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Our Partnership With You

Great health care comes from a partnership between the patient, the family, and the practitioner.  

This page describes what you can expect from PBH and what we ask of you in this collaboration.


PBH Agrees:

  1. To treat you with kindness and respect.

  2. To provide you with the best treatment, testing, or advocacy that we are able, within the community standards for good practice and informed by the available scientific literature.

  3. To answer your telephone calls in a timely manner and make emergency contacts available to help you through times of crisis.

  4. To maintain your privacy and your dignity by protecting your personal health information. (Please see our HIPAA privacy notification for details).

  5. To regularly communicate with your primary care provider and be available to your primary care provider to answer any questions or concerns, unless you do not wish us to do so.

  6. To bill your insurance company directly, if you have insurance coverage from a company we work with.

  7. If you leave our practice, we will help you find another provider and we will continue to treat you for a brief period until another provider is identified.  We will send copies of your records to the new provider, with your written permission.  Even if you are in the process of leaving our practice, if there is an emergency, we will continue to provide appropriate and necessary care.

By coming to PBH, you agree to:

  1. Pay the charges (or co-pay) at the time of service, just like you do with the plumber or at the grocery store.  Unfortunately, that includes any fees your insurance does not pay for any reason (for example, due to exhausted benefits, deductibles, etc.) and late or missed appointment fees.  If you do not pay, PBH reserves the right to suspend treatment, but we will help you find medically necessary services elsewhere.

  2. Show up when you say you will.  We usually have a waiting list, so if you are not able to make a scheduled appointment, there is someone who would like to come instead.  Please read our Cancellation Policy for details. 

  3. Tell us if you are unhappy with us.  If there is a problem with our office, we'd like the chance to make it right.  If there is a problem in therapy, we'd like the chance to figure out why and see if we can change our approach to make you more comfortable.

  4. Tell your friends if you are happy with us.  Your referrals are our best source of other great clients.

We look forward to having a warm and mutually beneficial relationship with you!

About Insurance

Understanding "The Network"

Insurance companies have "networks" of health care professionals that they are contracted to work with. If a professional is "in network" or "covered" for a particular insurance company, then you can use that person's services according to the terms of your insurance (for example, you pay a "copay" and the insurance company pays the rest of the cost). Pediatric Behavioral Health has worked very hard to contract with certain insurance companies so that we can provide you with flexibility in where you seek care and how you pay for that care.

About Mental Health Benefits

Most insurance companies use a separate company that manages Behavioral Health / Mental Health benefits. So, although the front of your insurance card lists one name, the back of the card likely lists another one. We are in-network for Optum/United Behavioral Health and Beacon Health Strategies. If you have one of the medical insurances below, chances are that our providers are covered by your insurance:

  • Apostrophe Health

  • Harvard Pilgrim

  • Health Plans

  • United Healthcare

  • GIC

  • Fallon Community Health Plan

  • Always Health Partners

 
Policies

Our Cancellation Policy

Please let us know if you are not able to keep your scheduled appointment.

  • Cancellations made 48 or more hours before the appointment will not be charged.

  • Cancellations made less than 48 hours will be charged $35.

  • Cancellations made less than 24 hours will be charged half the cost of the appointment.

  • Appointments missed without notification will be charged the full cost of the appointment.

Please be aware that these charges are not billable to any insurance company;  you have to pay them yourself.

Of course, if you have a true emergency, (such as an injury or significant illness) we will waive the charge.

We will understand if you show up late, but please know that we have to end on time so that we are not cutting into someone else's time.

Medication Refills

Running out of medication can be disruptive and stressful for you and your child and suddenly stopping can cause unpleasant or serious physical problems.

  1. Mark your calendar. Most prescriptions are for a 30-day supply. Mark the date on your calendar at least 1 week before you are going to run out. This will give you enough time to get the refill taken care of. If you are using mail-order for medications, the prescription will be for 60 or 90 days. Because mail-orders can take 7-14 days, you should mark your calendar at least 2 weeks before you will run out.

