Fees & Policies

Fees


Payment Methods: We accept cash, cashier's checks, certified checks, most major credit and debit cards, flexible spending account debit cards and healthcare savings account cards. Personal checks from Tennessee-based financial institutions are accepted if provided at least 1 week prior to the service. Personal checks from out of state financial institutions are accepted only if provided more than 2 weeks prior to the appointment so that the check is cleared before the appointment occurs. Should a check be returned, a fee of $50, plus any additional bank charges, will be assessed to the patient and must be paid before any appointment is scheduled. ​​ Fees: A $100 booking fee is required for all services at the time of scheduling, and is deducted from the cost of the service when payment is made for the balance for that service. If the appointment is cancelled with more than one day's notice, the booking fee will be refunded or may be applied to a future appointment. If the appointment is missed, or is cancelled or rescheduled with less than 24 hours' notice, the booking fee is forfeited and will not be refunded. Full Payment is required prior to, or at, the time of service. Ketamine infusion charges include all costs of providing the service, including medication, supplies, nurse services, and physician services. Dr. Jackson usually sees each patient during each visit for Ketamine infusion services. A cash discount is available on all services. “Cash” does not refer to checks, credit or debit cards, or other non-cash payment forms, which incur added processing costs for us. Initial Evaluation by Psychiatrist (50-60 minutes) $300 ($280 cash) Follow-up Appointments with Psychiatrist (25-30 minutes) $150 ($140 cash) Follow-up Psychiatrist Appointments (45-50 minutes) $300 ($280 cash) Ketamine Infusion, single session (60-90 minutes) $350 ($335 cash) Ketamine Infusion, series of 5 pre-paid sessions (60-90 minutes each) $1700 (reg. $1750) Ketamine Infusion, series of 5 pre-paid sessions, paid in cash $1650 cash (reg. $1700) Pharmacy calls, prescription requests, and extended telephone calls may be charged if they become excessive in time or number. Cancellations or Missed Appointments: Please notify the office as soon as possible if you are unable to come to a scheduled appointment. Telephones are staffed 7 days a week, and you may also leave a message. Cancellations less than 24 hours before a service, and missed appointments, will result in forfeiture of that session's $100 booking fee. No-shows and late cancellations will result in a loss of $100 of the value of the package, which must be repaid before the last treatment of the package is utilized. Repeated failure to attend appointments may result in termination of treatment.




Medicare & Insurance


Insurance and other third party payers We do not file claims, accept payments, enter single case agreements, or participate in any provider networks with TennCare, Medicaid, Medicare, Workmen's Compensation, HMO, PPO, or other private insurance plans. If there is any change in this policy, we will post it here. Upon request, within 5 business days, we will provide you with an itemized statement, showing the fees paid, and the appropriate diagnosis and service codes. You may submit these to your insurance company, for possible reimbursement. Actual payment of claims is between you and your insurance company. We cannot guarantee payment of any claims, by your insurance company. Ketamine treatments are not a covered service under any insurance plans, to our knowledge. You are responsible for payment for any staff or physician time in dealing with a insurance company or pharmacy benefit manager requests for information or other paperwork, such as for disability, prior authorizations, appeals, attorney requests, mail order prescriptions, etc.




Other Policies


Confidentiality We protect your confidentiality in accordance with accepted practices, HIPAA standards, mental health regulations, Tennessee state law, and the Code of Ethics of the American Psychiatric Association. Your treatment and records are confidential. We do not release information without your request and authorization. Possible exceptions may include subpoenas, facilitation of emergency care, persons under the age of 18, and situations requiring legally mandated reporting. We do not share information with your family or friends without your consent. You will be provided with a copy of our full policy on confidentiality. Informed consent You will be required to sign an informed consent document prior to receiving treatment. Please make sure you understand the nature of the treatment, and ask any questions before signing. You may withdraw your consent at any time by notifying Dr. Jackson or the office. If you are under 18, a parent or legal guardian is required to sign on your behalf. Children For their safety and your peace of mind, please do not bring infants or small children to the office. They will become bored and disruptive during long appointments. We do not have a changing room or play area, and our staff are not available to monitor children. Telephone calls There is no charge for brief, necessary telephone calls related to your treatment. We reserve the right to charge a fee for frequent or prolonged calls. If you have a complex problem that can't wait, it is usually best to request an earlier appointment in the office. Refills Please call ahead, within normal business hours (10:00 am – 6:00 pm), and allow 2 business days for any medication refills to be called in. Prescriptions are not refillable after 6 months without an office visit. Do not call for refills at night or on weekends. We charge no fee for refills, but significant medication changes will usually require an office visit. We do not authorize replacement of lost or stolen controlled substances. We do not authorize early refills for controlled substance prescriptions. Record Requests We do not release our original medical records. We provide copies of our records, or a summary, to physicians or other healthcare providers, at no charge. There will be a fee for copying and providing records to insurance companies, attorneys, or for other reasons.
Medication samples To help control the cost of care, we do not accept or dispense samples of medications. Samples are provided by pharmaceutical companies to encourage prescribing of the most expensive and profitable medications, rather than those which may be most appropriate or economical for the patient. We do not accept gifts, money, or travel expenses from pharmaceutical companies. Limits of care We may be unable to treat you, for any of a variety of reasons. For example, you may require or prefer treatment in a larger, more comprehensive practice. You may require treatment by a professional who is contracted with your health insurance plan. You may require services which we do not provide, such as emergency or hospital care, intensive outpatient or partial hospitalization programs, mental health case management, electroconvulsive therapy, telepsychiatry or in-home services, disability evaluations, marital and family therapy, or intensive psychotherapy. We may disagree on important aspects of your care. If these or other situations arise, please let us know. We will attempt to facilitate your transfer to a more appropriate healthcare provider. Smoking Smoking is not permitted on the premises, including on the sidewalk, the lawn, or in the parking lot. You may smoke in your car, but do not throw cigarette butts on the parking lot or sidewalk.
Research We are not engaged in any scientific research studies. If there is any change in this policy, you will be fully informed.




