Niels Nielsen, MD Psychiatry

Policies

Practice Policies and Guidelines

About me and my approach: 


As I welcome you to become a patient in my practice, it is important for me to help you become familiar with my treatment approach and some of my basic practice principles.  Having a small practice has many advantages, but also comes with some limitations and it is important for both of us to have a clear understanding of how my practice operates, so we can embark on a successful relationship and engage in meaningful treatment for you.  After reviewing office policies, you will be asked to sign that you have reviewed this document.


I trained in psychiatry and psychotherapy at the University of Virginia, where I also served as a chief resident. I am board certified in Psychiatry by the American Board of Psychiatry and Neurology, working in private practice in Seattle. In my treatment approach I emphasize how physical and mental health complement each other. Through understanding social, cultural, psychological and biological aspects of one's mental health, I provide a comprehensive treatment to my patients.



On becoming a patient:


Initial evaluation:

Our first appointment will be a consultation which generally lasts around one hour.
 

  • Before the first appointment I will provide you with a brief intake form that I require you to fill out before the time of the appointment and bring with you.  The form will ask some questions about your demographics and contact information, contact names and numbers for your other providers and will help me better understand reasons for you seeking treatment.  Having this information available before the initial evaluation will make our time spent at the appointment more worthwhile and focused.   
     
  • Sometimes further appointments may be required for me to complete this consultation, before I can conclude my assessment and discuss treatment recommendations.
     
  • The initial appointment is a consultation ONLY.  At the end of the initial evaluation or consultation, we will make a mutual decision on whether my practice fits your needs and expectations.  This means that I may decide that my practice cannot meet your needs and will not be able to accept you as a patient.   
     
  • Until we make a mutual decision to begin treatment, I will not initiate any treatment or prescribe medications.  There are times when 2-3 appointments are necessary to complete a thorough evaluation and recommend appropriate treatment.  If I decide that you require a different type of treatment or a more intensive level of care, I will do my best to provide you with appropriate resources.
     
  • I will do my best to provide recommendations that meet your needs, expectations, and abilities. However, you may not agree with my recommendations, and decide we are not a good fit. My initial appointment fees are for my time in assessing your needs and providing recommendations. Fees still apply, even if you decide to not continue our relationship.  
     
  • If you miss the initial appointment, it will NOT be rescheduled.
     

Communication and Collaboration with other providers:


  • In most circumstances a recent physical is required before psychiatric medication is prescribed. It is expected that every patient has established care with a primary care provider (a family physician, internist or pediatrician) before they see a specialist such as myself.
     
  • If you have had previous mental health providers, I may find necessary request to communicate with them or obtain records before we begin treatment.  
     
  • If you are currently in treatment with another psychiatrist (or psychiatric NP) and are seeking a second opinion, I welcome such consultation, but also request to have an opportunity to communicate with the current provider.
     
  • If you are transferring care to me from another provider, please understand that I may not agree with their treatment plan and may not be able to automatically renew the medications you have been receiving.  I will however review your past records and history and we will work on the most appropriate treatment plan together.  When transferring any care to me, prior records are always required before an intake appointment is scheduled.
     

Privacy:


  • Please review the privacy policy that has been provided for you before starting treatment.  
     

Frequency of appointments:


  • The frequency of our appointments will be variable depending on your needs (generally ranging from once a week to once a month)
     
  • It is expected that every patient is seen in the office, in person, at least once every 3 months.  
     
  • Once desired stability is achieved and you prefer to have your PCP continue with prescribing of medications (assuming they are comfortable doing so) and follow up with me only when adjustments need to be make, this may be acceptable in some situations.
     

Telemedicine appointments:


  • In some cases I may offer you the option to have appointments by video-conferencing technology, such as Skype, for your convenience.  
     
  • This may not be suitable to all patients.  
     
  • If that is something you desire, I do require at least one initial face-to-face evaluation, and one face-to-face visit each year.  
     

Medications:


  • Please notify me at least a week in advance if you require a medication refill.   
     
  • For controlled substances (e.g. stimulants for treatment of ADHD) I do not routinely refill them without an appointment.
     
  • Controlled medications will not be replaced if they are lost or stolen (unless a police report is provided).  
     
