OFFICE POLICIES

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Office Policies

Our office is following the guidelines established in Federal Health Insurance Portability and Accountability Act (HIPAA) regulations addressing the privacy of health care information, found at 45 CFR §§ 160 & 164; 42 CFR part 2 – Confidentiality of Substance Use Disorder Patient's records and Maryland's Confidentiality of Medical Records Act (MCMRA), codified at Health-General § 4-301 et seq. HIPAA and MCMRA both establish a general rule of confidentiality for health care information. MCMRA requires a health care provider to keep the medical record of the patient confidential and disclose information only as provided by the act itself or as otherwise provided by law. HIPAA enumerates permitted disclosures slightly more specifically by allowing disclosures: to the individual (patient); for treatment, payment, and health care operations; incident to a use or disclosure permitted by the act; and pursuant to authorizations, agreements, or certain public use exceptions. The 42 CFR Part 2 regulations serve to protect patient records created by federally assisted programs for the treatment of substance use disorders (SUD). Part 2 has been revised to further facilitate better coordination of care in response to the opioid epidemic while maintaining its confidentiality protections against unauthorized disclosure and use.

We do not accept any Health Insurance Plans for our Psychiatric Services!
Dr. Venera Miller is considered a Non-Participating Provider with All Insurance Companies. We stopped accepting most Health Care Insurances as Third-Party Payers in 2012. On January 1st, 2014, we stopped accepting the last insurance plan - Medicare. All insurance companies were notified about our decisions via necessary legal documents as certified letters. Once insurance plans received those letters, it was their responsibility to make necessary changes in their network to change the provider’s status from participating to non-participating providers. No Insurances were billed for any psychiatric services in Dr. Miller’s office since January 2014. Patients should contact their insurance companies to determine their out-of-network benefits. We will provide information to help patients submit for Medicare or out-of-network reimbursement on their own from their insurance company.

All services provided in our Psychosomatic Center (CIPM LLC) are qualified as a self-pay. The self-pay patients or patients with out-of-network benefits will be required to pay the full fee prior to each service provided. We accept only cash payments for any Initial Psychiatric Evaluations to eliminate the possibility of controlled substance diversion or prevent doctor shopping. Doctor shopping, a medical term, is the practice of visiting multiple physicians to obtain multiple prescriptions for otherwise illegal drugs or the medical opinion that one wants to hear. We accept cash, checks, Money order, and PayPal payments for any follow-up appointments. No credit cards are accepted at this time. There is a % fee ($4-15) associated with the use of Business PayPal. Please log in to PayPal and search for our business email [email protected] to make a payment. Patients should contact their insurance companies to determine their out-of-network benefits. We will provide information to help patients submit for Medicare or out-of-network reimbursement on their own from their insurance company.

If you are Experiencing a Medical or Psychiatric Emergency, please call 911, 988 or proceed to the nearest emergency room. All messages that are left on our office answering machine (410-535-6520) are being transcribed to a visual voice mail and sent to our secure business email address for quality services. We are screening and monitoring all incoming voice messages and emails regularly for any emergency issues not only during working hours but also after hours, on weekends, and holidays.
Since we are a private outpatient psychiatric clinic and not a psychiatric emergency department/service, we only address our active patients' emergency issues. If you are not one of our active patients, please call 911 or go to the nearest emergency room. We do not provide any emergency appointments for new patients with whom the patient's-doctor's relationship has not been established yet.

For any other non-emergency issues, please leave a message on the answering machine or email us at [email protected], and we will get back to you within 24 hrs on the next business day. If you leave a message on Friday we will get back to you on Monday. In case of Monday is a Federal holiday, we will return your call on Tuesday.

In our office, we are offering secure telemedicine powered by Doxy.me ( https://doxy.me). Doxy.me utilizes state-of-the-art security and encryption protocols, making this platform compliant with HIPAA and HITECH requirements. All the patient needs to start a telemedicine visit is a web link to the doctor's Doxy.me room using a standard computer or Doxy.me app on a mobile device. No special hardware or software is necessary. If you are scheduled for a telepsychiatry session with Dr. Miller, please log in to https://doxy.me/cipmllc at the time of your appointment and sign your name.