  2. Call your pharmacy first. Many prescriptions are written with 1 or more refills. This lets you get more medication easily and quickly (many pharmacies even have telephone directions for automated refills). If you do not have any refills (or do not have any left), ask your pharmacist to request a new prescription from your doctor. The pharmacy can then send us a refill request with all the important information already filled in.

  3. If you need to request a refill, use the Patient Portal or the Refill Line voicemail to requst a refill.

  4.  If your situation is urgent or you have questions or problems, call 508-835-1735, and press "0" for the receptionist.

  5. Check before you go. Save time, gas, and frustration. Call your pharmacist and ask if your prescription is ready for pick-up. Sometimes there are insurance or other reasons why your prescription could not be filled.

 

Your First Appointment

At your first appointment, you will meet with your practitioner and go through a diagnostic interview so that your practitioner can understand your concerns and your child's symptoms. 

To make the most efficient use of the time, and to be sure we truly understand your child's background, we ask that you fill out our intake questionnaire.  This form goes through a lot of information some of which you might not feel comfortable discussing in front of your child.  Please note this on your form, so that we make sure you have some private time with the practitioner. 

The intake questionnaire and other forms are available on the patient portal.

Frequently Asked Questions

Why don't you take my insurance?


It was a very difficult decision to limit the insurance plans we will work with. We did so knowing, and regretting, that we would not be able to see some children that we would really want to.The reality is that most mental health practices can't cover their own costs. The reason for this is that many (but not all) insurance companies pay less for mental health services than it costs to provide the service! Some companies try to make it hard to collect fees by using complex forms that are refused if not correctly and exactly filled out, by delaying payment, by denying payment if the service was after the fact determined not to be "medically necessary", or other little tricks. Can you imagine what would happen if you called a plumber and said "my toilet is broken. Come over right away. I'll pay you 80% of the cost of your plumbing supplies and half your usual fee. I'll be sure to get the payment to you in the next few months, but only if you submit the correct form with the correct code on it. If, after you leave, I determine it was not a plumbing problem but just a leaking water problem, I won't pay you at all." You would probably be sitting there with a broken toilet for a long time. We made the decision that at PBH we would only work with companies that are willing to pay reasonable rates and pay them reliably.




Why should I pay PBH when I can use my insurance elsewhere?


Of course, you may want to use your insurance elsewhere! But most of our patients have tried other places and find PBH to be a better fit. At PBH you will get enough time to have your questions answered; a comfortable, pleasant atmosphere; a knowledgeable, professional staff; and a comprehensive and flexible approach to treatment. You probably won't have to change your treatment provider as our staff turnover is very low and you may find services here that you can't find at another practice. At PBH you will find advocates and partners in treatment, not disconnected diagnoses and recommendations that can't be implemented.




Isn't it a lot of money to spend?


Yes. It is a lot of money, and it may not be the right thing for you, especially if you have a good provider elsewhere. However, some people do spend a lot of money on their children, and for a child paralyzed by anxiety or sadness, treatment can make a world of difference. For comparison, here are some of the costs born by families we know at local facilities: Costs At Pediatric Behavioral Health: 10 Sessions of Cognitive Behavioral Therapy (CBT) $1250 - $2000 Psychopharmacologist (per month) $135/$175 Costs Common for Parents: Braces $6500 Music Lessons (per year) $1500 Black Belt Package at a local Karate studio (flat fee) $6000 Karate studio membership (per month) $180 Day care, infant (per week) $375 Day care, school age (per week) $200 Horseback riding lessons (4 lessons) $240 Summer camp, sleep over, (2 weeks) $2500




How do other practices that do take insurance survive?