  • Controlled medications will not be prescribed earlier than scheduled.   
     
  • If you feel the need to have a different dosage of the medication, you must schedule an appointment to review your treatment.
     
  • Controlled medication prescriptions are confirmed by the online state prescription database, as per state requirements, to ensure that duplicate prescriptions are not written by other prescribers.  When consulting the Washington Prescription Monitoring Program database, I must enter your name and date of birth, identifying myself as your provider.
     
  • Every patient is responsible of updating all their physicians of any new medications that are prescribed to them.  I expect that you will provide me with an updated list of medications prescribed by others, to ensure that medications do not interact in unsafe ways.   
     
  • It also remains to be your responsibility to notify your primary care provider of medications that you are being prescribed (although we will certainly go over any potential interactions during an appointment).
     
  • At times an unscheduled toxicology screen may be necessary during treatment, either to monitor for presence of any illicit substances or confirm compliance with a certain medication.
     
  • I expect that I will be the only person prescribing psychiatric medications during our treatment.
     

Prior Authorizations:


  • Unfortunately many insurance companies require a “prior authorization” for some medications.
     
  • Sometimes completing a Medication Prior Authorization form may take time and I may need to charge you for that (see “Fees” below).    
     
  • I use a service called “CoverMyMeds.com” to make that easier for you and your pharmacist. I will not charge you if your pharmacy uses that service.  
     
  • If your pharmacy does not use that, please obtain the prior authorization form from the pharmacy or the insurance’s website or ask them to fax it to me. Ask the pharmacy to fill out the form as much as possible.  I will then complete the medical justification portion and send it to the insurance company for review.  I will not charge you if you and your pharmacy provide me with the correct form to fill out.  
     
  • If your pharmacist tells you that “the doctor has to call the insurance company,” you still need to either convince them to get you the form or obtain it from the insurance company.  Unfortunately I will not be able to make these calls for you, as this typically takes around 45 minutes, for which I would have to charge at an hourly rate, and I like to save you as much money as possible.   
     

Insurance:


  • At this time I do not accept new patients who wish for a provider to bill their insurance.   
     
  • You may choose to file a claim with the insurance company on your own, but I will not file any such claims on your behalf, nor will I be available to assist you in filing claims or engaging in any correspondence with the insurance company, as that will interfere with our treatment and take up the time that I prefer to utilize treating patients.   
     
  • I will provide you with a “superbill” with a diagnosis and billing code, which may be helpful to you in obtaining reimbursement from your insurance provider.
     
  • Should you need to utilize your insurance for services, please contact your insurance company for a list of participating providers, or ask them to explain their “out-of-network” reimbursement policies.  
     
  • I do not accept any new patients with Medicaid or Medicare at this practice location at this time.
     

Fees and Payment:


  • Payment is expected in full at the time of each appointment, paid by check, cash or credit card.  
     
  • New patient (first visit - 1h): $365 
  • Consultation for PCP or second opinion (90 - 120 minutes): $485 
  • 25 min (medication management): $195 
  • 50 min (medications + therapy): $280 
  • Phone call - less than 5 minutes: no charge 
  • Phone calls over 5 minutes, prior-authorization for medications, forms, etc: Pro-rated charge based on an hourly rate of $280. Your insurance will likely not reimburse you for this type of fee. 
  • If you intend to pay by credit card, I will give you a form, allowing me to store it under encryption for processing by my staff. After each session I will submit the appropriate charge to your credit card company, and provide you a receipt.   
  • Should you experience a financial hardship during the course of treatment, please discuss it with me so we can come up with a plan of action immediately in order for you not to have an interruption in your care.
     

Cancellations / Missed Appointments:


  • You will not be charged for cancellations made more than 24 hours in advance.  
     
  • You can cancel by sending me an email, or leaving me a voice mail.  
     
  • Cancellations made less than 24 hours in advance are billed at 1/2 the appointment rate.  
     
  • Missed appointments are billed at the same rate as the scheduled length of time of your visit.  
     
  • If you are more than 15 minutes late I consider that a missed appointment.  
     
  • If you are late for the appointment, I am not able to extent the time of the appointment, as it will interfere with care of the next patient.  You will be charged for the full appointment.
     
