Frequently Asked Questions About Dr. Mortimer's Private Practice in Child & Adolescent Psychiatry, and in General Adult Psychiatry
FREQUENTLY ASKED QUESTIONS ABOUT DR. MORTIMER’S PRIVATE PRACTICE IN CHILD & ADOLESCENT AND GENERAL ADULT PSYCHIATRY
Dear patients and families,
Welcome to Dr. Mortimer’s website! Some patients and their families are relatively new to Dr. Mortimer’s practice, and others might not yet be completely familiar with his office procedures or with the business aspects of his private practice. This document has a number of purposes.
- It is intended to acquaint you with Dr. Mortimer’s solo, private outpatient psychiatric practice.
- It will provide you with some of Dr. Mortimer’s professional qualifications.
- It will provide you with information about the situations, attitudes, politics, economics and other complexities that can potentially compromise your psychiatric treatment.
- It is intended to put in writing your agreement – or contract – with Dr. Mortimer regarding expectations of each other.
- It highlights areas that are frequent areas of contention so that there is less likelihood of misunderstandings.
The areas of potential misunderstanding include:
- Payment for Dr. Mortimer’s services.
- Charges for broken appointments.
- Telephone calls.
- Charges for prescription refills without an accompanying office appointment.
- Charges for the time that Dr. Mortimer must spend on the telephone with your therapist, grandparent, attorney, or pharmacy benefits gatekeeper
- The relative lack of guarantees of absolute patient confidentiality.
- FDA dosing guidelines
- What to do during a psychiatric emergency.
- Various legal issues: e.g., dual agency, split treatment.
Communication is necessary for a sound doctor/patient relationship, so if anything here is not 100% clear to you, do be sure to let Dr. Mortimer know about it right away!
One other thing: since Dr. Mortimer sees children, teens and adults, when you see "you" in the essay below, but the identified patient is a child or teen, please do make the necessary grammatical changes to the message (i.e., translate "you" to "your child") so it "fits" with your family's particular circumstances.
FREQUENTLY ASKED QUESTIONS ABOUT DR. MORTIMER’S PRIVATE PRACTICE IN CHILD & ADOLESCENT AND GENERAL ADULT PSYCHIATRY
- Where is the location and what is the office phone number for Dr. Mortimer’s solo, out–patient private practice? The office address: 10,000 NE 7th Ave, Suite #385, Vancouver, WA 98685. The office phone number: 360-882-9058. Dr. Mortimer’s office is on the third floor of the HH Hall Building in the Hazel Dell neighborhood of Vancouver. The office building is located three blocks west of Interstate 5 (at Exit 5), and one block north of NE 99th Street. [Do be aware that 99th Street runs east-west. Highway 99 is an entirely different road which runs north–south.] There is free and ample parking on the north and south sides of the HH Hall building. Dr. Mortimer (via his professional corporation or "P.C.") leases office space from Northwest Investments, which owns the building. Northwest Investments is responsible for assuring the safety and maintenance of the building. As part of the lease agreement, Dr. Mortimer (via his P.C.) pays NW Investments for these services.
- Who are the personnel (and some disclaimers)? Dr. Mortimer’s medical manager and medical assistant is Ms Jill Messinger. She is professional, courteous, friendly, knowledgeable, and efficient. Dr. Mortimer is the other employee of the P.C. (i.e., the Professional Corporation). Disclaimer: While Dr. Mortimer supervises Ms Jill Messinger's office work. neither Dr. Mortimer nor his professional corporation (the “P.C.”) is the employer of or supervisor for other professionals (e.g., psychologists, therapists, or other physicians), nor is Ms Messinger, Dr. Mortimer or Dr. Mortimer’s P.C. responsible for any of these other professionals’ acts of omission or commission. That is, Dr. Mortimer has no responsibility for the medical or psychotherapy services you (or the identified patient) receives elsewhere. Furthermore, unless he has a good reason to do so, Dr. Mortimer does not formally evaluate any therapist’s credentials, qualifications, treatment methods, or ethical standing. Dr. Mortimer will expect you to allow any therapist that you see (or the identified patient sees) to keep Dr. Mortimer apprised of significant changes in your medical/psychiatric condition or treatment, and to allow Dr. Mortimer to communicate with your therapist. Last disclaimer here: neither Ms Jill Messinger nor Dr. Mortimer are agents for your medical insurance company, and neither make claims or guarantees about the coverage your medical insurance will ultimately provide for Dr. Mortimer’s professional services. What professional medical services that your medical insurance covers is ultimately an issue between you and your medical insurance carrier.
- What are Dr. Mortimer’s office hours? Office visits are by appointment only, and vary. Office hours are typically Monday through Friday, 10AM to 4PM, excluding holidays, vacations, birthdays, unanticipated illness, and inclement weather. If you believe that you have an urgent concern that is not a medical emergency, but you simply can’t wait until your next appointment, please indicate this urgency in your telephone message. After the posted office hours, on weekends, and during holidays, you can always leave a recorded voice message. Jill and Dr. Mortimer respond to telephone message requests and queries during regular posted office hours as their schedule allows.
- What is psychiatry, what is a psychiatrist – and how are psychiatrists different from psychologists, counselors, and therapists? Psychiatry is the medical specialty that studies and treats a variety of disorders that affect the mind – mental disorders. Because our minds create our humanity and our sense of self, psychiatrists care for disorders that affect the core of our existence. The common theme that unites all mental disorders is that they are expressed in signs and symptoms that reflect the activity of mind – memory, mood and emotion, fear and anxiety, sensory perception, attention, impulse control, pleasure, appetitive drives, willed actions, executive functions, ability to think in representations, language, creativity and imagination, consciousness, introspection, and a variety of other mental activities. The medical specialty of psychiatry is defined by our patients, our science, and our history – and not by the form of treatment provided nor by the presence or absence of known mechanisms of psychiatric disorders. Psychiatry is defined by its province: the mind. Since psychiatry deals with disorders of the mind, it also deals with disorders of the brain. Thus, psychiatrists are physicians to both the mind and the brain. One of the underlying tasks of psychiatry is to help people find meaning in their lives. A general adult psychiatrist is a fully trained and licensed physician who has then completed four years of specialty training and supervision in general psychiatry. Psychiatric training includes: four years of medical school after which the Doctor of Medicine (M.D.) degree is granted; one year of supervised general practice in medicine, neurology, and general psychiatry in a hospital with adult patients in an approved residency program ( – after which a license to practice medicine is granted); and three years of supervised training in general adult psychiatry in an approved residency approved residency training. In the general psychiatry training years, the physician achieves competence in the fundamentals of the theory and practice of psychiatry. General adult psychiatrists may pursue elective certification in psychiatry by the American Board of Psychiatry and Neurology. After completing general adult psychiatry training, the psychiatrist can elect to pursue a two–year fellowship in child & adolescent psychiatry (or in, for example, forensic psychiatry, geriatric psychiatry, or addiction psychiatry). Most psychiatrists are not only trained in medicine, but also are trained to provide various types of psychotherapy. Legally, it appears that anyone can be self–identified as a “therapist.” Thus, Dr. Mortimer recommends that therapist’s licensing and /or certification should be verified by the patient (or patient’s family). Psychologists come in a variety of levels of training. The most common graduate degrees in psychology are the Ph.D., Psy.D, M.A., and M.S. Most states do not license master–level psychologists. Doctoral–level psychologists typically must complete five years of training including a dissertation with an additional 1–2 years of supervised experience. The Psy.D. focuses on both research and clinical practice, again, with an additional 1–2 years of supervised experience. Psychologist practitioners should provide evidence of graduation from an American Psychological Association (APA)–approved program. The Masters in Social Work (MSW) is a two–year program. To obtain licensure, social workers must practice under supervision for a state–specified number of hours prior to passing the exam. A clinical social worker may be a member of the Academy of Certified Social Workers (ACSW) or listed in the NASW Register of Clinical Social Workers. Other types of counselors include: Marriage, Family and Child Counselor (MFCCs); Certified Addiction Counselors (CACs); Psychiatric Registered Nurses; and Psychiatric Nurse Practitioners.
- What are Dr. Mortimer’s professional qualifications? After earning a B.A. in Liberal Arts from St. John’s College, Annapolis, Dr. Mortimer then received a medical degree (“M.D.”) from Oregon Health Sciences University (OHSU) School of Medicine in Portland, Oregon. He then continued his professional medical training at OHSU to first complete medical specialty training in general adult psychiatry, and then to complete OHSU subspecialty fellowship training program in child & adolescent psychiatry. Dr. Mortimer’s scores on standardized tests are non–pareil. Dr. Mortimer is a diplomate of (and certified as a medical specialist by) the American Board of Psychiatry and Neurology (i.e., Dr. Mortimer is “board certified”). Please see Dr. Mortimer’s resume (located elsewhere on this website) for more details about Dr. Mortimer’s stellar professional medical qualifications.