Other Medications & Controlled Substances


You must disclose all medications, including controlled substances (whether prescribed or not), because they may affect your response to treatment. We do not release this information without your permission. We do not authorize replacement of lost or stolen controlled substances. Please lock them in a secure location, and keep them out of the reach of children. We do not authorize early refills of controlled substances. Please do not increase your dose without authorization. Do not come to our office without an appointment, to request a refill of any controlled substance. We check the Tennessee Controlled Substance Database for controlled substance prescriptions, as required by Tennessee law. In addition, please review the following medication information: Opioid or narcotic medications for pain relief: We do not prescribe opioid pain medications. If these are required, you must receive pain management services from another physician. You must also agree to allow us to communicate with your other physician, if necessary. Buprenorphine or methadone for opiate dependence: We accept patients who are treated with buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail) or methadone, but we do not prescribe them. If any of these are prescribed for you, they may be essential for your continued recovery. You should continue to receive treatment from a legally qualified physician or clinic. You must agree to allow us to communicate with the other physician, if necessary. Stimulant medications (phentermine) for weight management: We do not prescribe these. Benzodiazepines and related medications for treatment of anxiety or insomnia: We discourage use of sedatives and tranquilizers, such as Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), Ambien (zolpidem), and others. These medications may provide short-term reduction of anxiety and insomnia symptoms. They are less effective with long-term treatment. Frequent adverse effects include medication dependence, increased risk of automobile accidents, falls and fractures, daytime drowsiness, cognitive impairment, drug interactions and overdoses, persistent depression, prolonged disability, worsening of sleep apnea, and other harmful effects. There is also recent evidence that use of benzodiazepines may reduce the efficacy of ketamine for depression. For those who already take tranquilizers or sedatives regularly, we will be happy to offer assistance to gradually and safely decrease or stop the drugs. Your treatment is less likely to be successful, if you plan to continue regular use of sedatives and tranquilizers, especially at higher doses. In that case, we may encourage you to seek treatment elsewhere. Other drugs: Marijuana: There is little scientific evidence that marijuana is an effective treatment for psychiatric conditions. Although we do not endorse it, occasional recreational use by adults does not seem to be harmful. Frequent or heavy use of marijuana may be associated with side effects, such as increased anxiety, impaired driving, or an increased risk of psychosis. Possession of any quantity of marijuana is a felony in Tennessee, and surrounding states. The stress of an arrest and prosecution is almost always detrimental to mental health. So called “synthetic marijuana” is a totally unrelated group of hallucinogenic drugs, which often result in severe or even fatal adverse effects. Alcohol: Excessive use of alcohol often causes or worsens depression, other psychiatric conditions, as well as other health problems. Treatment of depression and anxiety disorders is unsuccessful, if heavy drinking continues. If you have concerns about alcohol use, we will attempt to offer appropriate treatment alternatives. Treatment will not be provided if you appear to be intoxicated at the time of your appointment. Tobacco: Tobacco use is a major health risk. Tobacco use is more common among people with depression and anxiety disorders. Tobacco often reduces the effectiveness of psychiatric medications. If you currently use tobacco, you can stop. Effective treatments are available. Please ask.





Referrals

At this time, we are only accepting new patients who may be appropriate for ketamine therapy. A brief preliminary telephone screening will be provided, before an initial appointment is offered. We do not currently submit claims or accept payments from health insurance, Workmen's Compensation, Medicare, Medicaid, or TennCare. Payment is required either before, or at the time of all services. Upon request, we will provide an itemized receipt, which may be submitted. However, we cannot be responsible for whether you receive any reimbursement. Ketamine treatment is not usually a covered service.     
 
We welcome referrals from psychiatrists, psychotherapists, other physicians, and treatment programs. Potential patients may also refer themselves, or be referred by a friend or family member. Patients are normally expected to remain under the care of the referring healthcare provider, during and after ketamine treatment. Individual counseling or psychotherapy should also be continued. Patients seeking ketamine therapy primarily for chronic pain, or who are currently treated for a chronic pain disorder, should have evaluation and referral by a primary care, pain management, or other physician.
 
If you have questions about a possible referral or appointment, a member of our staff will speak with you as soon as possible. Our usual office hours are 10:00 am–6:00 pm on weekdays only. If we are unable to answer, please leave a message with your questions and contact information. You may also send a fax. A member of our staff will call back, usually within one business day. If you have not heard from us by the next business day, please contact us again. Appointments are required. We are unable to provide emergency or walk-in services.   

  Tel 423-328-7332 / Fax 423-207-1222 / info@ketamine-tn.com

© 2018 Ketamine Treatment Center of East Tennessee