Thank you for choosing Modyfi for your mental health and wellness needs!

Approach to care: Modyfi stands for mind, body, and fitness. Founded in 2019, we are reimagining the mental healthcare experience and inspiring change in the people we serve, both patients and providers. We believe in an individual and holistic approach to care, promoting changes that are sustainable, and working toward your goals to improve your life. We value accepting people as they are, collaboration and teamwork, finding the root of the problem, using evidence and science, feeling a little uncomfortable to make change, and presenting options for an individualized treatment plan. We will continually review progress and outcomes of the treatment plan, adjusting as needed. We believe in providing the most cost-effective care, in the least restrictive setting. Each individual clinician may be different in their approach to care, but these qualities are overarching at Modyfi. 

Treatment options and medical necessity: Modyfi currently offers individual therapy, couples therapy, group therapy, and psychiatric medication management services. All services rendered will be “medically necessary”. This means that 1) you have a covered condition (i.e., diagnosis) and 2) the services are expected to make improvements on that condition (as well as other factors).

Risks and benefits: Many people benefit from therapy, medications, and lifestyle interventions. Few people get worse from treatment. However, improvements do require attending appointments, effective communication, and following through with the agreed upon treatment plan. When we develop a treatment plan with you we will also discuss the risks and benefits.    

Disability and paperwork: Any and all paperwork will not be filled out during or immediately after initial evaluations, but can be completed at a prorated rate of $150 per hour. Any disability cases must be discussed in session and may require additional treatment programs. There is a 30 day turnaround period for all disability paperwork, but is often completed within 7 days.

Advance Directives: Every adult has the right to make decisions about their medical treatment. This includes the right to decide now whether to accept or refuse medical treatment in case you are physically or mentally unable to make the decision sometime in the future. This is outlined in an "Advance Directive" form. For a medical advance directive, you may ask your clinician or contact the state health board.

Crisis and Emergencies: If you are struggling or in crisis please call 988. If you are having an emergency that involves risk to someone’s life please call 911 or proceed to the emergency department of the nearest hospital. Once there, have the provider in charge of your case call your Modyfi provider. If you need an urgent response from your provider during office hours please call 833.366.3934.   

Fees associated with transitioning care: We are committed to providing you with quality and affordable services via telemedicine. Any expenses related to the transfer of a patient to our care from a previous provider, including medical record requests, will be paid for by the patient. With that said, the CARES Act of 2021 provides patients with access to their medical records immediately and at no charge. The same rules do not apply to therapy notes.

Private health insurance: Modyfi does not currently accept public health insurances, Medicaid and Medicare. All providers accept self pay, but private insurances accepted will vary by provider and state. To expedite verification of insurance coverage, please call your insurance company before contacting Modyfi. The patient is ultimately responsible for all charges and fees. If you are no longer able to afford self pay appointments, we recommend you obtain health insurance on the health insurance exchange: https://www.healthcare.gov/ 

Controlled substances via Telemedicine: Prior to the COVID-19 pandemic, a benzodiazepine, stimulant, suboxone, or any other controlled substance indicated for treatment would require an in-person assessment or telemedicine appointment at a DEA regulated facility (e.g. doctor’s office, hospital). Policies and procedures surrounding the prescribing of controlled substances online are still being finalized at a federal level, but we are currently able to prescribe schedule 2-5 controlled substances online without the need for an in-person assessment. This could change at any time for reasons outside of our control, including federal regulations as the COVID-19 pandemic resolves. If needed, we are prepared with contingency plans. 

FACT: 1 in 115 people in the United States are prescribed both a stimulant and a benzodiazepine. That’s 1 in 115 people, not patients, and the most commonly prescribed combination is Adderall and Xanax. This is a symptom of society not treating the root cause of a problem.

• Benzodiazepines: Medications like Ativan (lorazepam), Klonopin (clonazepam), and Xanax (alprazolam) are useful tools for treating panic disorder and extreme anxiety, but are often times overprescribed, in part due to physiological tolerance and dependence. At Modyfi, benzodiazepines are rarely prescribed as more than an emergency medication.