- What about the patient seeing an individual therapist other than Dr. Mortimer (– what some call "split treatment")? In most cases, Dr. Mortimer can provide psychotherapy to his children, adolescent and adult patients and, in most cases, Dr. Mortimer usually doesn’t see the need to complicate the clinical picture any further than it already is by adding a therapist or psychologist to the clinical picture. While you are free to chose whom you wish for individual psychotherapy and counseling, do be aware that Dr. Mortimer’s silence about your choice of therapists or counselors is not equivalent to his approval of your choice. The reality is that Dr. Mortimer does not have the time nor the resources to be acquainted with the countless therapists, counselors, and psychologists in the Vancouver, Washington area to allow Dr. Mortimer to make a determination of their competence or suitability with his patients’ clinical needs. Furthermore, while treatment divided among psychiatrists and other mental health professionals has almost become the norm in managed health care systems, be aware that it is fraught with dangers for both patients and psychiatrists. Without appropriate safeguards and policies, psychiatrists entering such relationships numerous face ethical, clinical and legal risks. Furthermore, patients having two therapists has a “hidden cost” attached to it – and that is the price of communication between therapists. For example, who pays for that time when the psychiatrist and therapist are meeting or talking on the phone to each other, trying to integrate their treatment approaches for any specific patient? Since, in split treatment, the psychiatrist carries the burden of financial risk, the psychiatrist has the right to determine the degree of clinical risk that will be tolerated. Dr. Mortimer’s professional liability (“malpractice”) risk is similar whether he sees a patient for 10 minutes every 3 months, or for an hour every day. Furthermore, Dr. Mortimer cannot rely on a non–medical therapist’s assessment of the patient's clinical situation: Dr. Mortimer must make his own clinical determination. Therefore, Dr. Mortimer must see patients frequently enough and long enough during each visit to make a reasonably accurate assessment of the clinical situation. If you have medical insurance, and if your insurance will only provide reimbursement for office visits with Dr. Mortimer for a duration of 10 minutes every 3 months, and if your clinical situation requires Dr. Mortimer to spend more time with you than is “covered” by your insurance, then this creates a problem for everyone, doesn't it? Additionally, a non–medical therapist and Dr. Mortimer may have different and conflicting treatment goals for you, and they may recommend conflicting treatment plans for you. If you want to give split treatment a try, then you must agree to reimburse Dr. Mortimer for the time it takes him to make some inquiry about the competence of your non–medical therapist. You must also be willing to reimburse both Dr. Mortimer and the non–medical therapist for the time required for them to collaborate on coordinating your treatment. Conversely, the non-medical therapist must be willing to stay in regular contact with Dr. Mortimer and vice versa. With the exception of a handful of therapists that Dr. Mortimer personally knows to be gifted therapists, Dr. Mortimer does not have the resources to know whether or not your therapist is qualified, competent, and clinically experienced enough to be addressing your particular psychiatric problems. If harm occurs to you as a result of your therapist’s acts of commission or omission, then you agree to indemnify Dr. Mortimer, Jill Messinger, and Dr. Mortimer’s professional corporation from any adverse consequences resulting from such harm. Others who might also be involved in your treatment might also include clergy, grandparents, teachers, and anonymous Internet posters and poseurs. If you mention to these others that you are seeing a psychiatrist, Dr. Mortimer can almost guarantee that everyone will give you their unsolicited opinion about your proposed psychiatric treatment, and these poseurs' opinions will almost always be dangerously wrong. Caveat emptor.
- Who is responsible for what? Dr. Mortimer is responsible only for providing psychiatric diagnosis and treatment services. Dr. Mortimer is not able to predict or prevent his patient from harming self or others, nor is Dr. Mortimer able to predict or prevent other actions performed by his patient that might have adverse consequences. As a condition for treatment with Dr. Mortimer, his adult patients must agree that they remain ultimately responsible for their own actions.
- How is a psychiatric assessment different from a general medical office visit? While psychiatrists may be efficient in collecting information and formulating a number of treatment options, it still takes time and effort to understand the medical, genetic, family, environmental and personality contributions to a patient’s problems – and to formulate practical, workable solutions. This comprehensive understanding cannot be accomplished in a 15–minute initial office visit. This time and energy requirement cannot be circumvented by simply perusing reams of old assessments and treatment notes from pediatricians, psychologists, therapists, or other psychiatrists. And the time and expense involved in obtaining an adequate understanding of the problem can’t be circumvented by “split treatment””– i.e., one person providing counseling (e.g., from a Masters–level therapist) or psychotherapy (e.g., from a psychologist), and the other (i.e., the psychiatrist) providing medications (– e.g., how easily do you think the therapist and the prescribing physician can find the time during their work days to discuss treatment progress and coordinate care, hmm?). In fact, studies are finding that split treatment is more expensive and much less efficient that if the psychiatrist were to provide for both the psychosocial and biomedical treatment of their patients.
- What is Dr. Mortimer’s approach to psychiatric assessment and treatment? Dr. Mortimer’s approach to psychiatric assessment and treatment is usually collaborative, non–intensive, and respectful of patients’ right to autonomy and self–determination. Since better decisions are likely to be made when patients (and parents if the patient is a minor) are well–informed, Dr. Mortimer will often give the patient (spouse and/or parents) reading assignments, or behavioral “homework” to complete. Dr. Mortimer will do his best to discuss treatment options with his patient but – unless there is a safety issue involved, or Dr. Mortimer is otherwise required by law or medical ethics to be more direct or assertive – it is the patient (or patient's parent or guardian) who has the ultimate responsibility for making the final decisions regarding which treatment options to pursue, and in which sequence – or whether, in fact, to comply with the recommended treatment program at all.
- What if a general medical problem is causing my symptoms? As a physician, the psychiatrist is trained to recognize general medical conditions that may be affecting how people think, feel, and behave. Many medications used in general medical treatments can have psychiatric side effects. Conversely, some who snore, sleepwalk, or grind their teeth at night may, may – as a result of fragmented sleep – experience impaired daytime alertness, attention, and impulse control. In such a situation, it may make the most sense for such a patient to schedule an appointment with a sleep disorders clinic as a “next step” in the assessment process. Conversely, the psychiatrist may focus on how emotions and thinking might be affecting the patient’s general medical health (e.g., anxiety, depression, and acute family stressors can worsen glucose control in a person with insulin–dependent diabetes mellitus). The psychiatrist is qualified to assume medical responsibility for the plan of psychiatric treatment, and is available to consult with the patient’s primary care physician to develop an effective treatment plan.
- Is psychiatric treatment effective? Yes, depending of the specific circumstances, psychiatric treatment of children, adolescents and adults is often be very efficacious – as effective, or even more effective than current treatments for a number of general medical conditions. For example, federal government studies of treatment efficacy found success rates for the treatment of panic and bipolar disorder were about 80%; the treatment success rate for major depression was 65%; and the treatment success rate for obsessive compulsive disorder was 60%. In comparison, treatment success rates for cardiovascular disorders in general was 52%; and the treatment success rate for cardiac angioplasty was 41%. There is increasing evidence that psychiatric treatment is also cost–effective. Obviously, adequate psychiatric insurance coverage can improve the likelihood that treatment success will occur. In fact, an Aetna Life insurance study found that appropriate psychiatric treatment led to a decrease in general health care costs for enrollees and their families, resulting in significant savings for Aetna over the long term.
- In order for treatment to be successful, what might be required of the patient? Successful treatment may require a commitment by the patient and his/ her family to investing adequate time, energy and money to maximize the likelihood of a successful outcome. A prerequisite for a good treatment outcome is making treatment with Dr. Mortimer a very high priority. Specifically, this means keeping all scheduled appointments – and arriving for your appointment on time; and following–through with agreed–on treatment. Please check your calendar carefully when making an appointment. When you commit to meeting with Dr. Mortimer, he sets aside that block of time specifically for you. A private psychiatric practice is unique in that such a large amount of time is reserved for each patient. Broken appointments will interfere with you reaching your treatment goals. Broken appointments will harm Dr. Mortimer’s private practice financially. Broken appointments may also increase Dr. Mortimer’s professional liability exposure. For these reasons, Dr. Mortimer requires at least two (2) full working days’ notice for cancellations. You will be charged for the time that reserved unless this notice is given (i.e., leaving a message Friday to cancel a Monday appointment does not constitute two working days' notice). Your time is also valuable, and Dr. Mortimer does his best to stay on schedule. A successful outcome usually requires a commitment on the part of the patient (and, if applicable, the patient’s family) so that treatment with Dr. Mortimer becomes and remains a very high priority. A commitment to a successful treatment outcome will require meeting with Dr. Mortimer frequently enough to make a difference in the current life trajectory of the patient. This commitment may require the patient (and, if applicable, the family) to rearrange their priorities, and may require scheduling office visits with Dr. Mortimer during school hours or during the patient’s (or family member’s) working hours. This commitment to a successful treatment outcome may also require the family to arrange for a babysitter for other children, or for special transportation arrangements for the patient to keep appointments with Dr. Mortimer. If the only time the patient willing to meet with Dr. Mortimer is after school or after work (i.e. 3PM or later), then treatment with Dr. Mortimer is unlikely to be successful!
- How much time is required for a successful treatment outcome? While the answer to this questions obviously depends on many things, Dr. Mortimer usually sees a satisfactory treatment outcome within twelve (12) office visits.
- What are examples of Dr. Mortimer considers a successful treatment outcome? Here are some examples from Dr. Mortimer's child and adolescent psychiatric practice: A sixth grade boy with multiple fears, phobias, time–consuming rituals, and poor academic performance had pretty much given up on school when he first met with Dr. Mortimer. Within one month of starting treatment with Dr. Mortimer, the youth’s confidence, concentration, academic productivity and efficiency had all significantly improved. After seven months of treatment, this boy’s semester grade point average (GPA) increased from 1.7 to 3.7! Here is a second case: after receiving all “Fs” yet again on his report card, the parents of a 17 year–old asked Dr. Mortimer for his professional medical/psychiatric assistance. Dr. Mortimer learned that the teen had a nearly life–long history of problems with attention, motivation, severe shyness, and multiple tics. Within six months of working together, all treatment goals were met, and the teen’s subsequent report card showed a semester GPA improvement from 0.0 to 3.75 ! Here is a third case: a thirteen year–old boy had an explosive temper and very poor manners. At a follow–up office visit after starting treatment with Dr. Mortimer, the youngster’s mother concluded her update on her son’s improvement by commenting: “You have done more for my son in three office visits than have all the school counselors, therapists, and pediatricians he has seen for the past eight years!”
