Frequently Asked Questions

General

New patient availability is kept current on our scheduling page. If we are accepting new patients you will be able to find appointment dates available for booking and you can self-schedule an appointment within 3 to 30 days based on availability. Please note that our system will not allow the scheduling of appointments for new patients within 72 hours to allow time for intake forms to be completed and reviewed. Therefore, if the scheduling system states that you need to call us to schedule, please select a different appointment time further into the future.

We accept patients 18 years of age and older at this time.

While we do treat elderly, we are unable to treat anyone enrolled in Medicare; We are opted out and not currently offering the private contracts Medicare requires.

Please visit our Diagnoses page for a very detailed description of the diagnoses we treat and details on the extent that we are able to treat them.

Maybe. There are numerous considerations that go into determining whether or not medication may be appropriate. An evaluation will help further clarify if medication is appropriate for you. Even if medications are not appropriate, or if you are not interested in medication, it is often prudent to get a lab workup and medical history review that can help rule out medical conditions that may manifest with psychiatric symptoms. We do not always encourage medication use and may recommend you work with a therapist instead.

We also have a guide on depression (also applicable to anxiety) that discusses some of the cues providers use to determine when medication is warranted. While you should never self-diagnose and always seek the opinion of a licensed clinician, this may provide some basic insight into the process.

We are willing to prescribe any appropriate medication, but there are a small number medications we do not prescribe or cannot currently prescribe. We are naturally very conservative in the prescribing of all controlled (addictive) substances as they often create more problems than they solve when not used conservatively and judiciously. As a telepsychiatry service we are normally prohibited from prescribing any controlled substances unless we conduct an in-office evaluation initially and in-office follow up at least every 2 years. During the COVID pandemic this restriction has been lifted, but may resume again in the future. Please review our controlled substances policy in the eligibility section of our scheduling page for more details. Additionally, we do NOT prescribe the following medications:

  1. Benzodiazepines
  2. Sedative hypnotics are not prescribed for patients new to our practice but may be considered later in treatment, usually on a limited time as-needed basis only.
  3. Clozapine (Clozaril).
  4. Hormone replacement therapy.
  5. Long-acting (ie; 30 day), intramuscular medications of any kind.
  6. NON-psychiatric medications.

We also cannot accept any new patients who are currently taking items 1 through 3 in the list above.

We are very flexible in allowing patients to be involved in the decision making process of selecting any (NON-controlled) psychotropic medications they are interested in trying when the category of medication is appropriate for their condition.

Offering an affordable service was a focus from the outset when creating this practice, in addition to ensuring we would have adequate appointment lengths to address patient needs. When designing this practice’s business model we analyzed various ways to cut healthcare costs without impacting quality. Lower costs were achieved by eliminating unnecessary expenses and waste typical of the traditional practice model while simultaneously implementing cost-saving technological advances. For example, patients are able to self-schedule and reschedule 24 hours per day in a way that is faster and more convenient than doing so by phone – and because we do not need to handle these requests via phone we pass the savings on to our patients.

As a provider owned business we are voluntarily accepting a (much) lower rate than market norms despite high demand. This also means we do not need to make an additional profit off of our providers (in addition to their salaries), as is typical of many large practices. We give patients the option to pay for their appointments in advance in exchange for a greater discount. This helps cut down on the very high cost of “no-shows” and last minute cancellations typical at most practices. We pass all of this savings on to our patients and this allows us to reach those who may not otherwise be able to afford treatment. In most practices, patients who regularly attend their appointments are subsidizing the very high cost of others who do not – we do not believe this is fair and do not do this. These are just a few of the numerous things we have done to keep our pricing low.

Please see our About page for detailed information on the practitioner.

In addition to federal laws protecting your privacy, we take your privacy very seriously and do not disclose your record to anyone who is not directly involved in your care without your consent. There are some exceptions, such as emergencies. Please refer to our privacy policy for detailed information.

Our patient retention rates are very high compared to norms, but there is no provider in the world that is a good match for all patients. We recommend reviewing the new patient eligibility criteria on our scheduling page and visiting our who we serve page to learn more about our very niche practice design.

Please e-mail us. Email is not the most secure method of communication, so we ask that you do not discuss specific personal details about yourself or treatment over email for your own privacy and security.