• Stimulants: Medications like Adderall (amphetamine) and Ritalin (methylphenidate) are useful tools for treating ADHD and treatment resistant depression, but are often times overprescribed, in part due to treating issues with focus, motivation, and hyperactivity that are associated with a different mental health condition. At Modyfi, ADHD and the need for stimulant therapy is assessed after rule outs have been assessed for any medical conditions, substance use, and mood or anxiety issues that may be informing the symptoms.

• Please be aware that:

  - You agree to take any controlled substances exactly as instructed
  - You will not take controlled substances written by another provider or specialist unless you have notified your Modyfi provider 
  - Your controlled subtance may not be replaced if it is lost, stolen or used up sooner than prescribed     

Medication refills: Please be assured that we will make every effort to provide you with sufficient medications or refills to last until your next appointment. In order to continue medications, regular follow up appointments and monitoring labs are required to assess progress and side effects and make adjustments to the treatment plan accordingly. Medication follow ups are required at least every 90 days, if not sooner, as determined by you and your provider. Any medication refill requests will be considered on a case by case basis and must be approved by your medication provider. In the event of running out of medications prior to your scheduled appointment, please complete the medication refill request form on our website. Please contact us at least 72 hours ahead to ask for a refill of your medication. 

We ask that you only use one pharamcy to get your controlled subtance(s).                                          

Card on file and authorization: Patients are required to have a valid method of payment on file at all times. You will NOT be able to see your provider until payment information has been added or updated. Additionally, statement payments must be made in a reasonable time to continue treatment. All major credit cards are accepted, including those associated with your FSA or HSA account. Please contact your FSA or HSA company prior to your first appointment to ensure your card can be used for our services. You can add or update your payment information through the patient portal.

Insurance copayment, coinsurance, or self pay: A valid method of payment is required for all initial evaluations where the patient will be using insurance. All self pay clients are required to prepay. Any other payments are due on the day of your appointment. Any copayments, coinsurance, deductibles, and amounts for services not covered by insurance will be charged to the credit card on file at the time of service if they are not collected ahead of the appointment.

Balances & payment plans: Occasionally, after a claim has been submitted and processed through insurance, there may be a balance remaining. This typically happens when a new patient is first having their claims approved by insurance, or when a patient’s health insurance plan is renewed and there are changes to the policy. Any remaining balance will be added to your patient statement and collected once the insurance claim is processed. For larger balances we offer payment plans. Know that we are here to help, and understand that a major cause of stress can be related to personal finances. Should a payment plan not be implemented, or a patient fails to make payments, past due balances exceeding 180 days may be forwarded to a collection agency, and additional fees may be incurred. If you are unable to pay your bill, please contact us at billing@modyfihealth.com

Cancellations, reschedules, and no-shows: We understand that life happens, but a late cancellation or no-show has an impact. If we have enough notice of a cancellation, we can provide care to someone else. A late cancellation or no-show means that we were unable to serve another person. Modyfi provides automated reminder emails and texts for appointments. These reminders are provided as a courtesy. You are responsible for attending your appointment for the complete duration of time. Please make sure you are available for the entire appointment time before scheduling your appointment. 

You can cancel or reschedule appointments 24 hours or more before the appointment time. Appointments that are ended early or started late by a patient are charged $50. Cancellations or rescheduled appointments within 24 hours and no shows are charged $100 for 60 minute therapy appointments, 30 minute psychiatry appointments, and 30 minute nutrition appointments, and $150 for 60 minute psychiatry appointments, whether new patient or follow up, and 60 minute nutrition appointments. If a patient is more than 10 minutes late for a 30 minute appointment or 20 minutes late for a 60 minute appointment, then the appointment is considered a no show, and the no show fee will be collected. If a patient arrives more than five (5) minutes late to their appointment, or needs to end their appointment more than five (5) minutes early, a fee of $50 may apply. If you have any questions, please email billing@modyfihealth.com. 

Minors and custody: Modyfi’s role is to help people with mental health issues make lasting improvements. It is not our role to conduct a custody evaluation, determine whether a parent is “fit” or not, recommend one parent over another, nor focus on reunification of a child and parent. We will not testify in court about custody issues, unless we are compelled by a court.