- What might interfere with achieving a successful treatment outcome? A successful treatment usually depends on the willingness on the part of the patient to invest sufficient time, energy, and money to ensure that the needed changes occur. That is, psychiatric treatment with Dr. Mortimer must be a sufficiently high priority for the patient if his or her treatment goals are to be met. In order to meet with Dr. Mortimer during his office hours, patients might need to be willing to rearrange their work, school, or after–school schedules. Patients might need to expend more effort over an extended period of time in order to learn to inhibit certain over–learned behaviors. Furthermore, since many substances (– alcohol, cannabis, illicit drugs, herbal concoctions, and other over–the–counter products) can cause medical and psychiatric symptoms, and since many of these substances can adversely interact with psychiatric prescription medications, patients must be willing to abstain from using all substances that might be causing adverse emotional, cognitive, or behavioral effects. Among other things, this means that Dr. Mortimer’s patients must avoid ALL alcohol, ALL cannabis products and ALL illicit substances. To the extent that family members are involved in the patient's treatment, they, too, would be wise to abstain from use of all alcohol, cannabis and illicit substances.
- From where does Dr. Mortimer’s new patients originate? The vast majority of Dr. Mortimer’s new patient referrals have been from the word–of–mouth recommendations of his present and former patients and patients’ family members. Other patient referral sources include: pediatricians; family practice physicians, internists, psychologists, and therapists; and Regence Blue Cross Blue Shield's preferred provider list.
- What advantages might Dr. Mortimer have over his “competition”? Does Dr. Mortimer really have any competition? Dr. Mortimer has the longest established out–patient private practice in child & adolescent psychiatry and in general adult psychiatry in Clark County (– Dr. Mortimer started his out–patient private practice in Clark County in 1991). Furthermore, not only does Dr. Mortimer believe that his medical office assistant, Ms Jill Messinger, is the best office manager in the world, but most – if not all – of his patients and their families are convinced of this as well. Dr. Mortimer's standardized medical test scores and credentials are non–pareil. Since moving to Clark County in 1991, Dr. Mortimer has gone out of his way to network with his local medical colleagues in other medical specialties. By Dr. Mortimer’s count, he has sent over 1,000 mailings of clinical articles on topics that he believed would be of interest to over 550 local physicians, pharmacists, and psychologists. Dr. Mortimer has also invited primary care physicians to meet with him for breakfast or lunch (he offers to pay) to discuss clinical issues, practice philosophies, and how they could be professionally beneficial to each other. Dr. Mortimer has served the community in such positions as a physician presenter for Clark County Medical Society’s "Docs and Cops" program; and for several years, Dr. Mortimer served as the [self–appointed] Chairman [and Sole Member] of the Clark County Medical Society Committee for the Promotion of Profit and Joy in Medical Practice (affectionately known by the Clark County Medical Society Executive Committee as “the CCMSCPPJMP”). Dr. Mortimer is one of the few of the Clark County psychiatrists that actually lives in the state of Washington, and who actually lives in this county (i.e., Clark County), so Dr. Mortimer believes he is more au courant with local community resources than those Vancouver–based psychiatrists who live in Portland, West Linn, or other cities greater than 50 miles away from their Vancouver medical offices. Dr. Mortimer is also a native English speaker. Based on his experience in attempting to decipher hand–written psychiatrists’ notes in those patients’ medical records which he has reviewed, Dr. Mortimer has concluded that his handwriting is the most legible of any psychiatrist practicing in the county – heck, perhaps even in the entire Pacific Northwest! Dr. Mortimer’s written and typed psychiatric assessments and treatment plans are thorough, comprehensive, readable, and logical. He knows how to speak clearly, and can write both legibly and in complete sentences. Unless Dr. Mortimer is on vacation or otherwise out of the office, his office manager Ms Jill Messinger can usually schedule a new patient within a few days of the prospective patient’s first phone call with Jill.
- What kinds of clinical situations/ concerns that are outside the scope of Dr. Mortimer solo, out–patient private psychiatric practice? Those kinds of clinical situations/ concerns outside the scope of Dr. Mortimer's practice include: those persons experiencing an acute psychotic or manic episode; those persons experiencing acute suicidal/ homicidal thoughts or plans; those with imminent risk of harm to self or others; the geriatric population (i.e., those persons older than 60 years of age); or forensic situations (i.e., Dr. Mortimer does not perform psychiatric evaluations or provide legal testimony regarding: child custody and related matters; evaluations of suspected sexual abuse; evaluations related to child, adolescent or adult criminal cases; Workman’s Compensation examinations or determinations; or psychiatric disability examinations or determinations. Those who have criminal charges pending must look elsewhere for psychiatric assessment and/or treatment.) In summary, the scope of Dr. Mortimer's psychiatric practice does not include Internet, concierge, forensic, correctional, infant, geriatric or zombie psychiatry.
- How do I schedule a first appointment with Dr. Mortimer? Simply phone Dr. Mortimer’s office during normal business hours, and talk with his office manager, Ms Jill Messinger. The office phone is: 360-882-9058
- What should I expect during the first office meeting? If the prospective patient is a child or teen, then the first office visit is reserved for Dr. Mortimer to meet with the youngster's parents or guardian – without the youngster. A separate appointment is then scheduled for Dr. Mortimer to meet with the child or teen. Whenever it is feasible and clinically indicated, Dr. Mortimer keeps parents in the room with his patient so everyone is aware of – and is invited to participate in – the clinical assessment and the proposed treatment plan.
- What should I bring with me to the first meeting; and what should I leave at home? No matter what the designated patient’s age might be, please bring any of the patient’s elementary school report cards that you can find. Please bring with you: a written list of the identified patient’s current medications and doses (and the name of the prescribing physician); a written list of the identified patient’s previous prescribed psychiatric medications and doses (and the names of the previously prescribing physicians); your completed and signed New Patient Registration form for the identified patient; your completed and signed Financial Agreement form. Dogs are not permitted in the office building.
- What about confidentiality? Medical records of patients are confidential. With certain exceptions (e.g., medical emergencies), information contained in the medical record will not be released to others without written, informed and voluntary patient consent. Physicians have many challenges in their attempts to protect patient confidentiality. For example, patient information faxed from pharmacies to physicians or vice versa may be inadvertently sent to the wrong phone number; cell phone calls between patient and physician might be intercepted by a shortwave radio scanner; insurance carriers might insist on obtaining copies of confidential patient chart notes before paying for psychiatric services; one of Dr. Mortimer's patients may see another patient in his reception area; or a clerk working for your insurance carrier might recognize your name as one of his/her neighbors. Secondly, medical insurance carriers do not have the ethical obligations to protect confidential patient information that physicians have. Confidential medical and psychiatric patient information now travels through the mail, over the telephone lines, and through the Internet. Confidential patient information is found in insurance company computers and managed care files, and is read by clerks, doctors, nurses, and reviewers who have no clinical reason to have access to this confidential medical information. Lastly, while it is more difficult for the judge in a court case to obtain a patient’s medical records than it is for the medical insurance company, nevertheless, there is a growing consensus that state agencies and the courts can violate the sanctity of patient confidentiality any time they please. Despite these obstacles, as part of their medical ethics, psychiatrists do what they can to protect patient confidentiality. Psychiatrists avoid discussing identifying information about their patients with others without the patient’s assent and the guardian’s consent – except as required by law, or unless a safety issue is involved. Most psychiatrists will, for example, only send confidential medical information to medical insurance companies, life insurance companies, or government agencies after first obtaining written, informed, and voluntarily given consent from the patient or the legal guardian. Be aware that once the confidential medical and/or psychiatric information has been sent to these other agencies, neither Dr. Mortimer nor his office manager Ms Jill Messinger are able to prevent the subsequent transmission of confidential patient information to other parties. Dr. Mortimer's general stance is that unless the patient instructs him otherwise, he keeps the patient’s primary care physician or the referring professional informed of the general progress of treatment. Before Dr. Mortimer sends confidential patient medical information elsewhere (i.e, to government agencies, schools, employers or other entities), Dr. Mortimer may insist on written, informed, and voluntary consent. Exceptions to confidentiality include: statements the identified patient may make of his/her intention to commit suicide; statements the identified patient may make which indicate he/she is a clear danger to another person; information that would facilitate treatment of a medical emergency; statements indicating that the identified patient has committed acts of child abuse or intend to commit such acts; information necessary to process insurance claims; and information necessary to collect unpaid account balances. Washington State statues specify physicians’ duties regarding the issues of patient confidentiality, protection of confidential medical information, and the proper transmission of confidential patient information.
- What does the treatment contract with Dr. Mortimer entail? As part of your written treatment contract, Dr. Mortimer will do his very best to provide the identified patient with competent medical/ psychiatric treatment. In return, Dr. Mortimer expects the identified patient to: assume responsibility for his/her own behavior (i.e., the identified patient will refrain from portraying himself/herself as a "professional victim"); make an inviolable commitment to no self–harm; keep all scheduled appointments with Dr. Mortimer, and arrive on time; be as truthful, honest and candid with Dr. Mortimer as possible; pay for treatment at the time of service (– if the patient is a minor, then the parent or guardian is expected to pay for treatment at the time of service); follow–through with the agreed–on treatment plan; keep prescribed medications in a safe location which is secure from theft and diversion; take all medications as prescribed; abstain from all non–prescribed herbs, and all substances of abuse (e.g., the identified patient will abstain from use of ANY alcohol and ANY cannabis/marijuana products); obey all laws; establish and maintain a good professional relationship with a primary care physician; promptly pay any outstanding balances on the identified patient’s account (including charges that might accrue between scheduled office visits); and notify Dr. Mortimer right away if any of the above treatment contract conditions will not be met.
- What is this dual relationship about which I'm hearing? One of the more important features of a physician’s private practice is the doctor–patient relationship. Historically, this has always been a relationship of trust and mutual respect, and this is what Dr. Mortimer wants with his patients. In addition to the professional nature of his relationship with his patients however, there is a business relationship which consists of the physician’s willingness to provide a professional medical service to his patient, and the patient’s agreement that he or she will be financially responsible for payment of the physician’s professional medical services. Physicians in private practice quickly learn that they are not only trained medical professionals, but are also – of necessity – businessmen, and they must be committed to doing what they can to ensure that their private practices become and remain profitable. Additionally, physicians also realize that they have an ethical obligation to themselves, their staff, their families, and their patients to run a profitable private practice. The psychiatrist’s most valuable commodity is his/her time, and the time value of money is critica. Therefore late payments from either patients or insurance carriers cannot be tolerated.