There is a 24-hour notice required to cancel a routine appointment (medication management, substance abuse treatment appointment, group therapy, individual/couples/family psychotherapy). A cancellation with less than 24-hour notice will be charged the late cancellation fee, which is equivalent to the missed appointment fee. Any Initial evaluation/consultation appointment should be canceled during working office hours at least 48 hrs in advance to avoid missed/canceled initial evaluation/consultation appointment charges. Two missed initial evaluation appointments will result in no further initial appointments being scheduled. If the office is closed and you find it is necessary to cancel your appointment, you may leave a message on the answering machine (410-535-6520) or email us at [email protected] with your name, phone number, day and time of the call, and day/time of your scheduled appointment. To ensure you are not charged, it is your responsibility to call the office during regular office hours (9:00 am - 4:30 pm Monday - Thursday, 10:00 am – 12:00 pm Friday and closed Saturday and Sunday) to confirm the appointment was canceled within the appropriate time period. Two consecutive missed appointments for any services provided will result in discharge from the practice.

We are no longer making reminder calls. The absence of a reminder call does not relieve you from your responsibility to provide us with a 24-hour cancellation notice for follow-up appointments and 48-hour cancellation notice for initial evaluation you are unable to keep. You will be getting a text reminded or voice reminder on your provided phone number 24 hrs before your scheduled appointment. Please reply to the text message to confirm or cancel your upcoming appointment. The text message also will provide you with the links to the telepsychiatry session.

Past due balances and fees for miscellaneous requests are due at the time of the visit. You will be required to pay the full fee prior to each service provided. Payments for medication management appointments must be provided before the initiation of the appointment. If payment for the services is not provided on time, your appointment will be rescheduled until we will collect the payment. There is a $50.00 charge for all returned checks. The patient will receive one phone call regarding this matter. The payment is required within 48 hrs of notification that the check was returned. We will not accept a check from those patients whose check was returned at least once. Non-payment will result in legal action from the State's Attorney Office and discharge from all services.

Regular Medication Management appointments are 15-20 minutes at the cost of $100.00. If you need additional time with Dr. Miller (20-30 minutes), an additional charge of $50.00 for the Extended Medication Management will be charged at check out. You can, of course, let the receptionist know in advance if you feel you will need additional time with Dr. Miller, and we will give you an appointment time that will allow for the additional time you need.

You have to arrive 15-20 minutes early for the initial evaluation to fill out the paperwork. We accept cash only for 60-90 minutes of Initial Evaluation. Being twenty or more minutes late for the initial evaluation will result in the cancellation of your appointment, and appropriate cancellation fees will be applied.

If you have not been seen in our Psychosomatic Center for more than one year – you will be automatically discharged for non-compliance with treatment. In order to receive any services from us again, you will need to re-enroll as a new patient and comply with associated new patient's rules, policies, and fees. The re-enrollment is done on a case-by-case basis and depends on the patient's treatment history or circumstances of the discharge.

We no longer re-fill prescriptions without an appointment. Dr. Miller provides you with enough medications and/or refills until your next appointment. Please check the number of given refills you have with your pharmacy. If for some reason you run out of medications before your next appointment please call (410) 535-6520 and speak slowly and clearly state your name, date of birth, contact phone number, medication you are requesting, and pharmacy name and phone number. The situation will be evaluated and it may take 48-72 hrs until the electronic prescriptions will be issued. Medication requests are not filled after hours (after 4:00 pm during weekdays) or on weekends (Friday, Saturday, and Sunday) and holidays, so please plan accordingly. It is wise to schedule your appointment in advance to avoid running out of important medications. If you require prior authorization for the prescribed medication, your pharmacy should fax us the Prior Authorization Form at (410) 535-6523, and it will be your responsibility to make sure that we received that form. We need 48-72 hrs. to complete the prior authorization process. If you are requesting the prior authorization on Thursday, we may not be able to complete the process until the following Monday.

