Payment is due at the time of service. You must have a credit card on file, which will be charged the day of the service (the out-of-network, OON fee if I am not in network with your insurance; cards may also be charged for late-cancellation or no-show fees, form fees, or fees for deductibles or services not covered by your insurance). I accept credit cards, cash and checks.

I am in-network with Carefirst and Cigna and will submit the bills directly to them. You are responsible for:

—Ensuring, before your appointment, that mental health and psychiatric services are covered. Any copay or deductible is due at the time of service.

—Payment of services that are not covered by your insurance company.

—Updating your insurance information with me if there are any changes, as well as for payment of services not covered due to a delay in informing me.

For insurance companies outside of Carefirst and Cigna, I am considered an out-of-network (OON) provider, and you will have to pay the OON fee. If you have OON benefits, I can supply you with a superbill as requested, so you may submit for OON reimbursement with your insurance company.

I am unable to accept Medicaid and Medicare patients at this time.

Under federal law (No Surprises Act), health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. 

If you are a self-pay patient, you have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. 

You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For more information, see: https://www.cms.gov/nosurprises

You will need to make an account with Charm Personal Health Portal (an invite from me will be sent) in order to complete forms and questionnaires:

https://phr2.charmtracker.com/login.sas

All forms must be completed and/or signed (patient intake forms, releases of information, questionnaires, notice of NPP receipt, credit card authorization form/financial agreement, treatment consent, telehealth treatment consent if applicable, and Patient Services Agreement) for an appointment to be scheduled.

Please have ready, at the first appointment:

• Photo identification

• Insurance card

• Name and contact information for an emergency contact

• Preferred pharmacy

• List of all medications (prescribed and over-the-counter), dosages, vitamins, supplements

• Copies of medical records from your prior psychiatrist or mental health clinician. This is especially important if you have had a neuropsychological evaluation for ADHD. 

• Or, be prepared to sign a release of information so I may obtain copies from your prior clinician(s).

You will need an account with Charm Personal Health Portal for telehealth visits:

https://phr2.charmtracker.com/login.sas

Please find a private, quiet area for your appointment.

You must be located in Washington D.C., Maryland or Virginia during your telehealth appointment. You cannot be driving during your appointment. Please reschedule your appointment if you will be driving or outside of the DMV. I will need to end the appointment and charge a no-show fee otherwise. 

I will need to know your exact location at the beginning of the appointment in case any emergency arises. You can tell me or write that in the chat box.

In the event that a technical problem interrupts the visit, please call me at 571-620-6349, or I may call you. 

You may be required to come in-person for an appointment (this is judged on a case-by-case basis).

If you are converting your scheduled in-person appointment to telehealth, please do so by noon of the preceding day.

I am required to check the state Prescription Monitoring Program or Prescription Drug Monitoring Programs before prescribing controlled medications (for example, medications of the stimulant or benzodiazepine class). 

Some medications, including some controlled substances, will not be prescribed with concurrent regular use of alcohol, cannabis or other non-prescribed, mind-altering substances.

I do not provide prescriptions for buprenorphine (Subutex, Suboxone), methadone, medical cannabis, daily benzodiazepine prescriptions, ketamine, esketamine.

Controlled medications are generally prescribed 30 days at a time. Early refills are not given for lost or stolen medications.

Urine drug screens may be required before or during treatment with controlled substances.

I place orders for medications and refills at your appointments, typically enough to last until your next appointment. If you are running out before your next appointment and are unsure if you have refills, please check your bottle or call your pharmacy to check. Sometimes their texting systems are not accurate. 

If you do need a refill, submit requests through Charm PHR. I do not refill based on pharmacy requests. 

Please allow between 1 to 3 business days for the refill. 

If it’s been a long time since your last appointment you may be required to be seen before a new prescription is ordered.

My email address, contact@jennyungmd.com, is used for business purposes and general inquiries. While it is encrypted and HIPAA-compliant on my end, no electronic communication is 100% secure. By emailing, you consent to my use of email for correspondences, including appointment scheduling and general inquiries.

Instead of email, please send messages through the secure Charm portal. You will need to make an account with Charm PHR for secure messaging and telehealth appointments with me (an invite from me will be sent).

If you consent to text exchange you will have to make an account with Spruce Health as well, for app-to-app text messaging: https://sprucehealth.com/patients

I use Spruce texting for appointment reminders only, so please use Charm for messaging. 

For urgent matters, I recommend phone calls over messaging. My voicemail at 571-620-6349 is secure. Leave your callback number and best times to reach you if you leave a message.

Messaging and phone calls are best for brief questions. If there is an issue that is more involved, an appointment will be required.

I will do my best to return your call within 1 to 2 business days. I will prioritize urgent calls.. However, in an emergency, such as when fearing for your life or safety, you must call 911 or go to the nearest emergency room.

Please cancel no later than 48 hours before your appointment. Late cancellations will incur a fee that is half the out-of-network (OON) cost of the appointment (for example, $175 late cancellation fee for a 60 minute appointment, and $92.50 for a 30 minute appointment).

No show fees will be the full OON cost. 

You have the option to opt into reminder/confirmation texts (through the Spruce app). 

Late arrivals will be seen for the remaining duration of the appointment; if self-pay, the fee will not be prorated.

No shows for initial appointments won’t be rescheduled.

For various reasons, we may make a mutual agreement to discharge you from my care. Some reasons might be patient relocation, insurance changes, etc.  If you feel we are not a good fit and wish to see another doctor or clinician, please let me know in person or in writing. I can help by providing names of other clinicians or practices. 

Other reasons for termination of care include:

• Needing a higher level of care than I can provide within the practice

• Repeated no-shows or cancellations

• Non-payment for services

• Non-response to outreach with no future scheduled appointments

• Threatening behaviors or harassment

• Consistently not following treatment recommendations

• Not disclosing misuse, or abuse of medications or substances

  If I terminate treatment, I will first discuss this with you; provide 30 days’ notice, referral resources and can send a copy of your records to your new provider.

Please review the Notice of Private Practices (separate handout) for more detailed information. This section is to highlight common concerns about privacy that arise in psychiatric treatment.

• For digital communication containing PHI, please use the Charm PHR  and Spruce, which are secure and encrypted.

• Your medical information is private and cannot be released without your written consent, outside of specific situations as outlined in the NPP. 

• I am unable to share information with your family without your consent. However, I am able to hear family members’ concerns if they contact me. 

• I am able to contact your other providers if needed for purposes of ensuring good medical care.

• I am a mandated reporter for concerns about child, disabled adult, elder abuse, or of imminent harm to someone else. 

• If I am concerned about your imminent safety I can break confidentiality. 

• I may sometimes consult with another clinician on clinical questions involving your care, but identifying information will not be shared.

No unattended children for in-person appointments.

With regard to psychiatric medication management, while you may see another psychiatrist for a consultation or 2nd opinion, you should be working with only one psychiatrist or prescribing clinician for psychiatric medications on an ongoing basis.

I highly recommend you also work with a primary care doctor if you don’t already have one. A release  of information from your PCP is also needed.