- What else should I know before making an appointment? Business hours are 10AM to 4PM by appointment only. Dr. Mortimer’s office phone number is: 360-882-9058. When an appointment is made to meet with Dr. Mortimer, this is professional time which Dr. Mortimer has reserved especially for the identified patient. Since a psychiatric practice is unique in medicine in that so large an amount of office time is sent aside for each patient, broken appointments have a significant effect on Dr. Mortimer’s working day. The identified patient will be billed (or the patient’s parent/guardian) for the professional time that Dr. Mortimer has reserved for seeing the identified patient. Please arrive early for your scheduled appointment.
- What is the cost for psychiatric treatment? The fees of the psychiatrist are based predominately on the complexity of the treatment, the amount of time and expertise required to provide competent care, and to cover overhead expenses. Depending on the clinical situation, psychiatric treatment sessions may be scheduled on a regular or irregular basis, with length of sessions varying depending on the treatment plan and goals. Given how much treatment typically improves social, academic and family functioning, most parents affirm that their decision to see Dr. Mortimer was time, energy, and money well spent. In Dr. Mortimer’s private practice, a comprehensive psychiatric evaluation typically requires 2-4 hours of face-to-face office time plus a review of medical, psychological, academic and other records. These evaluative services typically require a number of office appointments, occurring on different days. Dr. Mortimer bills for the time, effort and expertise necessary to competently, ethically, and safely perform his professional medical tasks and duties – including the time involved in reviewing relevant medical, psychological, academic, legal, and other documents. all of which typically occurs over a number of days. In more than half of Dr. Mortimer’s patient population, the patient’s family has medical insurance which covers somewhere from 50% to 100% of his professional medical fees. About 30% of Dr. Mortimer’s patients do not have medical insurance coverage for his professional medical services (e.g., these patients might have a managed health care insurance coverage through Aetna, Cigna, Kaiser Permanente, United Behavioral HealthCare, ValueOptions, or Washington Basic Health). Nevertheless, even if a family pays for treatment entirely “out of pocket,” the vast majority of patients (or the parents of patients) believe that the resulting improvement in the identified patient’s mental, emotional, vocational and/or academic well–being was well worth their investment.
- How are Dr. Mortimer's professional medical fees established? Professional medical services are rendered to you the patient, and payment of Dr. Mortimer’s medical fees is ultimately your responsibility. As a courtesy to you, Dr. Mortimer’s medical office manager, Ms Jill Messinger, can submit medical claims to your primary insurance carrier. Jill can also give you advice to help in filing claims with any secondary insurance carrier or coverage you might have. A copy of Dr. Mortimer’s current fee schedule listing his most commonly used professional services is available to you upon request from Ms Jill Messinger. The fees for your office visits reflects the time that Dr. Mortimer spends with you during your office visit, the complexity of your medical condition, any treatment he provides – plus his years of clinical experience and expertise, plus overhead expenses. Additionally, proper attention to your care also requires that Dr. Mortimer – and/or his medical assistant, Ms Jill Messinger – spend additional time beyond that which is spend in the office with you. Such additional time may be used to: create, maintain, and store your medical record in a safe location; review your academic records, psychological assessments, and medical records from the identified patient’s primary care physician, hospitals and other psychiatrists; ordering lab tests or other diagnostic tests for the identified patient; review, interpret and document all normed behavioral/ symptom checklists, lab tests and computer testing results, and communicate those results – orally or in writing – to the identified patient and (if appropriate) to other family members and the identified patient’s primary care physician; review current lab results and computer test results, and compare them with previous results and scores; prepare and mail consultation reports, as well as compose letters exhorting patients to schedule a follow–up office visit with Dr. Mortimer; consult via phone about your clinical situation – as appropriate – with the identified patient’s referring physician or the patient’s primary care physician, therapist, psychologist, teacher or (if appropriate and with the permission of the patient or patient’s guardian) other family members; prepare referral letters to medical specialists as needed; prepare patient educational materials; conduct medical research relevant to the identified patient’s current clinical situation; complete insurance applications and claim forms on the identified patient’s behalf; safely and securely store the identified patient’s medical record for the required seven years after the patient's last office visit with Dr. Mortimer (– and for a much longer period of time if the patient is a minor); with the patient’s (or patient’s guardian’s) written authorization, Dr. Mortimer will then review, copy and then mail a copy of the patient’s medical record in PDF format burned to a CD (e.g., to forward the patient’s records to another physician, psychiatrist, government agency, attorney, or disability insurance company).
- Why are so few psychiatrists on my insurance plan’s list of participating providers or preferred providers? “Preferred providers” and "participating providers" include physicians/psychiatrists who have agreed to see the medical insurance plan’s subscribers at steeply discounted reimbursement rates. A large percentage of psychiatrists “prefer” not to “participate.” That is, a large percentage of psychiatrists refuse to sign the typical managed medical care organization contract – usually for a number of ethical, legal, and/or financial reasons. Frequent concerns that psychiatrists have had about these contracts include: lack of protection of patient confidentiality; loss of the physician’s economic and professional autonomy; and increased risk of medical liability (i.e., if there is an adverse patient outcome as the result of managed care organization refusing to cover the cost of a psychiatric treatment, Federal law [“ERISA”] shields many insurance companies and third party administrators from legal liability resulting from its negligence, leaving the treating psychiatrist legally and financially liable for actions of the insurance company). Then there are managed medical care organizations’ notoriously poor financial reimbursements to psychiatrists’ professional services. The financial problems include both steeply discounted psychiatric fees, and managed care organizations’ seemingly intentional delay of reimbursement to the psychiatrist for the work he or she has already performed (– the longer the insurance carrier or administrator stalls on paying claims, the more money the medical insurance carrier makes on “the float”). Private practice overhead costs are relatively fixed, and since psychiatrists’ billing – unlike other medical specialties – is predominately based on time, the psychiatrist cannot see more patients per hour to compensate for the reduced reimbursement resulting from signing these managed care contracts. Thus, many psychiatrists “prefer” not to “participate” by contracting with the vast majority of for–profit, Satan–controlled, managed medical care companies. Thus, one of the more galling consequences of a physician being a “participating provider” in a managed care network is working longer hours to obtain the same weekly income (– this is assuming, of course, that the managed care plan will indeed pay his or her claims, and in a timely manner). For physicians to do their job competently and safely, they need adequate time to sleep, exercise, study, and “recharge.” They also make spending quality time with their own families a life priority. Thus, the prospect of: (1) a longer work week; (2) time–consuming telephone calls without reimbursement; (3) more required paperwork without reimbursement; (4) loss of professional autonomy; and (5) decreased income all of which would result from signing a managed care contract quickly leads many physicians – especially including many psychiatrists – to a “no deal” conclusion.
- What tests might Dr. Mortimer order for me? Special tests are sometimes necessary to help diagnose psychological or learning disorders, or to help determine whether an emotional problems has physical elements or a physical cause. The use of certain medications will require laboratory monitoring. Dr. Mortimer will discuss the use of all tests with you prior to ordering and will provide you with results of all tests as soon as he receives them.
- What about prescription medications and refills? Depending on the patient’s particular clinical situation, Dr. Mortimer may or may not recommend a trial of prescription medication for his patient. Whether or not he prescribes medications for the patient, Dr. Mortimer expects the patient to be candid and honest with him regarding the patient’s current medications – as well as being candid about any herbs, vitamins, and substances of abuse that Dr. Mortimer’s patient may currently be taking. For those that wish to pursue a trial of recommended medications, Dr. Mortimer will consider treatment options, weighing safety, efficacy, and cost effectiveness of all the treatment options available – plus the patient’s stated preferences regarding treatment options. Dr. Mortimer will serve as the patient’s consultant. The decision whether or not to pursue a trial of a particular medication or treatment that Dr. Mortimer recommends is ultimately the patient’s (– or the patient’s guardian’s) decision. Taking the wrong medication can lead to serious complications, including death. In order to minimize medication errors, it is the patient’ (or parent’s or guardian’s) responsibility to examine any medication purchased from a pharmacy at the time of purchase. If you are not sure it is the medication you expect, return it to the pharmacist at the time of purchase and ask the pharmacist to contact Dr. Mortimer. Psychiatrists have more training skill and other qualifications in prescribing psychiatric medications for mental disorders than other providers (i.e., psychiatric nurse practitioners have about 3% of the medical training of psychiatrists; very few psychologists have an additional medical degree). So, please: do not permit a psychologist or therapist to recommend psychiatric medications for you. If another provider wants to prescribe medication or other treatment for your psychiatric condition, ask the provider to discuss this first with Dr. Mortimer. Dr. Mortimer reserves the right to insist that patients schedule a follow–up appointment scheduled with him before he authorizes medication refills. While not always possible, Dr. Mortimer’s goal is to write for a sufficient amount of prescription medication to last until your next scheduled office meeting. Therefore, the need to refill medications between scheduled appointments should be a very rare event. If, however, because of unforeseen events, refills are needed before patients meet again with Dr. Mortimer, do please contact your pharmacy to request refills of those medications that can be renewed via telephone or fax. If a written prescription is needed, please leave all the necessary details with Dr. Mortimer’s medical assistant, Ms Jill Messinger. Dr. Mortimer requires at least two full days’ notice to process prescription refill requests. Since most medical insurance plans will only authorize pharmacy benefits coverage for a 30 day supply of a prescription medication, this is typically the amount of medication treatment which most most physicians prescribe. A 90–day prescription of medication (i.e., through a mail–order pharmacy service) is reserved only for those established patients who are doing well on their current medication and who have demonstrated that they can keep their medications secure from misuse, overdose, theft, and diversion. For those who don’t keep their appointments, and who then request a medication refill without a follow–up appointment, there will be a $50 charge for each prescription written or re–authorized without an accompanying office visit. Do be aware that this professional service charge will not be covered by your insurance. So, do keep your appointments! Do be aware that Dr. Mortimer reserves the right to refuse to refill medications prescribed to patients by other physicians or for other medical conditions. Thus, if you need a refill of your birth control pills or want a prescription for treatment of a urinary tract infection, Dr. Mortimer expects you to contact your primary care physician or medical specialist for treatment of these non–psychiatric medical conditions.