Any court or other legal appearance requested to be made by Dr. Venera R. Miller or other office staff to serve as a testimonial witness or to give a deposition will necessitate the cancellation of patient treatments for the entire day. As such, court or other legal appearances will be charged on a per-day basis and require full payment (according to treatment charges) in advance (minimum two weeks in advance) via retainer, and a two-week cancellation notice must be given for fees to be returnable. Unless canceled a minimum of two weeks in advance, the fees are non-refundable, even if testimony or deposition is deemed not necessary.

All patients under Dr. Venera Miller's care will be subjected to randomized drug analysis (oral, urine, or hair testing) to assure compliance with the prescribed medication regimen and the presence of illegal substances. Refusal or failure to comply will result in termination of the patient-doctor relationship and discharge from the practice. An additional charge of $ 25.00 could be applied for randomized urine or oral toxicology screen for any patients who have been prescribed scheduled controlled medications (Stimulants, Benzodiazepines, and Medications for sleep).

If a patient qualifies for certification to use Medical Cannabis for health reasons, he/she must disclose the Cannabis use, name of the recommending physician and present the official medical documentation that will confirm the necessity for medical cannabis administration. It is up to Dr. Miller's discretion to evaluate the legitimacy of the presented medical documentation, qualifications of recommending physician, and the justification for the medical use of cannabis.

If you have not been seen by the physician for more than six months, you will not be given refills on any medications (scheduled or non-scheduled). You must schedule a follow-up appointment and be re-evaluated for the effectiveness of the current medication regimen and possible side effects or complications. If you have not been seen in an office for more than three months, you will not be given refills on any Anxiolytic Medications (Benzodiazepines: Xanax, Ativan, Valium, Klonopin, and others) as well as ADHD medications (Stimulants: Adderall, Ritalin, Vyvanse, Concerta, Dexedrine and other). Make sure you allow sufficient time to have your appointment scheduled to be re-evaluated for the necessity of controlled medications and to avoid possible withdrawal symptoms due to the abrupt discontinuation of Benzodiazepines.

Please note that pharmacies were instructed not to provide any automatic refills for any patients. At the end of every follow-up appointment, the patients will receive the date and time of their next appointment based on Dr. Miller's recommendations. The frequency of the follow-up appointments with Dr. Miller ranges from 1 week to 3 months, depending on the patient's stability and the type of appointment. If you are running out of medications, you need to schedule an appointment with Dr. Miller if you don't have one. Sometimes, patients cancel the appointment and ask for refills. Please be aware that we are not granting those refills in our psychiatric practice. Dr. Miller only provides a specific number of refills that are safe and therapeutic until the patient's next appointment. Any extension of the patient's visit, other than recommended by the physician, could compromise the patient's psychiatric stability and possibly lead to safety concerns.

If you lose a scheduled medication prescription for Stimulants (Methylphenidate, Dextroamphetamine, Amphetamine, Vyvanse, Dexedrine, Adderall, Ritalin and other), Opioid Dependence medications (Suboxone/Subutex/Buprenorphine, Zubsolv, Bunavil), Benzodiazepines (Xanax, Ativan, Klonopin, Valium and other) and Sleep Medications ( Ambien, Sonata, Lunesta and other) you will not be given another prescription until it's time for a scheduled routine refill and you will be required to provide detailed information about the incident and copy of the police report. Based on circumstances and physician determination, you may or may not be prescribed this specific medication again. ADHD medications are scheduled controlled substances and must be written by a physician in the office during the appointment. The office staff will also not be calling pharmacies to check the availability of medication. The patient may want to call the pharmacy prior to requesting a new prescription to ensure the pharmacy has the requested medication.

The Comprehensive Substance Abuse/Opioid Dependence Program includes medication management, mandatory group therapy sessions, and regular toxicology screening (urine, oral, or hair testing). Fees for medication management, group sessions, and urine toxicology screen are due at the time of service. If payment is not provided before or at the time of service (med management, group therapy), the medication management appointment will be rescheduled. If you have missed the group therapy session, the $80 fees will be charged ($50 +$30) and the next medication management appointment will be canceled if payment was not provided. The urine toxicology screen must be done before the regular medication management appointment to evaluate the effectiveness and compliance with the treatment. All Suboxone/ Subutex (Buprenorphine/Naloxone; Buprenorphine, Zubsolv) prescriptions will be provided only during routine Opioid Dependence treatment appointments. The Sublocade and Vivitrol injections are being administered by Dr. Miller at the office. All patients will be subject to toxicology screens at every visit as well as randomized screens, some of which may or may not be observed. We will give as much notice as possible to the patients. In case of doubt accuracy of results and the patient is re-tested, the patient will be responsible for payment of the second specimen cup/oral swab. Due to stricter regulations, Benzodiazepines will no longer be prescribed to patients who are taking Buprenorphine.

