonpayment
Treatment non-adherence
Disruptive or unsafe behavior
Patients will receive written notice and 30 days of emergency coverage to allow transition.
Outstanding balances remain due after termination.
12. Privacy Practices
Our full HIPAA Notice of Privacy Practices is available here: Privacy Policy.
13. Artificial Intelligence (AI) Scribe
We may use HIPAA-compliant AI technology to assist with documentation.
Notes are always reviewed, edited, and signed by your provider
The AI system does not store audio recordings
Your information is not used for training AI models
AI is used only for transcription support, not for medical decision-making
Patients may opt out at any time.
AI Clinical Support Tools
We may also use AI-supported evidence tools (such as OpenEvidence) to help review medical literature, treatment guidelines, or medication safety information. These tools do not access or store any patient information, and they do not make clinical decisions. All medical decisions are made solely by your clinical provider team.
14. Non-Billable Family/Collateral Visits
Family or collateral visits without the patient present are not billable to insurance.
Up to 25 minutes: $250
Up to 50 minutes: $500
Used only when clinically appropriate.
15. Telephone Calls Outside of Scheduled Visits
Brief administrative or medication-clarification calls are not billed.
Non-urgent clinical calls over 10 minutes may be billed as a professional service (not covered by insurance).
Fees
Up to 10 minutes: $150
10–20 minutes: $250
Emergency calls are never billed.
16. Additional Administrative Fees (Non-Covered Services)
Custom Letter: $75 per page
Patient Assistance Program Submission: $25
Prior Authorization Submission: $25
Narrative reports: $100
Letters: $50
FMLA/Disability forms: $50/page
17. AUTHORIZATION & CONTENT
By applying to become a patient, you consent to the following:
Examination and treatment by providers at Vijapura Psychiatry.
Release of information to insurers for billing and coordination.
Disclosure of relevant information to other treating providers, facilities, or care teams when necessary for treatment, care coordination, and safety (in accordance with HIPAA)
Assignment of Benefits: Direct payment of insurance benefits to our practice.
By signing the New Patient Administrative Agreement, you acknowledge that you have reviewed and agree to all practice policies listed on this page. Updated versions will always be available here.
Last updated October 1, 2025