- What is going on with all of this "prior authorization" nonsense? More and more medical insurance plans are now hiring pharmacy benefits managers (e.g., Medco; Express Scripts; Prescription Solutions) to delay or deny authorization of a patient's pharmacy benefits for prescribed medications. Third party payers (e.g., medical insurance plans) are insisting on preauthorization for more and more medications to intentionally delay and thus sabotage treatment. Your medical insurance company may demand that Dr. Mortimer first provide extensive patient information about your diagnosis and treatment in writing or by telephone before pharmacy benefits are provided to you or your family member. If this misfortune befalls you, and if you want Dr. Mortimer to schedule this time–consuming professional medical service for your benefit, then your options include: (1) payment to Dr. Mortimer of $100 feee in advance plus your completion of a written authorization form; or (2) scheduling an appointment with Dr. Mortimer during which you and Dr.Mortimer can struggle together in composing either a report demanded by your medical insurance carrier – or both meet and talk via phone with your pharmacy benefits manager hired to delay pharmacy benefits coverage of your prescribed medication (– the longer the delay before the proposed treatment is authorized by the medical insurance company or pharmacy benefits manager, the more money your medical insurance carrier or pharmacy benefits manager makes on "the float.").
- What does FDA “Approved,” “Labeling,” and “off–label use” of prescription medications mean? “The words “approved” and “labeled” have different definitions and implications, and the failure to recognize this distinction can lead to erroneous descriptions about a medication and its use. This is a complicated subject. Please see Dr. Mortimer’s blog on this topic. Here is a summary: A medication is “approved” by the Food and Drug Administration (FDA) for marketing if its database supports its benefit for a recognized medical condition and its risks are sufficiently offset by its efficacy for a particular medical indication. That is, a medication is “FDA–approved” is deemed safe and effective if used as directed. The term “labeling” refers to the indications for which a medication can be promoted (or advertised) by the pharmaceutical company that is marketing the compound (e.g., penicillin is FDA approved, and indicated for the treatment of adults with certain infections). When a physician uses a medication for indications beyond the what is in the FDA–approved package insert, then an “approved” medication is being prescribed for an “unlabeled” indication.” Most medicines prescribed to children in the U.S. are done so in a non–FDA–approved, “off–label” manner, with doses for the youngsters “extrapolated” from adult data. Most medicines prescribed to pregnant women in the U.S. (e.g., prescribing an antibiotic to a pregnant woman) are also done in a non–FDA–approved, “off–label” manner, with doses for the pregnant women being “extrapolated” from data from non–pregnant adult data. The FDA controls what the manufacturer can claim about the medication, which is based on the information that the manufacturer originally provided to the FDA about its medication – this information is often years or decades out of date. The FDA does not purport to regulate the practice of medicine, nor are FDA pronouncements intended to be authoritative sources of medical/ clinical information. Greed–based, for–profit insurance companies and their pharmacy benefits managers (“PMBs”) will quote FDA medication dosage advertising limits to deny pharmacy benefits. However, the FDA has warned that it is inappropriate for insurance companies to use FDA limits as authoritative. In published FDA Rules, “Labeling and Prescription Drug Advertising; Content and Format for Labeling for Human Prescription Drugs, Final Rule. 21 CFR Parts 201 and 202. DHEW. FDA. FR 44:124:37434-467, June 26, 1979: “[The FDA] Commissioner recognizes that the labeling dose not always contain the most current information and opinion available to physicians because advances in medical knowledge and practice inevitably precede formal submission of proposed new labeling. Good medical practice requires that physicians remain free to use drugs according to their best knowledge and judgment and liability of a physician depends upon all of the facts surrounding that use, not merely upon whether that use is approved in label. [The FDA] Commissioner notes that a physician may deviate from the recommendations made in labeling according to his best knowledge and judgement – labeling dose not infringe on a physician’s right to practice medicine.” The Physicians’ Desk Reference is a collection of package inserts – that is, it is a collection of pharmaceutical company advertising. No prudent physician considers the Physicians’ Desk Reference as an authoritative medical reference.
- What are “Controlled” prescription medications? These are medications which the federal government considers to have significant potential for abuse and chemical dependence. The federal government decides how many of each “controlled” medication is produced every year by its respective manufacturer ( – hence, the term “controlled”). Do be aware that it is a felony to divert (that is, to sell or give) a controlled substance to another person! By receiving a prescription for a controlled substance from Dr. Mortimer, you agree that you will keep the medication safe from theft and diversion. Dr. Mortimer cannot write for refills on Schedule II controlled medication prescriptions (e.g., Adderall, Concerta, Dextroamphetamine, Focalin, Metadate, methylphenidate, Ritalin, Vyvanse). The pharmacist must have the original piece of paper (prescription) in his/ her hands before these prescriptions can be filled (or renewed). Dr. Mortimer expects you to protect your medications from theft by and diversion to other family members, friends and enemies. Before he considers authorizing a premature refill of a controlled medication, those patients or family members who insist that the controlled medication prescribed by Dr. Mortimer was stolen, eaten by the family dog, or flushed down the toilet will need to first send Dr. Mortimer a copy of the: police report of the theft; a veterinarian’s autopsy report; or a plumber’s bill, respectively. Do be aware that renewing medication refill requests outside of your schedule office visit is time–consuming. Your medical chart must be pulled, the medication records must be reviewed, the prescriptions must be approved and written (or phoned in), documentation of that such a refill was made must be recorded in your medical chart, and then your medical chart must be re–filed. Thus, Dr. Mortimer requires two full business days to respond to requests for medication refills outside the office visit. Patients will be billed $50 for each prescription that you request refilled outside our regular office visit. Do be aware that medical insurance will not reimburse patients for this professional medical services provided outside the office visit. If you need a refill and want to save some money, you might consider making an appointment with Dr. Mortimer.
- Are there any problems with generic medications? Oh, yes, there can be big problems with some – but, thankfully, not most – generic medication. Do be aware that a generic medication is considered “equivalent” to the brand medication if the generic is shown to be at least 70% as effective as the brand version. Human brains are arguably the most complex organ in the universe, and the most sensitive human bodily organ. While a generic which is 70% as effective as the brand might be tolerable for a medication used to manage an infection or blood pressure, just think about getting only 70% of the sleep you need at night. Is your brain really going to function optimally on 2.4 hours (or, about 30%) less sleep at night? Dr. Mortimer doesn't think so! Do you really think that a generic psychiatric medication which is 70% as effective as the active ingredient in the brand will be as effective as the brand medication for optimal functioning of your brain and mind? Think again! Some generic manufacturers are notorious for making less effective (or in some cases, completely ineffective and sometimes toxic) generic substitutes. Generic companies have particular difficulties with accurately (and cheaply) making generic medications in the extended release formulations. The fillers and binders in the generic pill or capsule are often the cheapest substitutes possible, resulting in the active ingredient being inconsistently absorbed and inconsistently effective. These cheap binders and fillers can themselves cause allergic reactions or adverse side effects in susceptible patients. Here is the first example of generic junk medication: brand thyroid (i.e., Synthroid) for treatment of hypothyroidism and related medical conditions is not equivalent to the generic (levothyroxine). In fact, two senior endocrinologists in Clark County have confided to Dr. Mortimer that they never prescribe generic levothyroxine: the generic levothyroxine simply causes too many problems to them and to their patients. Here is the second example of generic junk medication: after six years of psychiatrists and patients complaining to the Food and Drug Administration (FDA) about generic Wellbutrin (bupropion) being ineffective, in 2012, the FDA determined that generic bupropion manufactured by Impax Laboratories and marketed by Israel–based Teva Pharmaceuticals USA was “not therapeutically equivalent.” Rather than treating major depression, the generic bupropion XL 300 mg tablet was found to actually cause or worsen depressed mood (– along with causing headaches, stomach–aches, and foggy thinking). The FDA subsequently banned Teva from importing its bupropion XL 300mg tablets into the United States. Is generic bupropion masquerading as brand Wellbutrin’s generic equivalent – now manufactured by other generic manufacturers – also crap? Only time will tell. Here is a third example of generic junk medication: In 2014, the FDA issued a warning to the United States public about the generic methylphenidate version of brand Concerta used in the treatment of attention–deficit/hyperactivity disorder (ADHD) and manufactured by both Mallinckrodt Pharmaceuticals and Kudco Ireland Ltd. The FDA stated: “But do be aware that we have convincing evidence that these two generics should be avoided at all costs.” Since then, Dr. Mortimer has found that those of his patients who were unwittingly switched from brand Concerta to the generic Concerta's round tablets (which are certainly not biologically equivalent to Brand Concerta) have either completely returned to their baseline impaired ADHD state or worse – experiencing such fatigue from the generic Concerta that is so severe that Dr. Mortimer’s patients have not been able to stay awake in their classes. There are “generic” substitutes and there are “counterfeit” medications. The focus here is on generics. If you buy medications over the Internet, they will most likely be counterfeit. Consider yourself warned. Mail order pharmacies (e.g., Express Scripts; Medco) are considered to provide the poorest quality medications (especially Teva brand) and quality control, and the highest cost for generics. Mail order pharmacy decisions about medications and insurance coverage are based on financial issues, such as market share incentive rebates (kickbacks to the pharmacy benefit managers – which they invariably keep). The mail order pharmacies’ priority is cheapest cost for medications – not quality control (e.g., purity of medication). In recent years, psychiatrists have reported problems with prescription generic psychiatric medications manufactured by: Teva (Israel); Dr Reddy (India); Apotex (Canada); and Mylan (West Virginia). Teva, the major manufacturing company for generic medications in the world, has an especially poor reputation among psychiatrists for problems with their generic medications. The majority of the problems with Teva's generic medications appear to have started soon after Teva bought China–based Tianjin Hualida Biotechnology Company. China manufactured generics have a reputation for having major problems with monitoring the quality of the products. The very good news is that Dr. Mortimer does his best to network with physicians/psychiatrists from around the world so that he can be alerted as early as possible to which generic medications are likely to be worthless crap.
