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Our polices are available on this page for your reference.

They will be included as individual forms in your intake paperwork located in the patient portal which must be signed before your appointment. The most up-to-date policies can be found here.

Please review fully and contact us with any questions.


Collaboration: Collaboration between healthcare providers is vital to your overall health and well-being. Prior to being scheduled for your first appointment you should be established with a primary care provider and have had a physical exam with any appropriate testing and laboratory data completed within the last 12 months. Please bring copies of your recent lab tests with you to your first session. We will ask that you provide consent to obtain health records from your primary care provider and any relevant specialists. We prefer to coordinate this prior to your first session.


Patient Portal: Our patient portal is the preferred method of communication because it is encrypted and conforms to HIPAA standards. The patient portal will be utilized in several different ways to provide you with comprehensive care. If you are unwilling to utilize an online patient portal we will be happy to refer you to another provider.


Evaluation and Care Plan: The initial appointment is for an evaluation. If you are in agreement with the plan of care and the nurse practitioner agrees that you are a good fit for the practice, treatment will start. If the nurse practitioner’s expertise does not meet your needs we will assist with appropriate referrals. 


Responsibility for Payment:

  • Services are provided with the understanding that you (not an insurance company) are ultimately responsible for the cost of treatment. Insurance plans vary and not all services may be covered. You are responsible for knowing what services are covered by your particular plan, please check with your plan by calling the number on the back of your card before your appointment. If your plan requires prior authorization for services, this must be completed before you are scheduled.

  • If your insurance does not pay your claim it will be your responsibility to contact them to resolve any issues of coverage or coordination of co-coverage. If you have a change in your insurance, it is your responsibility to notify the office as soon as possible to ensure that the correct company is being billed and that your account does not become past due.

  • We will only bill primary insurance plans. If we are not in-network with your primary insurance plan we will not bill secondary insurances. You will be responsible for the full fee.

  • We do not and are unable to bill Medicaid, Medicare, or any Medicare private health plans/managed Medicare. Please note that they will not cover any services provided by out-of-network providers.



  • Payment for deductibles, co-pays, uncovered services, or any balance due on your account are to be paid at the time of your appointment. 

  • Cash, check, and credit cards are accepted.

  • We may require a credit card be kept on file for any outstanding charges.

  • There is a $35.00 fee for checks with insufficient funds.

  • Other billing and financing fees may apply as outlined in our policies.


Cancellations and No Shows: Please do not miss your appointment as the time will be reserved for you. Appointments must be cancelled at least 24 working hours in advance. If you cancel your appointment with less than 24 working hours notice, you will be charged for that time. The fee for a missed intake is $250.00 and a missed follow-up appointment is $100.00. Please note your insurance will not cover a missed appointment.  Weekends and Holidays do not count as normal business hours.  For example, if your appointment is on a Monday at 2:00 pm, we must be notified by the Friday prior by 2:00 pm in order to fall within the 24 working hour cancellation policy.


Punctuality: If you arrive more than 10 minutes late to an appointment it will be considered a late cancellation/missed appointment and you will be rescheduled for another time. We understand that sometimes it is just not possible to keep an appointment, and we will always listen and record the circumstances for the postponement or cancellation. In certain circumstances the charge for the appointment time may be waived at our discretion, on a case by case basis. 


Additional Services: Forms, coordination of care, and legal matters are subject to additional fees as outlined in our policies.


Prescription Refills:

  • Prescriptions will be written with enough refills to last until your next appointment. We recommend scheduling your next appointment at the end of each session so that we can be sure you are following your treatment plan and also do not run out of medication.

  • Medication refills are done during the appointment time only. If something unexpected occurs, please have your pharmacy fax a refill request. Please allow up to 5 business days for the refill to be approved, if appropriate, and schedule an appointment as soon as possible.

  • Controlled substances such as benzodiazepines and stimulants are tightly regulated by the DEA. These medications can be very useful when indicated, but require more monitoring and must be part of a comprehensive treatment plan. If you do not stick to the agreed upon treatment plan, I will continue to work with you, but will not continue to prescribe controlled substances. There will be no early refills of controlled substances for any reason.

Discharge from Treatment: If you do not return within the agreed upon time frame, or cancel scheduled follow-up appointments and 3 months have passed since you were last seen we may discharge you from treatment, although you are welcome to discuss re-initiating care should you require treatment in the future. We reserve the right to terminate our relationship under the following conditions: If we believe our services are no longer beneficial to you; If we believe that another professional would serve you better; Not agreeing to or adhering to the treatment plan; When you have not paid for two sessions; When an invoice is outstanding for more than 90 days; When you have failed to keep two appointments without 24 business hours’ notice or for frequently missed appointments; When you missed your last appointment without contact "no call-no show" and did not notify the office within 24 hours of the missed appointment to indicate that you want to continue treatment; If you or your family member/significant-other break any local or federal laws on premises, are hostile or aggressive to staff, or cause any disruption in our office; If you are diverting or misusing any prescribed medication.

Feedback and Rights: Feedback is how we improve our care and your comments will be addressed seriously and respectfully. You may also request a referral to another mental health practitioner and are free to end treatment at any time. You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, or national origin. You have the right to ask questions about any aspects of therapy and about specific training and experience. You have the right to expect ethical, respectful behavior from your practitioner at all times.

We reserve the right to revise or amend these policies at any time.

Samantha Roche South Shore Collaborative Psychiatry NP
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