Telepsychiatry

These sessions consist of live, interactive 2-way audio and video communication. We communicate the same as we would for an in-person visit but do so over the internet. You can access sessions via desktop computer, laptop, tablet, or cell phone. Our Telepsychiatry setup is as simple as they come! Fifteen minutes prior to your appointment you will automatically receive an email with a unique URL (website link) that you can enter into any web browser. The website link contains a long, randomly generated string of characters for security and it will take you to a secure, virtual waiting room where you can test your internet connection, microphone, and camera. When everything is working properly you can enter the session. You can also access the link inside the patient portal. A unique appointment link is generated for every appointment for enhanced security.

Note: Audio and video must be 2-way and interactive to deliver safe care and maintain compliance with state and federal regulations. We cannot deliver care via just audio or video, both components must be conducted in a live manner.

It is a legal requirement that patients must be inside the state of Maryland at the time of their appointments. To prevent any issues we generally say Maryland residents only. However, if you are officially a resident of another state but reside in Maryland and/or can realistically be in Maryland at the time of all remote visits, this is okay.  However, we will take steps to verify someone who resides out of state is inside Maryland at the time of their appointments. Additionally, prescriptions will always be sent to a Maryland pharmacy. We very strictly cannot treat individuals when they are outside the state of Maryland. As long as you have an appropriate location to attend the appointment it does not matter where in Maryland you are.

Not likely! If you are using a Windows or Android device Mozilla Firefox and Google Chrome are the 2 supported browsers. If you use an Apple Mac or I-Phone the supported browser is Safari. All of these browsers are free downloads if you do not already have them.

If you are using a mobile device please make sure these browser apps have permission to access your camera and microphone or the Telehealth sessions will not load or otherwise properly function.

If you have a modern laptop, tablet, or smartphone: Probably not! If you use a device with a webcam, microphone, and speakers built-in, you will not need any extra hardware or equipment.

If you use a desktop computer: You will need a basic webcam, microphone, and speakers.

A headset is recommended but not required. This will ensure no one in your immediate area can overhear the session. Although we conduct sessions in a private area on our end, we still use a headset as an added layer of privacy for our patients.

Most modern internet accounts will likely suffice. About 15mbps should be more than adequate. This is 15 megaBITs per second (mbps) or a little less than 2 megaBYTEs per second (MBps). You can check your internet connection strength in the appointment lobby.

Keep in mind that if other devices are connected to your internet, especially if streaming or downloading at the same time as your session, you will need extra speed to accommodate for that. WiFi connections are also not as strong as wired connections.

Telepsychiatry settings and capabilities can vary greatly. Telepsychiatry offers enormous convenience and cost savings over traditional office visits that require significant travel time and expense. However, safety is our number one priority and there are some risks that may not make it appropriate for all individuals. Telepsychiatry patients generally need to be a little more proactive in their treatment and meet our new patient eligibility criteria as outlined on our scheduling page. Here are some other factors or questions to consider:

  • Are you comfortable scheduling your initial evaluation and completing an intake packet online? Are you comfortable and competent with operation of basic technology and computing? Are you comfortable with most communication between us outside of appointments being conducted electronically, such as through a secure messaging service built into our patient portal? Existing patients are given several secure ways to contact us, including phone for important messages. However, we do not schedule appointments or typically communicate with patients between appointments via phone.
  • Do you have severe or complex medical conditions that require close supervision, close monitoring of vital signs or lab (blood) work, or frequent collaboration with other providers? We can work with patients to have them monitor their own vital signs if necessary. We still conduct lab work and can collaborate with other providers on rare occasions when necessary. However, individuals with complex medical or psychiatric conditions or those who need constant provider collaboration will be better served by a facility that offers in-office visits for closer supervision of their status and are not appropriate for treatment with us.
  • We may be less likely to discover or diagnose the onset of a movement disorder via Telepsychiatry. These disorders can occur from the use of neurolpetic (antipsychotic) or other medications. If we need to prescribe these medications we will thoroughly educate patients on the warning signs so they can proactively collaborate with us to prevent these.
  • We do not provide emergency services.
  • Our Telepsychiatry service is not appropriate for those in the middle of an acute (severe) crisis in which they do not have the cognitive capacity or functioning to reliably and responsibly follow treatment recommendations. This would require emergency services or close supervision from an in-office visit, depending on the circumstances of the case.

There are likely some other minor risks or limitations for Telepsychiatry that are not likely to impact the large majority of prospective patients. The convenience and cost savings are major benefits for most individuals.

If medication is deemed appropriate for you we will send an electronic prescription to a local pharmacy of your choice after completion of your 90 minute evaluation. If the medication is in stock and the pharmacy is not busy, your prescription will likely be ready for pickup within an hour.