- More on payment for Dr. Mortimer’s professional medical services. Dr. Mortimer’s is committed to providing effective treatment. Please understand that prompt payment of Dr. Mortimer's fees is an important component of the treatment contract. A copy of Dr. Mortimer’s current fee schedule with his most commonly used medical and psychiatric procedural codes can be obtained from Ms Jill Messinger at their office – or from elsewhere on this website. If you do not have medical insurance which covers any of Dr. Mortimer’s professional medical services, then payment in full is due at the time of each appointment. For your convenience, payment can be made with: cash; check; or Visa, MasterCard, Discover credit cards; or gold, silver, platinum, palladium, or rhodium bullion. For those with Regence Blue Cross medical insurance coverage for some of Dr. Mortimer’s most commonly billed office visits, your copay is expected at the time of each appointment. For those with medical insurance coverage of Dr. Mortimer’s professional medical services outside the Regence Blue Cross umbrella: your estimated portion of the charges for the office visit are expected at the time of service. If your insurance has not made a payment within 30 days’ from the date of service, then the responsible party (i.e., the patient or guardian) will be expected to pay the balance on the account. If and when the for–profit managed care company finally pays, then your account can be adjusted, and any over–payment can be refunded to you – or applied to future charges. Please be aware that the only “third party” that Dr. Mortimer’s office can bill is the primary insurance carrier. Dr. Mortimer cannot bill a natural parent who does not reside with the patient, and Dr. Mortimer cannot bill anyone who has not signed his financial policy agreement – regardless of what a court decree states to the contrary. Those patients with an outstanding balance on their account over 30 days must make arrangements for payment prior to scheduling a follow–up appointment with Dr. Mortimer.
- What about for those who do have medical insurance for Dr. Mortimer’s professional medical services? Verification from your insurance carrier is required in advance as a condition for billing your medical insurance carrier. You must also complete and sign the New Patient Insurance Benefits Verification Form. If you wish, Dr. Mortimer's office manager Ms Jill Messinger can help you with submitting medical insurance claims for my professional medical services to your primary medical insurance. Ms Jill Messinger – who is also Dr. Mortimer’s medical assistant – can also help interpret the specifics of your medical insurance policy to you. However, since this is your policy, it is ultimately your responsibility to be familiar with the specifics of your individualized insurance policy, including: the amount of your yearly deductible (if any) which must first be met before medical insurance provides reimbursement for your medical treatment; what professional services provided by Dr. Mortimer are covered by insurance, and at what reimbursement rate; what medical services are not covered; and what you must first do before medical insurance reimbursement is provided to you. Do be aware that the process of verification of insurance benefits can often be a very time–consuming task for Dr. Mortimer’s medical assistant, Ms Jill Messinger. While insurance coverage for psychiatric services is often not equal to that for other medical specialty services – even in those cases where the same treatment is provided – most insurance companies to which Dr. Mortimer send medical claims provide reimbursement somewhere between 50% and 100% of the majority of Dr. Mortimer’s various office visit fees.
- What does "medical necessity" or "medically necessary" mean, anyway? “Medical necessity” has been the rope in a tug-of-war with physicians on one side and medical insurance (and managed health care plans and pharmacy benefits managers) on the other. One of the more controversial parts of the definition related to authority: Who should make the medical necessity decision: the treating physician or the medical plan? Typically, the insurance company (e.g., the managed care company) will take the position: “We won’t pay for this new treatment because it is not medically necessary” while the physician responds with: “Wait a minute; I am the one who decides what is medically necessary, not you!” One commonly seen definition of medical necessity has been: “any drug, procedure, or treatment that is essential and appropriate for the continued health and comfort of the patient as determined by a prudent physician in the community. The treatment must have proven efficacy and should be neither investigational nor experimental.“ Then, in 12/1998, the AMA adopted a definition of medical necessity which included: “Health care services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing or treating an illness, injury, disease or its symptoms in a manner that is (1) in accordance with generally accepted standards of medical practices; (2) clinically appropriate in terms of type, frequency, extent, site and duration; and (3) not primarily for the convenience of the patient, physician or other health care provider.” But as some have argued, health care plans attempt to contractually define medical necessity and in these definitions, impose “lowest cost” criteria. This clearly suggests that some health plans and third-party payers are focusing their medical necessity determinations solely on cost. That is, some medical insurance CEOs don’t care about your health – some only care about providing the cheapest treatment option available (e.g., In March 2019, in a scathing legal decision, US Chief Magistrate Judge Joseph Spero [US District Court for the Northern District of California] blasted a subsidiary of United Behavioral Health – the nation's largest insurance company – for implementing policies on medically necessary treatments which were so restrictive that it was obvious that United Behavioral Health was focusing on the "bottom line as much or more" than patients' health, asserting that United Behavioral Health illegally denied treatment to thousands of people. While the American Medical Society has one definition of medical necessary, medical insurance companies have a different definition. For too many medical insurance companies, “medical necessity” and “medically necessary” means: “whatever is the cheapest treatment option available.” Here is one example of a medical insurance company's definition of medical necessity: in its “Prudent Buyer Benefit Booklet” for 1999-2000, Premera Blue Cross defines medical necessity as: “...those covered services and supplies which are, in the judgement of Premera, determined to meet all of the following requirements. They must be: (1) essential to the diagnosis or the treatment of an illness, accidental injury, or condition harmful or threatening to the enrollee’s life or health, unless provided for preventive services when specified as covered under this program; (2) appropriate for the medical condition as specified in accordance with authoritative medical or scientific literature; (3) medically effective treatment of the diagnosis as demonstrated by (a) sufficient evidence exists to draw conclusions about the effect of the health intervention on health outcome, (b) evidence demonstrates that the health intervention can be expected to produce its intended effects on health outcomes, (c) expected beneficial effects of the health intervention on health outcomes outweighs its expected harmful effects; (4) cost effective as determined by being the least costly of the alternative supplies or levels of service which is medically effective and can safely be provided to the enrollee. A health intervention is cost effective if there is no other available health intervention that offers a clinically appropriate benefit at a lower cost; (5) not primarily for research or data accumulation; and (6) not primarily for the convenience of the enrollee, the enrollee’s family, the enrollee’s physician, or another provider.”
- What does “Usual, Customary and Reasonable” mean? Given Dr. Mortimer’s professional medical qualifications, his extensive clinical experience, and the range of professional medical services offered to my patients, his fees are a bargain, and are well within the community range for what is usual, customary, and reasonable. However, be aware that some of the professional services that Dr. Mortimer’s provides to you or your family may not be covered under your medical insurance policy. Your insurance company might even assert on your EOB (Explanation of Benefits) that Dr. Mortimer’s professional medical service charge exceeds “usual and customary” rates. Be aware, however, that these assertions (that Dr. Mortimer’s professional medical service charge exceeds “usual and customary” rates are completely without merit. These Usual, Customary and Reasonable (UCR) reimbursement rates are arbitrary determinations which each insurance company calculates differently and are designed to antagonize the therapeutic alliance between the patient (or patient’s family) and the treating physician. The reality is that medical insurance companies refuse to fairly reimburse the patients and families for the majority of professional medical services that physicians routinely provide. This common insurance tactic is, in fact, a price–fixing scam which was recently targeted for criminal investigation by the NY District Attorney. here is the conclusion of just one NY District Attorney's criminal investigation: United HealthCare and its wholly–owned subsidiary Ingenix was found guilty of fraud, and agreed to pay millions of dollars as part of its settlement. If your medical insurance asserts that Dr. Mortimer’s fees are above “usual, customary and reasonable” charges, then Dr. Mortimer’s encourages you to view this libelous insurance tactic for what it is; and Dr. Mortimer’s encourages you to file a complaint with your State Insurance Commissioner about this fraudulent practice by your medical insurance company. You may contact Dr. Mortimer's office for the name, address and phone number of your State's Insurance Commissioner.
- What if I have a yearly deductible? Some patients have selected a medical insurance policy with a low monthly insurance premium. The trade–off for the low monthly medical insurance premium is a high yearly medical deductible. This yearly deductible must first be met before insurance begins to reimburse patients for medical services. For those in this situation, if you have not met their yearly medical deductible yet, then you must agree to pay for Dr. Mortimer’s professional medical services in full at the time of service until your yearly deductible is met. Your payments can then be credited toward meeting your yearly insurance deductible.
- What if I have only catastrophic medical insurance coverage? Some patients have selected a medical insurance policy which only provides medical reimbursement for catastrophic medical costs only. The trade–off for this very low monthly medical insurance premium is lack of medical insurance coverage for outpatient psychiatric services.