Legal requests and subpoenas: Modyfi providers do not testify in court-related matters, unless court ordered by a judge. If a provider is court ordered to testify, attend court, or prepare documents, client will be required to provide a minimum of $3,000 retainer for services, to include, but not be limited to the following: letters and reports, phone calls, preparation and submission of records, time required due to giving a deposition and/or testimony, travel time, lodging and mileage, attending court appearances and meetings, filing documents, and administrative and material costs, labor, and all attorney fees, loss of wage, and incidental costs incurred by Modyfi. Unused retainer fees will be refunded. Fees include but are not limited to: Reimbursement of court fees in order to quash a subpoena; Work required in-office billable at $350 per hour; Work required out-of-office will be billable at $500 per hour; Minimum court/hearing appearance fees are $2,000 per day, plus mileage, accommodations, and any incidentals.

Children of divorced parents: We expect the parents to communicate with each other about services, decide who will schedule appointments, who will bring the child to treatment, etc. The clinician and the child cannot be messengers between parents. It is important to note that both parents have access to a child’s record, regardless of custody. The only exception is if parental rights have been revoked. Since children benefit from an expectation of some privacy, we try not to share details of what a child says or does in treatment. We will share progress in treatment, as well as notify parents of any risks of harm. We include parents in treatment for the benefit of the child.

Minor consent: Decision-making for outpatient mental health treatment is autonomous for any adult who is 18 (eighteen) years or older. Adolescent autonomy varies by state, and is subject to change at any time. There may be very clear legal or clinical reasons why a parent should not be involved. These reasons include physical, emotional, or sexual abuse by a parent or being “emancipated”. Additionally, minor children may give informed consent if lawfully married. It is also important to know that parents have a right to access a minor’s record, unless parental rights have been revoked, up until the patient reaches the legal age of decision-making authority. Patients with legal decision making ability must have their own phone number and email address in order to engage in treatment.

Legal guardian obligation: Except in situations when a dependent can legally consent to their own care, a parent or legal guardian is required to be present during the Telehealth appointment. If not, the appointment will be canceled and a no show fee will be assessed.  

Supervision: If receiving Therapy services, please be aware that:

1) Your counseling services may be provided under clinical supervision
2) You consent to the recording of counseling sessions with the knowledge that the recording may be shared with and be limited to the supervisor
3) You consent to the sharing of client information between the licensed graduate professional counselor and the named clinical supervisors. 

Supervised by Amy Weaver, Maryland 12757

Discharge: Patients who have not received services during the most recent consecutive 90-day period, and for whom attempts to contact have been unsuccessful, will be sent a formal email and/or text message stipulating that the client may be discharged if he or she has not communicated with and/or made an appointment with their medication prescriber or therapist within 30 days of the date of the letter. After 90 days of no contact and unsuccessful attempts to contact the client, he or she may be administratively discharged. Patients discharged in good standing are welcome to return to the practice at any time.

Complaints and Grievances: If you are displeased with services at Modyfi, you have the right to file a complaint. You may do it informally by talking directly with your medication provider, therapist, or other staff member. You may also write a formal letter to our corporate email info@modyfihealth.com or physical address: 300 Delaware Ave., Suite 210-343, Wilmington, DE 19801. Most complaints addressed via email should be resolved within a week. However, it may take up to sixty days to respond to inquiries sent to the physical address. If there is an urgent situation (i.e., someone is at risk of harm), the complaint can be resolved within 48 hours once we receive the complaint via email. You may appeal the response to the complaint verbally or in writing. We will not retaliate if you make a complaint. We treat anyone who complains with respect and confidentiality, and we also respect the confidentiality of our staff.

Notice of privacy practices: For information on privacy practices please CLICK HERE

Rights & Responsibilities: For more information on rights & responsibilities please CLICK HERE

Changes to this Document: We may change the terms of this Consent and Privacy Document at any time. If we change this Document, we may make the new terms effective for all PHI that we maintain, including any information created or received prior to issuing the new Document. If we change this Document, we will post the new document on our website.

Effective Date: This Document was first effective on March 2, 2019 and was last amended on Feb 25, 2024.