S-CAT® Program Service Agreement

Selective Mutism Anxiety Research and Treatment Center

Review of Center Policies

Insurance Policy

The SMart Center does not accept any medical insurance plans. Some services provided by Dr. Shipon-Blum are considered out-of-network and she is considered out-of-network provider.

If you have out-of-network insurance coverage, we recommend contacting your insurance company to see if they may offer some reimbursement to you for our services. Note out-of-network coverage does not apply to all clinicians or professional services provided at the SMart Center.

We will provide to you a receipt for services with Dr. Shipon-Blum with the information insurance companies can review for each consult (except school consults which are considered a professional service only).

All correspondence with your insurance company regarding reimbursement is between you, as the member, and your insurance company. We cannot promise reimbursement for our services as every insurance provider is unique in their coverage conditions.


Payment Policy


For S-CAT® Program initial evaluation/treatment consultations:
A $100 deposit is required to secure an initial consultation.
The deposit is 100% nonrefundable if canceled within 2 weeks of the scheduled consultation.
The deposit is 50% nonrefundable if canceled prior to 2 weeks of the scheduled consultations.  

Final payment for initial S-CAT® Program and the first month of treatment/support:
In-person consultation: Due at time of service.
Web-Ex consultation: Due at least 3 days prior to date of service.

For S-CAT® Program monthly follow-up consultations:
Payment is due, which includes the following month of treatment/support:
In-person consultation: Due at time of service.
Web-Ex consultation: Due at least 3 days prior to date of service.

Returned Check Policy: All returned checks are subject to a $30.00 return check fee. We reserve the right to restrict future transactions to cash or money order.

Late Payments: Incur a $30 per month late fee.

Accepted Payment Methods: Credit Card (Visa, Master Card, American Express, and Discover), Personal Check, Money Order, or Cash


Cancellation Policy

We ask that you give us as much notice as possible prior to a scheduled consult if it needs to be rescheduled.  We have a long waiting list for appointments and the sooner you let us know, the better the opportunity to allow for another patient in need of our services to take that time.  We understand that unforeseen circumstances can cause a family to cancel their appointment. Our office staff sends out reminders via email and phone so families are able to confirm their appointment.  If we receive less than 24 hours notice that a consult time needs to be rescheduled then the consult payment is still due as previously scheduled.  No show appointments, unless a sudden emergency occurs where documentation can be provided, are not acceptable and payment is required for the no-show appointment.

Communication & Scheduling With Our Center

Our Front Desk Office Hours are 9:00am to 4:30pm EST Monday through Friday and we have an answering service available 24-7 in order to leave urgent messages.

For scheduling needs and service questions: Please call us at 215-886-6090.  We can also be reached by email at admin@selectivemutismcenter.org. Any patients wishing to correspond with support staff via email must sign off on the Email Correspondence Permission Form, which can be found in the Patient Permission Form.

Patient Updates to Dr. Shipon-Blum & Jennifer Brittingham: Please send updates on patient progress through our Update the SMart Center form on our website:

https://fs4.formsite.com/smartcenter/form9/secure_index.html

Please note that updates sent to Dr. Shipon-Blum/Jennifer Brittingham are reviewed and used in your treatment plan development for discussion at your next scheduled consultation.

Any questions that need to be addressed prior to your next consult with Dr. Shipon-Blum/Jennifer Brittingham should be addressed during your support phone consult with or by calling our support coordinators at 215-886-6090. If we need to schedule an additional consultation to address your question an additional consult fee will apply.

 

Medication Policy

When Dr. Shipon-Blum is the prescribing doctor for a patient, it is required that the patient come to our office in-person once a month for the first 3 months for close monitoring of the patient’s tolerance and response to medication.   Thereafter if Dr. Shipon-Blum deems they are stable then the patient must be seen in-person at a minimum of once every 3 months.

If a patient is unable to commit to 3 monthly visits and then as determined (at a minimum of once every 3 months) then Dr. Shipon-Blum will be unable to remain their prescribing doctor and the patient will be referred to their local physician to take over medication management.

It is necessary that patients on medication be monitored regularly to review their side effect profile and progress in treatment. Medication should never be missed or stopped suddenly. Weaning off of medication must be done under the care of a physician.

In order for a patient to begin a regimen of medication through the SMart Center (only if deemed necessary and agreed on by the family and Dr. Shipon-Blum), parents must sign off and a Medication Policy Agreement Form, which will be provided at that time.

 

Our Dedication to Privacy

Please see the HIPAA Guidelines in the New Patient Packet.