- What are Pharmacy Benefits Managers? Pharmacy Benefits Managers (PBMs) promise medical insurance companies that the medical insurance company contracts with the PBM, then the PBM will coax, bully and/or coerce prescribing physicians to prescribe the cheapest mediations possible for their patients. PBMs earn their bonuses partly by denying or delaying pharmacy coverage of expensive medications or doses which the treating psychiatrist deems necessary for the proper treatment of a patient. Ah, but what if the treating psychiatrist’s definition of medically necessary is different from the medical insurance (and PBM) definition of medically necessary (read: cheapest)? Typical PBM treatment sabotage tactics include PBMs asserting that the medication dose or choice of medication is not medically necessary (using the medical insurance definition of medically necessary - that is, “cheapest”), thus providing the “ammunition” necessary for a medical insurance company to then deny pharmacy benefits coverage of an expensive – but effective – medication prescribed for the patient. Do be aware that PBMs such as Medco, Express Scripts, and Advance PCS have been repeatedly charged with fraud in federal court, resulting in managed health organizations paying millions of dollars in penalties. Has this stopped this nefarious practice? Well, no, of course not – it is too profitable. Dr. Mortimer's current stance on this: since the treating psychiatrist has personally examined the patient, and as a result of a thorough and individualized assessment of the patient, while exercising in–depth clinical judgment, the patient has been given a prescription to assist in a treatment plan which was individualized for the patient’s specific needs. Since the treating psychiatrist has personally examined the patient and the pharmacy benefits manager (PBM) physician, pharmacist, and pharmacy clerical staff have not, and because of the treating psychiatrist’s expertise and medical credentials, it is not possible that any PBM physician or pharmacist on the PBM staff would have greater expertise in assessing the patient and determining a treatment plan. For the PBM staff to disagree with the treating physician about what is the most medically necessary and appropriate treatment for the patient without first examining the patient is tantamount to the PBM staff both practicing medicine without a license and making a medical assessment of the patient without personally evaluating the patient. This is medical malpractice and should be reported to your State's Medical Board. Medco has been one of the largest managers of prescription medication plans. In the late 1990s, it received more than $3 billion in rebates from pharmaceutical manufacturers seeking to promote sales of certain drugs – especially medications manufactured by Merck. In July, 2011, Express Scripts bought Medco for $29 billion. With this merger, pharmacy benefits managers (PBMs) will now have much more “clout” to apply even more financial pressure on physicians (via patients) to prescribe 90 days’ worth of medication via mail order, and that the patient be switched from an effective medication which has been well tolerated to a generic which can only be obtained via the PBM mail order service – a generic which might be less effective [see above] and might cause more side effects (and subsequently, requiring more phone calls and office visits to the prescribing physician’s office to sort out just what is causing the pesky headaches, GI upset, depressed mood and fuzzy thinking) than the patient’s current and effective medication and dose. Again, this criminal PBM tactic demands that more time and energy be spent by physicians and office staff outside the patients’ office visit to deal with these latest incursions of the“dark side” into the practice of medicine. Lastly, to those patients or parents who attempt to apply pressure on Dr. Mortimer or other physicians to prescribe the cheapest (– not the most safe or effective, but cheapest) treatments for themselves or their family members: be assured that we physicians are well aware of the costs of medications and medical treatments, and you have our sympathy. However, please do not be surprised or offended if we physicians politely refuse to prescribe 90 days’ worth of – for example – a potentially lethal generic medication for you your physician is aware that there is a potentially suicidal family member in your household.
- What does it mean that Dr. Mortimer is a preferred provider for Regence Blue Cross (and its subsidiaries)? Dr. Mortimer has signed a legal contract with Regence Blue Cross to permit Regence (and, thus, automatically with some of its associated Blue Cross plan affiliates) to allow Blue Cross to steeply discount all of his most commonly used office visits codes. In exchange, Regence Blue Cross agrees to: refrain from deceitful or fraudulent practices in its professional dealings with Dr. Mortimer; list Dr. Mortimer as a preferred provider, thus increasing the likelihood of Dr. Mortimer obtaining new patients (– although at steeply discounted reimbursement); and reimburse Dr. Mortimer for his covered professional medical services (– although at steep discounts of his posted professional medical fees) within 30 days of the date of patient service.
- Why is the professional service provided to me (or my family member) by Dr. Mortimer deemed “Disallowed” by my insurance carrier? This is a too–frequent occurrence of what Dr. Mortimer means when he asserts that his professional medical services are being steeply...um... "discounted" by your medical insurance carrier.
- What if I have a medical insurance policy other than that which is part of the Regence Blue Cross/Blue Shield “family”? Payment in full is expected at the time of service. Payment options include: cash, check; Visa, MasterCard, Discover credit cards; and gold, silver, platinum, palladium and rhodium bullion. As a courtesy to you, Dr. Mortimer’s office can also send medical claims to your insurance for you. Once your medical insurance starts reimbursing you (or Dr. Mortimer’s practice) consistently and reliably for his medical claims, then Dr. Mortimer can either refund the balance on your account to you, or apply the balance to future office visits or professional medical services with Dr. Mortimer might subsequently provide to you. Patients will sometimes ask Dr. Mortimer if he would be willing to sign a contract with their managed care, for–profit medical insurance. Dr. Mortimer has already had the “managed care experience” [the prison euphemism is "picking up the soap"] and does not wish to have this done unto him again. For example, Marsh Advantage and MultiPlan have attempted to bluff Dr. Mortimer into voluntarily agreeing to accept steep discounts on his office visit fees for patients who have various managed care medical insurance plans contracts. If Dr. Mortimer refuses their demand that he accept only 50% (or less) reimbursement as payment in full, then Marsh Advantage or MultiPlan has threatened to greatly delay payment to him. Do be reassured that Dr. Mortimer is not intimidated by attempted extortion tactics. If your insurance resorts to such tacky stall tactics with Dr. Mortimer, Dr. Mortimer will simply look to you for prompt payment of the balance on your account. After you have paid the balance on your account, then – if you wish – Ms Jill Messinger will then do what she can to ensure that you are promptly reimbursed by your insurance company for Dr. Mortimer’s covered professional medical services. Keep in mind that your medical insurance policy is basically a contract between you and your medical insurance company. As a service to you, Dr. Mortimer will file your insurance claim if you assign the benefits to him (i.e., Dale B. Mortimer, M.D., P.C.). In other words, Dr. Mortimer will file your medical insurance claim on your behalf if you then agree to direct your medical insurance company make payments to Dr. Mortimer directly.
- My medical insurance plan is stalling on payment for Dr. Mortimer's professional medical services – what can I do? Medical insurance companies pay out more money in claims than they collect in monthly medical premiums. Medical insurance companies make their money through investments in stock, real estate, tobacco, fast–food restaurants, and other businesses. Some assert that medical insurance companies divert the money into investments that should have been used to pay patients’ medical claims. The longer the medical insurance delays paying out medical claims, and the more procedures that the medical insurance rejects, then the larger the CEO's annual bonus. Federal and state insurance (e.g., Medicare and Workman’s Comp) have used the same stall, deny and downcode tactics in order to save budget dollars. Many for–profit medical insurance companies have terrible reputations of intentionally delaying physicians’ medical claims in order to make money (or interest) on “the float.” Be aware that any claims not paid by your medical insurance within 30 days of the professional service will be billed to you. Accounts over 30 days old are subject to finance charges at the rate of 1.5% per month on the unpaid balance, regardless of whether or not your for–profit insurance company asserts that the medical claim is “pending.” There is also an additional $30 per statement rebilling fee for accounts over 60 days old. If and when Dr. Mortimer receives a payment from your insurer for his professional medical services, he will refund you any overpayment to you. Here is what you can do about this odious situation: An irate insurance policy holder calling his/ her medical insurance company to demand prompt settlement on a “pending” medical insurance claim (sent from Dr. Mortimer's office to your insurance company which is conveniently ignored by your managed care, for–profit insurance company) is far more likely to produce results than a polite call from Dr. Mortimer's office asking to please expedite the medical insurance claim. What is often most effective in forcing your medical insurance to promptly pay your medical claim is a letter to the State Insurance Commissioner complaining that your insurance is not paying a claim as per the written policy agreement that your medical insurance has with you (or the policy holder). The key part of this strategy is also sending a copy of this letter to the insurance company. Insurance companies really, really do not like policy holders (you) sending complaints to the State Insurance Commissioner. Jill and Dr. Mortimer can help you write your letter of complaint. If you have your medical insurance policy via a plan in the State of Washington, the address for the Washington State Insurance Commissioner is: Washington State Insurance Commissioner, Insurance Building AQ 21, PO Box 40255, Olympia, WA 98504-0255.
- Who is responsible for keeping scheduled appointments? Unless the office meeting is to be your last meeting with Dr. Mortimer, you are expected to schedule a follow–up appointment with Dr. Mortimer before leaving his office. You are also responsible for keeping track of your appointments with Dr. Mortimer. Unless you direct us to do otherwise – and while they are under no obligation to do so, as a courtesy to you – either Dr. Mortimer’s medical assistant Jill or Dr. Mortimer may phone you 1–2 working days before your scheduled appointment to remind you of your scheduled appointment. Whether or not they make this courtesy phone call to you, it is still your responsibility to keep your scheduled appointment and arrive on time!
- What about if I: am running late for my scheduled appointment, or what if I want to cancel my scheduled appointment or what if I don't show at all for my scheduled appointment or what if I've been out of town (or the country) for the past three or more months? You are renting Dr. Mortimer's professional medical time which he has set aside for you. Be aware that if you are late for your appointment, you will still be billed for all the professional time that Dr. Mortimer has reserved for meeting with you. And in consideration of his next scheduled patient, if you do arrive late, Dr. Mortimer will still end your appointment at its designated time. If you must reschedule, please notify his office right away so that Ms Jill Messinger can attempt to schedule another patient for the time reserved for you. If you do not provide enough notice (i.e., two full working days’ notice), then you will be responsible for payment for the time that Dr. Mortimer has reserved for seeing you. Do be aware that medical insurance will not reimburse you for charges for cancelled appointments. Dr. Mortimer will assume that the patient, guardian, or patient’s spouse is responsible enough to phone Dr. Mortimer’s office to call to reschedule if the identified patient cannot keep a scheduled appointment. If the patient is a "no show," then the patient (or the person responsible for paying for the patient's treatment) will be billed for the professional time which Dr. Mortimer has set aside for seeing the identified patient. If you wish for Dr. Mortimer to remain responsible for your psychiatric treatment, then your must remain an active patient. One requirement of remaining an active patient is that you must meet at least once every three months with Dr. Mortimer – and more frequently if Dr. Mortimer deems this clinically appropriate. If your last appointment with Dr. Mortimer was over 3 months ago, then Dr. Mortimer will conclude that you have decided to terminate the professional relationship with Dr. Mortimer. Dr. Mortimer may then send you a written note – by regular US Postal Service mail – acknowledging this fact. If it has been over three months since your last meeting with Dr. Mortimer, you automatically become an inactive patient. You acknowledge that if you then become an inactive patient, then Dr. Mortimer is no longer responsible for your medical/ psychiatric care. And, those who are inactive patients will need to meet again with Dr. Mortimer before he authorizes any medication refills or changes to your treatment plan.