If we suspect the Diversion, Multiple Sources, or Illegal/Illicit drug use, Dr. Miller will determine, based on available facts and circumstances, the necessity for the continuation of medical care or discharge from the practice for non-compliance. If medical care continues, serious limitations in regards to prescribing medications (Stimulants, Benzodiazepines, Buprenorphine, Sleep Medications, and others) will be implemented with ongoing random toxicology monitoring. If the patient is being discharged from the practice for non-compliance, a referral to another physician or facility will be provided.

Diversion – drug screen negative for drugs prescribed. If diversion is suspected, prescribing controlled substances is illegal. No prescription will be provided by Dr. Miller. A repeat test must be completed within 48 hrs.
Multiple sources – drug screen positive for controlled substances not being prescribed by our practice. If a patient appears to be receiving benzodiazepines, stimulants, Buprenorphine, buprenorphine/naloxone from multiple physicians. Dr. Miller will not continue to prescribe controlled substances for these patients.
Illegal/illicit drugs– a positive screen. Absolutely no controlled prescription will be prescribed. Controlled substances cannot be safely prescribed in patients taking illicit drugs, including cannabis.

Past due balances and delinquent accounts for all services rendered are subject to collections under the following guidelines: two telephone attempts to reach patients and two statement mailings (email and regular mail) resulting in non-payment will automatically be referred to Practice Attorneys for Court Processing and to a Debt Collection Agency.

In the case of office closure due to inclement weather or other urgent situations, office staff will attempt to notify patients scheduled. Patients are encouraged to call the office and confirm office hours if inclement weather is in question.

Under the state law, you have the right to obtain a copy of your medical records. You have to make a written request which includes your name, the name of your health care provider, the date of the request, and your signature. You also will be required to sign a confidentiality release form for medical records. Our fees for a copy of the medical records include 0.75 cents per page plus actual postage and handling fees. According to the law, we have the right to withhold your records until you pay the fee. We prefer for the patient/former patient to pick up the requested medical records from the office in person. We will not upload/send medical records electronically even upon request of the patient or a represented party because we cannot guarantee confidentiality.

As a supplement to in-office appointments, we are inviting you to use email to communicate with our clinic. Our email address is [email protected] and is HIPAA compliant under the Business Associate Addendum (BAA) with Google LLC. Your decision to utilize email is strictly voluntary, and your consent may be rescinded at any time. The email will be accessed, and responses will be provided via phone or email communication by Dr. Miller or a staff member within 24-72 hrs, depending on weekdays or weekend schedule. You may use email to communicate with our office for prescription refill requests, appointment requests, or other matters not requiring an immediate response. The email should never be used in an emergency if you are experiencing any desire to harm yourself or others, if you are experiencing a severe medication reaction or if you need an immediate response. Unlike trading voicemail messages, email allows you to see exactly the question the doctor is responding to and have a written record of that exchange for future reference. Risks of communicating via email include but are not limited to: Email may be seen by unintended viewers if addressed incorrectly; Email may be intercepted by hackers and redistributed; Someone posing as you could access your information; Email can be used to spread computer viruses; There is a risk that emails may not be received by either party in a timely matter as it may be caught by junk/spam filters; Emails are discoverable in litigation and may be used as evidence in court; Emails can be circulated and stored by unintended recipients; Statements made via email may be misunderstood thus creating miscommunication and/or negatively affecting treatment; There may be an unanticipated time delay between messages being sent and received. You must let Dr. Miller know immediately if your email address changes. If you do not receive a response from Dr. Miller or office staff in the time frame indicated, you need to contact the clinic by telephone if a response is needed. You must advise Dr. Miller in writing should you decide that you would prefer not to continue communicating via email.