We do not directly dispense any medications or products. We are not affiliated with any pharmacies.

We order lab testing. We may order these electronically or mail the form to you and you can take it to your local lab.

Our primary and preferred communication method is a secure messaging system available through the patient portal of our electronic medical record. It’s very easy to use and can be accessed through a computer or mobile device app. This communication is stored in your chart and also in your portal for reference as needed. We can also be reached via phone when appropriate. Lastly, encrypted email communication is available for general questions not specifically related to care.

Baltimore Psychiatry takes pride in ensuring personalized care and responses for existing patients. All communication from existing patients goes directly to a provider or a trained assistant who can respond to inquiries or forward them to the provider to answer when necessary.

Nothing special is required. If you do not frequently use your microphone, webcam, or speakers it is a good idea to test them out. While you can attend appointments from the convenience of your own home, please make sure you have a quiet area to complete the session free from interruptions.

Make sure that emails sent from our electronic medical record are not going to your spam or “promotions” folder and check those folders if you have not received your appointment link. Although you can also access the appointment link by logging into the patient portal, it is best to ensure these emails are being received appropriately.

Use an Ethernet (direct wired) connection whenever possible as this will solve the majority of connectivity issues. When an Ethernet connection is not available, we recommend remaining as close to your router as possible when using WiFi.

If using WiFi is necessary, always use password protected WiFi and never public WiFi. As a matter of policy, we will not knowingly conduct appointments over public WiFi. Data connections via LTE are not as secure as password protected WiFi. Although LTE vulnerabilities are very unlikely to cause issues, it is better to avoid using LTE whenever possible.

 

 

 

 

Scheduling and Administrative

The short answer is that we have designed our website and patient portal to do nearly everything we can do by phone much more efficiently. Attempting to do this by phone would be redundant and an extra, unnecessary expense for our patients.

The long answer is we have created a website to answer all of the questions we typically receive along with an efficient patient portal where any individual can request an initial appointment, complete the intake paperwork, pay for the appointment and meet with a provider. Patients can also cancel and reschedule at their convenience 24 hours a day and much quicker than they ever could by phone. Existing patients can also contact their provider via secure messaging or phone.

Almost all of the questions we receive over the phone are answered on our website and we are available over email for additional questions. As a Telemedicine provider we process all of the necessary legal and history paperwork through a patient portal we have integrated into our website. Even if we manually accepted appointment requests over the phone we would need individuals to complete the necessary paperwork beforehand. The only thing we could do over the phone is redirect patients to our website, which we have done already via our recording.

Having the initial appointment request completed online also helps us ensure that the individual has the ability, comfort, and basic technical skills required to attend Telemedicine appointments. We can also review their history to ensure they are appropriate for our service. We understand that some individuals feel more comfortable speaking to a secretary when they schedule a new appointment and this is traditionally how requests have been handled. However, having someone solely for this purpose would be an unnecessary expense that would benefit very few patients while increasing costs for many. This simply does not align with our philosophy. For those who have a strong preference for booking over the phone, we recommend trying a different practice that will better suit your needs.

Initial evaluations are 90 minutes, with 75 minutes scheduled in person. Your practitioner will spend about 15 minutes evaluating your history and intake documentation prior to your appointment. Medication management follow-ups are scheduled for 30 minutes.

Our goal is to get patients stable as quickly as possible so they can invest their time, energy, and money on the enjoyable aspects of their lives and not on medical appointments. Exactly how often one needs to be seen depends on their diagnosis, medications used in treatment, response to treatment, compliance with treatment recommendations, and many other factors that cannot be predicted prior to treatment.

As a very rough reference point, new patients are typically seen monthly until medications are adjusted and working well. Once medications are stable we will trial one appointment in 60 days, and if things are still going well and medication adjustments are not needed, we will then start 90 day visits routinely. After one year of quarterly visits some patients may be eligible to switch to visits every 6 months if they are functioning at a high level and the provider feels this change would be safe. If someones status begins to decline between appointments they can always request to be seen sooner.

We have a strict controlled dangerous substances (CDS) policy and patients requiring CDS will be seen monthly for a minimum of 3 months and then may be switched to every 90 days at provider discretion.

We are located in and offering services throughout the state of Maryland via Telepsychiatry. Since the start of the COVID pandemic we work remotely with no office accessible to the public. We no longer offer in-person office visits. We can treat patients anywhere in Maryland.