- What is the policy on phone calls initiated from patients or patients’ family members to Dr. Mortimer? During office hours (Monday through Friday, 10AM to 4PM excluding holidays, vacations, birthdays, and inclement weather), Ms Jill Messinger is usually available to relay telephone messages to and from Dr. Mortimer. After hours, you may leave a message for either Jill or Dr. Mortimer via voice mail. Jill and Dr. Mortimer respond to telephone call requests during office hours as their respective schedules allow. Some days are very hectic, and Jill or Dr. Mortimer might not return your phone call until later in the day – or the next business day. Telephone calls from patients require that Jill or Dr. Mortimer pull the patient’s chart, document the substance of the conversation, and the rationale for the advice/ treatment given. Physicians giving advice over the phone incurs the same professional liability (“malpractice”) risks as that given to a patient in the physician’s office. In fact, there is more professional liability in giving advice over the telephone than seeing the patient in the office, since the physician can’t pick up on non-verbal clues (alcohol on breath), can’t check vital signs (blood pressure, pulse, temperature, respiratory rate), can’t check conditions of the skin or eyes, and can’t evaluate the patient's affect. Therefore, Dr. Mortimer views using the telephone for informational exchanges, not for therapy (– unless the phone call occurs, for example, during a pandemic). Do be aware that unless there is a pandemic or other national emergency when temporary emergency rules apply, medical insurance companies will not reimburse patients for time a physician spends on the telephone on the patient's behalf. Furthermore, Dr. Mortimer has observed that there is often clinical "magic" which happens when the patient is in the same room as the physician which doesn't necessarily happen when the physician's conversation with the patient is by telephone. Therefore, if you have a complicated clinical concern, then please make an appointment to see Dr. Mortimer in his office so that he can adequately assess your situation. While medical decisions made via telephone require the same professional cognitive deliberation and written documentation as does an office visit, Dr. Mortimer does not charge for brief phone calls (i.e., to answer straightforward questions, or to “check in” with him), but he does charge for phone calls that require a significant amount of his time or that increases his professional liability (“malpractice”) exposure. When in doubt, please make an appointment!
- What about electronic communications with Dr. Mortimer or Ms Jill Messinger? Since e-mail, cell phone texting, Zooming/Skyping and all that are not secure, neither Jill nor Dr. Mortimer are willing to communicate with patients or with patients' families or with other persons asking about a patient's protected medical information via E–mails, text messages, “Skype” or “Zoom.” This is a professional liability risk which Dr. Mortimer wants to avoid. If you wish for Jill or Dr. Mortimer to review information from you before your next office visit, you can send mail it, send it as a fax, leave a voice message, or deliver the information by courier to Dr. Mortimer’s office. Since Dr. Mortimer does not check E-mails when on vacation or when ill, since the Internet server might shut down unpredictably, since there are worms, Trojan horses, viruses and probably also some sort of extraterrestrial ooze that can infect computers via E-mail and the Internet, and because of unresolved issues regarding confidentiality, medical liability, and reimbursement for the time it takes Dr. Mortimer to read and respond to E-mail, Dr. Mortimer is unwilling to share his e-mail address or cell phone number with patients or their family members. So, please do not ask for the e–mail address or personal cell phone numbers for either Dr. Mortimer or Ms Jill Messinger. If you wish to send Dr. Mortimer information, please send him the information via fax, telephone voice mail, US Postal Service, or make an appointment!
- What if I have paperwork that I want Dr. Mortimer to complete? Patient–initiated requests that Dr. Mortimer complete paperwork (e.g., for schools, employers, state agencies) or compose special reports (e.g., for disability insurance, attorneys, or the court) typically consumes a considerable amount of Dr. Mortimer's professional medical time. Be aware that if you request that Dr. Mortimer compose a special report or complete some special paperwork, Dr. Mortimer will bill you for the professional time it takes for him to complete this task – and there are no insurance companies who will reimburse any physician for the time it takes him/her to compose or complete paperwork outside the office visit. Thus, it might be worth your time to schedule an office visit with Dr. Mortimer during which time you can work together in completing this task.
- What are some of Dr. Mortimer's limitations on his time and availability? As you know, Dr. Mortimer has a solo outpatient psychiatric practice. When Dr. Mortimer is out of the office, Dr. Mortimer is “off duty.” Dr. Mortimer is not available for returning phone calls after posted office hours, on weekends, or during vacations. Dr. Mortimer does not made arrangements with another child & adolescent psychiatrist or general adult psychiatrist to “cover” for his out–patient private practice when he is unavailable. Therefore, if a prospective patient wishes for Dr. Mortimer to be responsible for his/her psychiatric treatment, then that prospective patient must be willing and able to make an inviolable commitment to no–self–harm as a condition for working with Dr. Mortimer. Those who are unwilling to make this commitment to no–self–harm must pursue psychiatric treatment elsewhere. Also because of the limitations on Dr. Mortimer’s solo, out–patient private practice: all prospective patients wanting to work with Dr. Mortimer must agree to establish and/or maintain a professional relationship with a primary care physician. Dr. Mortimer does not provide emergency psychiatric or medical services. In the event of an unexpected psychiatric or medical emergency after posted office hours or on weekends, be aware that Dr. Mortimer is not a “bottom–line” psychiatric resource for you (– or for your family member who is the identified patient). In the event of a serious medical emergency, do not wait for Dr. Mortimer to return your phone call. Your options include: calling your primary care physician; calling 911; or presenting yourself to a hospital emergency department.
- How might treatment with Dr. Mortimer end? Patients may terminate their treatment relationship with Dr. Mortimer at any time. Failure to follow through with agreed–on treatment plans made for your medical and psychiatric care will be viewed by Dr. Mortimer as your intent to terminate your professional relationship with Dr. Mortimer. Therefore, if you do not follow the agreed–on treatment recommendations which Dr. Mortimer believes is necessary, then Dr. Mortimer will conclude that this is your implicit statement that the treatment with him has been terminated, and that you do not wish to continue with him. Dr. Mortimer will honor what he believes to be your wishes about this. Conversely, Dr. Mortimer may terminate his treatment relationship with any patient without cause with 30 days’ notice. The most common reasons which lead to Dr. Mortimer to decide to terminate the treatment relationship is patients’ failure to honor the written treatment contract with him. Under certain circumstances, Dr. Mortimer will remain the treating physician of record for 30 days after he has notified his patient that he will be terminating the professional relationship. This may or may not include providing continued medication refills for the 30 days after notification of termination of the treatment relationship – this determination is at Dr. Mortimer’s discretion. Dr. Mortimer will not provide referral to another psychiatrist if he believes that: there has been a show of bad faith; that the patient has abused his/ her relationship with Dr. Mortimer; that the patient has deliberately harmed himself or others; or that continued psychiatric treatment – from anyone – is not likely to be beneficial to the patient.
- Collections. For those who fail to satisfy their financial obligations with Dr. Mortimer, the account may be assigned to a collection agency or be reported to the Internal Revenue Service. If assignment to collections occurs or if the debt is reported to the IRS, it is not a breach of confidentiality. No one will know the contents of your treatment record, only the amount owed.
- Your medical record. It is a state law that Dr. Mortimer maintains a record of the treatment given to you. The medical record that Dr. Mortimer has on his patient is the paper/ written records that are relevant to Dr. Mortimer’s patient’s treatment. This record might include patient intake forms, insurance forms, treatment contracts, session notes, testing, summaries and evaluations of treatment, letters written about his patient, phone message records, consultation notes, billing records and any evidence of communication with anyone in reference to the patient. This record will contain the information that will allow Dr. Mortimer to chart the course of your treatment. Dr. Mortimer will use it only for that purpose. It is Dr. Mortimer’s hope that no one other than his office manager and himself will ever see what is contained in your medical chart/ record. Dr. Mortimer is the custodian of the your medical records. Dr. Mortimer believes that his efforts to keep your records secure and confidential are reasonable. This does not mean that your records are kept in a locked bank vault, but access to them is limited to those individuals who have a right and a need to see them. Medical records are kept in an off–site cabinet that is locked when not in use. Because of the ease at which things can go wrong, Dr. Mortimer is often less than enthusiastic about sending copies of patient’s medical records via fax. You may receive a copy of your medical record by providing Dr. Mortimer with a signed and notarized release of information request, plus payment of fees for this professional administrative service. Dr. Mortimer may, instead, provide you with a synopsis of the course of treatment and outcome in lieu of the actual record. You agree that you will pay, in advance, for either the copying cost of the actual record or the time required for Dr. Mortimer to prepare a treatment summary. This includes providing copies of reports to any court or legal representative or designate. In the event of your death, these requirements will be binding on any heirs, successors, or executor(s). If the treatment meetings/ sessions contain more than one patient, you agree that no one person may obtain the complete treatment file. Dr. Mortimer will attempt to maintain a separate record on each patient. However, only that individual is entitled to his or her own record. You agree that Dr. Mortimer may compose a synopsis of the course of each individual’s treatment as opposed to providing a copy of the notes may have been produced during any therapy session. The records of inactive patients are stored in a locked cabinet in an off–site location. The laws of the State of Washington requires that the medical record be maintained for a period of seven years for adult patients, and longer if the patient is a child or teen. Dr. Mortimer will maintain the medical records for that period of time. At the end of that period, Dr. Mortimer will destroy the patient’s medical/ psychiatric record.