“Wounding and healing are not opposites. They're part of the same thing. It is our wounds that enable us to be compassionate with the wounds of others. It is our limitations that make us kind to the limitations of other people. It is our loneliness that helps us to to find other people or to even know they're alone with an illness. I think I have served people perfectly with parts of myself I used to be ashamed of. ” ― Rachel Naomi Remen

Treatment Agreement and Practice Policies

This contains important information about the professional services and business policies of Jim Ashe, M.D. Please read it carefully and discuss any questions you have with Dr. Ashe.

ASSESSMENT AND TREATMENT

Dr. Ashe will provide an assessment of you/your child’s difficulties and available treatment options. Treatment may include individual psychotherapy, family therapy, mindfulness and lifestyle practices and/or medication management. You are entitled and encouraged to ask questions about all aspects of treatment. Dr. Ashe will help you secure a consultation with another mental health professional whenever it is requested. If you could benefit from any treatment that Dr. Ashe does not provide, he has an ethical obligation to assist you in obtaining those treatments.

THE PATIENT’S ROLE

Dr. Ashe views his work with patients as a collaboration. Patients are expected to play an active role in treatment, including working with Dr. Ashe to outline treatment goals and complete assessment instruments when requested.

HOURS/AVAILABILITY

Psychotherapy and/or medication management sessions are typically scheduled for 50-minute sessions. If you need to contact Dr. Ashe between sessions, please leave a message on the voicemail, and your call will be returned as soon as possible, usually within one or two business days. In an immediate crisis, you can contact Dr. Ashe’s personal cell phone. Be aware however, that Dr. Ashe may not always be available to answer his cell phone. In any event, you should also contact the local emergency room, psychological emergency services, or crisis intervention/suicide prevention services. Please also leave a message on Dr. Ashe’s voicemail so he can coordinate care with the emergency services contacted.

CONFIDENTIALITY & CONSENT

CONFIDENTIALITY

The confidentiality of communications between the Patient and Psychiatrist is important and, in general, is legally protected. Dr. Ashe will make every effort to keep the results of your evaluation and treatment confidential, as required by law. Information about you will be released only with your permission, with the following exceptions:

When there is suspected elder or child abuse or neglect.
When, in Dr. Ashe’s judgment, the patient is in danger of self-harm or harming another person.
If Dr. Ashe is ordered by a court to release information as part of a legal proceeding.
As otherwise required by law.
If you seek reimbursement from your insurance company, Dr. Ashe may release information to your insurance company upon their request.
If you fail to pay your bill, and it becomes necessary for Dr. Ashe to use a collections agency to collect your outstanding balance, he will release to that agency information necessary for them to make collections.

EMAIL: Email is a very convenient, efficient way to communicate. However, please remember that the confidentiality of email communications cannot be guaranteed and any third party may be gain access to your email communications. Your email communications with Dr. Ashe become part of your medical record.

CONSENTS FOR MINORS

It is agreed that Dr. Ashe may obtain the written or verbal consent of only one parent during the course of treatment for Release of Information, etc.

CONSULATATION, SUPERVISION, AND TEACHING

In order to provide you with the highest quality treatment, Dr. Ashe may at times seek consultation with other professionals regarding your case. In this event, he would maintain confidentiality by not revealing identifying information. Dr. Ashe provides education and supervision to other professionals, and teaches in the community. For the purposes of education in these settings, Dr. Ashe sometimes uses case examples. In this event, he maintains confidentiality by not revealing identifying information.

PAYMENT, REIMBURSEMENT AND CANCELLATIONS

FEES

The fee for a initial evaluation is $1,170.00. The initial evaluation usually involves a thorough consultation for adults. For children and adolescents, the consultation is divided between parent interviews, child interviews, report review, and speaking with relevant professionals such as teachers, therapists, or pediatricians. For ongoing treatment (after the initial evaluation), the fee is $390.00 per 50-minute session. A fee of $290.00 applies to 20-30-minute medication management sessions. Longer sessions may be prorated. If your session time runs over, you may be charged for the extra time. You may also be charged a prorated fee for any time Dr. Ashe spends on your/your child’s case, including, but not limited to: telephone calls, field sessions, site visits, review of records, travel time, copying, billing, report writing, letter writing, contact with other professionals, individuals, or entities regarding your case. Fees may be raised annually.

PAYMENT

Payment is due at the time of your session. It is your responsibility to present payment information in advance for services rendered. Dr. Ashe collects credit card information for all new patients and bills once the service has been provided. If Dr. Ashe is required to send a bill for non payment (i.e. your credit card is declined), he will bill you for the time spent on billing activities. There is no statute of limitations or expiration date on your account balance.

LATENESS, CANCELLATIONS, AND MISSED APPOINTMENTS

Your session is a time reserved just for you. It begins at the appointed time and typically ends 50 minutes later. If you are late, your session will still end on time, and you will pay the fee for the full session. Dr. Ashe asks for 48 hours advance notice if you need to change or cancel your appointment, otherwise you will be billed the full amount of the session. You may not cancel a Monday appointment on the weekend. If you cancel by telephone, you must receive a confirmation or your appointment is not cancelled. In the case of a minor child, the parent/guardian is responsible for notifying of cancellations. If you ask your child to cancel a future appointment, and they forget to do so, you will be charged for a missed session. The full fee will be charged for all appointments that are canceled without at least 48 hours notice as well as any missed appointments.

Please understand that when you commit to an appointment you are reserving a certain amount of time that is devoted only to you. When you do not show, your treatment and my practice are both effected. I allow one unbilled late cancellation or no-show per year if there is an emergency. If you cancel your appointments too often, I will bring this up with you. If you continue to cancel frequently, I may end treatment.

REIMBURSEMENT

You are responsible for collecting reimbursement from your insurance company or other source. Dr. Ashe will provide you with an Invoice/Statement of Services upon request.

LITIGATION FEE: You agree that should Dr. Ashe be involved in any legal proceedings as a result of your involvement in those proceedings in any way (whether you are the plaintiff or the defendant), involving other individuals, agencies, or institutions (such as, but not limited to, disability claims, divorce and custody disputes, personal injury lawsuits, malpractice lawsuits, etc.), you will pay Dr. Ashe a fee of $390.00 per hour, with a five hour minimum. You will be charged for any time Dr. Ashe spends on the case, including, but not limited to, depositions, telephone calls, review of records, travel time, photocopying, report writing, letter writing, or contact with other professionals, individuals, or entities regarding your case.