Something has to compensate for the difference between the insurance payments and the costs. Many institutions, like hospitals and community mental health centers, are subsidized by their other sources of income, government contracts and grants, and charitable donations. Some practices pay their employees poorly or skimp on benefits, and so there is often a high turnover. Some require their practitioners to severely limit the amount of time they spend with families, making it hard to get the necessary information about the child and answer your questions.




My insurance company says my PBH provider takes my insurance, but PBH says that isn't so. Why?


Please note: if your insurance company tells you that a provider listed above is an "in-network" provider, be careful to check at which location. Some of our providers work at other facilities, where they may accept insurance other than what is listed above. That does not mean that they can bill the same insurance company for work at PBH: the facility holds the contract with the insurance company, not the provider. You are welcome to try to see the providers in their other locations, however, those situations are generally limited to a particular type of patient and a particular situation.




Is testing covered by insurance or not?


Maybe. It's best to call your insurance company and ask. A simple evaluation for ADHD can be done as a part of a diagnostic evaluation and treatment planning consultation, which is often covered by insurance. More complex evaluations for learning disabilities or other subtle educational difficulties are often not covered, however, most often neurological or psychiatric evaluation issues typcially are. Call your insurance company for the most accurate answer to this complex question.




What is the difference between a Psychiatrist, a Psychologist, a Social Worker, and a therapist?


A Psychiatrist is a medical doctor just like a pediatrician or a surgeon. A Psychiatrist attends medical school, then undertakes 1 year of clinical training in Medicine or Pediatrics (internship) then 2 to 3 years of clinical apprenticeship training in Adult Psychiatry (Residency), where he or she works and studies under supervision of experienced psychiatrists. A Child and Adolescent Psychiatrist spends 2 additional years in advanced training (Fellowship) learning about the complexities of treating children with mental illness. Psychiatrists, as medical doctors, are competent to diagnose mental illness and prescribe medication. Psychiatrists are also trained in several kinds of psychotherapy and non-pharmacological treatments. Psychiatrists have MD or DO degrees. They are licensed by the state Board of Medicine and are bound by the ethical standards and continuing education requirements of that board.
A Psychologist is someone who has attended graduate school and earned a doctorate in Psychology, either a PhD or a PsyD. These programs are 5 to 7 years of intensive study and practical training in psychotherapy, psychological testing, and/or designing psychological research. Psychology graduate students write a doctoral thesis in one particular area of expertise. Psychologists have supervised clinical training in testing and treating patients throughout graduate school, but have intensive training during the last year of their program (internship), and then for a year or more after receiving their doctoral degree (Postdoctoral fellowship, or "Post-doc"). A Psychologist cannot prescribe medication but is an expert in using non-medical techniques to diagnose and treat mental illness and behavioral problems. Psychologists are licensed by the State board of licensing and must adhere to state standards for psychologists, including ethics and continuing education. A psychologist cannot be licensed until after completing a postdoctoral fellowship.
A Social Worker has a masters degree (MSW or LICSW). This is a focused 2 year degree during which time the social worker has intensive training in Psychotherapy. Social Workers are experts in the techniques they use, but may not be able to use as many different kinds of psychotherapy techniques as psychologists. Social Workers are licensed through the State Board of Licensing and are required to adhere to state standards for social workers.
A Therapist is a general term for someone who performs therapy. A therapist could be hold an MD, a PhD, a Masters degree or in some states no degree at all. Therapists in Massachusetts must have a Master's degree and be independently licensed to do therapy, for example a Licensed Mental Health Counselor (LMHC) is a therapist.




What is a nurse practitioner?


A Nurse Practitioner (NP) and a Registered Nurse Clinical Specialist are two similar but not identical designations. People who are NP's or RCNS's have bachelors’ degrees in nursing, usually a minimum of 2 years practical nursing experience, and then a two year masters degree that includes both academic study and clinical experience in providing a particular kind of medical care, such a psychiatry, pediatrics, or neurology. Both NP's and RCNS's can see patients and prescribe medication, but most states require them to be supervised by a medical doctor.