  • Your insurance will likely not reimburse you for this type of fee.  
     

Contact Between Appointments:


  • Although I generally make myself very available to patients and encourage contact with any questions or concerns, I may not be available for your needs 24/7.  You may contact me by calling, emailing or using your Patient Portal. I will do my best to respond within 24 hours. As a solo physician, I do not have weekend or evening coverage.  
     
  • Please note that information exchanged by email may not be secure and is generally best reserved for appointment scheduling.  If you ask more detailed clinical questions by email, I will likely ask you to schedule an appointment.  Also keep in mind that email communication will become part of the medical record.
     

EMERGENCIES


  • Emails are never appropriate for use in an emergency.
     
  • Should an emergency arise and you cannot reach me immediately, please call 911 or proceed to the nearest emergency department.   
     
  • You can also call the 24-hour King County Crisis Line at 211.
     
  • Should you be hospitalized at any time, I anticipate that the inpatient physician coordinate your care with me.  If that is not done, I may not be able to continue medications that were prescribed in the hospital if I find the treatment plan to be unwarranted or potentially harmful.
     

No photography, video, or audio recording is permitted in sessions.



Services I do NOT provide:  


  • Emotional Support Animal Letters 
  • Disability Evaluations   
  • Forensic Evaluations   
  • L&I assessments 
  • Assessments for ability to return to work, ability to own a weapon, ability to drive a certain vehicle, etc. 
  • Transcranial Magnetic Stimulation / Electroconvulsive Therapy Ketamine – I can refer you to outside services.   
  • Suboxone Treatment   
  • Couples or Family Therapy   
  • Court-ordered treatment, or treatment under the Washington Involuntary Treatment Act (ITA)  
     

You have the right to review and obtain a copy of your health information, with limited exceptions. You may request a copy of your records by submitting a written request to Niels Nielsen, MD.  There may be a nominal fee to cover printing/photocopying and shipping costs.




On becoming a former patient:


People end treatment with their physicians for many reasons. It’s best to talk with me about reasons for ending our treatment relationship so that if needed I can help with your transition.  On some occasions I may encourage a patient to seek treatment with a different psychiatrist if they do not seem to be benefiting from treatment with me or simply require a different setting or different expertise.  Like most important decisions regarding relationships, this one is best made after discussion and input from patient and physician. The success of any physician-patient relationship depends greatly on indefinable qualities we sometimes refer to as "chemistry."  Because of this I want you to feel free to discuss with him your interest in changing to a different physician.

On rare occasions I may also find it necessary to terminate our treatment without your agreement.  For example, this may be done if you choose not to comply with treatment recommendations to such an extent that the treatment is ineffective.  Treatment may also be terminated if:


  • You fail to keep two appointments: either no-show or less than 24 hours cancellation.
     
  • You fail to return for an in-person appointment at least every 3 months. (If you wish to resume treatment at a later time, a new comprehensive assessment may be necessary.)
     
  • You fail to participate in or misuse your treatment.
     
  • You do not agree with my treatment recommendations (for example if I believe that you require psychotherapy in addition to medications or a neurology consultation and you do not wish to follow recommendation, we may need to terminate treatment as I do not believe in providing subpar care).
     
  • You do not pay the bill at the time of each appointment.  I do not mail out bills for later payment and do not offer payment plans.
     
  • You engage in any unprofessional, intimidating or threatening behavior.
     
  • You do not follow through on my treatment recommendations.
     
  • You see another psychiatrist or physician for management of the same or related condition and do not notify me (I do welcome you going to see someone for a second opinion, but request being able to communicate with that provider).
     
  • I am not comfortable with medications prescribed to you by another provider.
     
  • You require a higher level of care, or different treatment that I am not equipped to provide.
     
  • You misuse medications or obtain duplicate prescriptions (particularly for controlled substances) from other providers.
     
  • You are suspected of trading, selling or giving away controlled medication.
     
  • You make a request for me to misrepresent diagnosis or level of functioning in order to obtain benefits that you are not entitled to.
     

Please note that I reserve the right to terminate any patient from my practice without providing a reason.  

Under certain circumstances I will remain responsible for your care for up to thirty days after I have advised you that I will no longer provide care. This may or may not include providing continued medication refills at my discretion.