We are offering convenient Saturday appointments 12pm to 9pm and some (variable) weeknight hours 4PM to 9PM throughout the week. Instead of offering traditional business hours that conflict with most of our patient’s work schedules, we can usually accommodate our patients busy schedules. Your provider can also be reached throughout the week for any important needs. Please visit our Contact page for more information.

You may use the “manage appointments” link sent with the confirmation email or return directly to the booking page and click on the “manage appointments” link to reschedule. Existing patients may also reschedule through the patient portal once their account has been setup. The entire rescheduling process can be completed in as little as 60 seconds and is accessible 24 hours a day.

With remote accessibility anywhere in the state and our weekend and weeknight appointment options, appointment attendance has never been easier or more convenient.

Rescheduling: Requires a minimum 72 hour notice. If less than 72 hours’ notice is provided, full payment will be due and rescheduling will incur an additional appointment cost.

Cancellations (without rescheduling): To keep our rates as low as possible for everyone our practice does not offer refunds for cancellations once an appointment is booked, but reschedules are permissible.

Services and Payment

We offer psychiatric evaluations and medication management throughout the state of Maryland. Please refer to our Services & Fees page for detailed information on a detailed breakdown of services we offer, the cost of these services, and payment methods accepted.

If you have a yearly deductible to meet we will almost always beat your insurance costs by a significant amount! Even once your deductible has been met our pricing rivals the standard insurance copay. Click here to see how our fees are often lower than what individuals would pay with their insurance.

We do not participate with any insurance; we are considered “out of network” with private insurers. You may be eligible for some reimbursement from your insurance company if you file an out-of-network claim. We are opted out of Medicare. If you are enrolled in Medicare, law requires that we both sign a contract agreeing that neither party will seek reimbursement from Medicare. Due to the record-keeping requirements involved for these contracts and to keep our costs low, we are not able to serve patients enrolled in Medicare at this time. This unfortunately remains true even if they are willing to pay out of pocket.

By not accepting insurance, we believe that most of our patients, even those with insurance, end up paying significantly less. Insurance adds a significant administrative burden and otherwise complicates running a practice in ways that we believe reduce quality of care for patients. So if we can provide a better service for a lower cost, why not? There are many reasons we decided against it but here are a few:

Have you ever visited a healthcare provider and felt like they spent more time documenting than they did speaking with you?  The likely reason was the documentation requirements of insurance. Statistics vary, but roughly half of appointment time is now spent performing required documentation. Some providers prefer to shorten appointments and document afterwards, but the net result is similar. Insurance companies understandably want to make sure claims are legitimate and good documentation is important. However, the cookie-cutter documentation requirements often involve asking questions and documenting items that have little bearing on your current situation. Patients are deprived of a large amount of their appointment time, reducing the quality of care delivered. This is particularly troublesome because insurance companies limit medication management appointments to brief time periods already.

Accepting and billing insurance is a considerable expense itself. If we accepted insurance we would need to raise our base rates considerably for all patients to accommodate that. Our rates would still be abnormally low, but we want to keep them as low as possible. If we accept insurance the insurance company will require us to bill patients at the full reimbursement rate even though it is likely higher than the current cash rate. In other words, our patients would end up paying more by using their insurance. The only way we would be allowed to offer the cash rate to someone on an insurance network we accepted would be if we also offered the discount to the insurance company. While we are happy to provide individuals with a low cost service, we do not want to work for significantly less for the benefit of for-profit insurance companies.

In order for a provider to be paid, insurance requires a psychiatric diagnosis on initial evaluation. This diagnosis will be permanently stored by the insurance company. While this is usually not detrimental, certain mental health diagnoses could limit one’s ability to work in specific career fields, such as the military or those requiring security clearances. This can be particularly problematic because diagnoses can be wrong. They can also change over time as more information becomes available or be contingent on lab results that are not immediately available on a first visit. If a patient has enrolled with an insurance company, the insurance company can audit and read a patient’s medical and psychiatric record without the patients consent or knowledge.

At the end of the day we felt we could offer a better quality service without accepting insurance. At the same time, most of our patients, even those with insurance, end up paying less with us.

We are charging what we believe to be some of the lowest rates in the country to all of our patients. Please let us know during your appointment if you are struggling financially because there are often indirect ways we can help ease your overall treatment costs. We work with patients in numerous ways to keep their overall treatment costs as low as possible, but we cannot offer further discounts on appointments below our currently advertised rates.

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