Amy Walton, MD

OFFICE POLICIES AND CONSENT FOR TREATMENT

Welcome and thank you for choosing our practice! We appreciate the opportunity to work with you. Please read this document carefully as it contains important information about professional services, business policies, and the respective rights and responsibilities of both provider and client. By signing this agreement, you are providing informed consent to engage in a treatment relationship. Please feel free to ask questions about the information below before you sign.  

Confidentiality

Trust and safety are critical to a therapeutic doctor-patient relationship and we take confidentiality very seriously. Federal law prohibits the release of any health information without your written permission, except in the following circumstances:

1. If your provider believes you may harm yourself or others

2. If your provider suspects child or elder abuse

3. If a court subpoenas your records

4. If you are using health insurance benefits, we may be required to provide information to your health plan, including some or all of your record of treatment, in order for your carrier to pay for services. Psychotherapy notes are handled separately under HIPAA and have additional protections. 

5. If you are party to child custody litigation at any time in the future, the court may order release of information about your treatment in this office. 

6. In some instances, as provided by the state law of Texas, information about your healthcare may be exchanged with other healthcare professionals involved in your treatment.

Initial Consultation

Dr. Walton and her associates are board certified in the state of Texas to practice psychiatry, which includes prescribing medications, providing psychotherapy, or both, depending upon your particular treatment needs. During your initial visit, your provider will take a detailed history and make treatment recommendations. Successful treatment requires an active and committed approach by both patient and provider and initial consultations are designed to help determine if you and we are a good fit for continued work together.   

Physician-Patient Relationship

We believe the physician-patient relationship should be collaborative. We will do our best to explain our reasoning for any treatment recommendations and engage patients in the decision making process. In turn, we expect that patients will adhere to agreed upon treatment plans, including taking medications as prescribed, attending therapy modalities recommended, and obtaining lab work. Patients who are consistently noncompliant with treatment recommendations, follow-up, and lab draws may be terminated due to the risks associated with non-adherence. We expect the patient will be forthcoming and honest in all interactions. Deliberately misleading the provider or staff may be grounds for termination from the practice.  

In an effort to provide a safe environment for everyone in the office, direct or indirect threats will result in immediate termination from the practice. This includes, but is not limited to: threatening phone calls, yelling or screaming in person or over the phone, vulgar or profane language, intimidation, or threats. We will not tolerate deliberate property destruction. The office is a gun free zone. Neither open or closed carry is permitted. 

You have the right to discontinue treatment at any time. We will assume you have discontinued treatment if you’ve missed a scheduled appointment and do not reschedule within 30 days, you fail to schedule a follow-up appointment within 3 months of your last appointment, or you have not been seen in 6 months. Upon written request, our office will transfer records to an alternate provider.

Patient-Provider Communication

The secure patient portal is our preferred method of communication with patients.  It is HIPAA compliant and more secure than email. Typically, we can respond to portal messages much faster than via email or phone calls if you have questions or concerns about your treatment outside of your scheduled appointment time. We will make every attempt to respond to messages within 24-48 business hours. You will be invited to create a patient portal account when your initial appointment is scheduled.  

At this time, our patient portal does not support patients uploading and sharing .pdf or .jpg files (ex: prior treatment records, medication lists, updated insurance cards). Therefore, we utilize Spruce, a HIPAA-compliant messaging platform, for document sharing. We will invite patients to create a secure account. After receiving the invitation, you will create a username and password, and will be able to access your secure Spruce account from the Spruce mobile app or from a web browser. Once you have established a secure connection, we can exchange secure messages. These conversations are fully secure. 

Insurance

Dr. Walton is currently accepting self-pay patients only. Sabrina is in-network for Blue Cross Blue Shield PPO and Cigna PPO plans. At this time, we do not accept Medicaid or Medicare. If we are not a provider for your insurance plan, we can provide you with a coded invoice (“superbill”) which may be presented to your insurer for reimbursement.  

*We strongly recommend you clarify your benefits and coverage before scheduling an appointment. Only your health insurance plan can describe your benefits to you or verify provider eligibility. If charges are denied by a health insurance plan they become entirely your responsibility, even if you had understood from your health insurance plan that the charges would be paid by them. 

Payment

Payment is due in full at the time of service. All patients are required to keep a current credit card on file. We will charge the card on file at the time of service, unless you request to use another form of payment prior to the end of the visit. We accept cash, checks, and most major credit cards. There is a $25 fee for returned checks. 

Fees

Our fee schedule is listed below. Paperwork such as school/work leave or accommodations, disability,  or insurance authorization forms can be time consuming for providers. We reserve the right to evaluate whether we are the appropriate clinical resource to complete these requests and/or refer accordingly.  We do not write letters for emotional support animals. 

Late Cancellations & Missed Appointments

Treatment is available by appointment only. We value every patients’ time. A space held for you is a space not available to another person seeking help. Therefore, we require at least 48 hours advance notice should you need to cancel your appointment for any reason. The full self-pay fee will be charged to the card on file for all appointments missed (10 minutes after the scheduled appointment) or cancelled with less than 48 hours notice. Please note that health insurance plans do not pay for missed appointments, therefore these charges will be entirely your responsibility. Three missed appointments or late cancellations in a 12 month period may result in termination from the practice. Patients canceling or missing their initial assessment more than twice will not be rescheduled a third time.

Medications and Prescription Refills

Prescription of psychoactive medications requires provider monitoring of medication effectiveness and side effects to ensure patient safety. Rather than discontinuing prescribed medications or adjusting dosages in between appointments, please let us know if you are experiencing intolerable side effects. 

It is our policy to prescribe enough medication and refills to last until your next scheduled appointment. It is your responsibility to schedule follow-up appointments before your prescription runs out. It is at the discretion of the doctor whether or not a medication will be refilled without an appointment. Certain scheduled medications require an appointment for each refill to ensure medical necessity. We do not prescribe pain medications. Please see your primary care physician or pain specialist for narcotics. We also do not typically prescribe benzodiazepines or other potentially habit-forming medications. At the provider’s discretion, formal psychological testing (completed by a licensed psychologist or neuropsychologist) validating a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) may be required before stimulants will be prescribed. 

Emergencies

We make every effort to respond to voicemails or portal messages within 24-48 hours.  If you need more rapid attention for your own or someone else’s safety, do not delay while waiting for our office to return your telephone call. Please call 9-8-8 or go to your nearest hospital emergency room. The suicide hotline for Travis County is 512-472-HELP (512-472-4357). You may also call Austin Oaks Hospital (512-440-4800) in the event you feel you need psychiatric hospitalization. The after-hours doctor is for emergencies only, not for routine refill requests. No new controlled substances will be called in after hours or by on-call doctors.

In compliance with the No Surprises Act issued January 1, 2022, we are asking all current and potential patients or clients to review this fact sheet.