Patient Rights and Responsibilities
Telehealth Regulations
Pink Wellness, LLC providers are committed to helping you achieve optimal health and wellness. They will do what they can to ensure you get the care you need while keeping you safe.
You must be physically present in Oregon to receive services. If you are out of the state for any reason, you cannot be seen under current telehealth laws. If you are not determined to be in Oregon at the start of your visit, the visit will be canceled, and you will be responsible for the no-show charge.
Telehealth can ease access to care, but not all medical conditions should be treated through telehealth. If you have any conditions that Pink Wellness, LLC feels are better suited to in person treatment, you will be referred to another provider.
Appointments are made online, and all visits are completed through 2-way video on Zoom.
SMS, Texting, 10DLC Privacy Policy
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
You will be able to consent to receive SMS messages when you enter your phone number on the intake paperwork. Select “Yes” if you would like to receive SMS messages or select “No” if you do not want to receive SMS messages.
Message and data rates may apply. You can opt out of messaging anytime by sending STOP and get more help by sending HELP.
Mutual Respect
You will be valued as you are. You will not be shamed for your beliefs, the sex you enjoy, or the drugs you use.
The sessions should be about mutual respect between you and your provider. Your provider will be kind and respectful, and you are also expected to be kind and respectful. The providers should not be yelled at, cursed, or demeaned in any way. Any violations of mutual respect will lead to discharge from the practice.
We hope that you feel comfortable with your provider to provide honest answers that will be used to provide the best care for you. However, providing misleading answers could lead to improper treatment and potentially harm your health. If you find yourself not in a place to tell the whole story at first, you will always be welcome to share the story again without any judgments.
Confidentiality
Everything is kept confidential per state regulations. However, if you state you are wanting to hurt yourself, hurt someone else, are not able to take care of yourself, or abusing a child or an adult, a call will be made to emergency services in your area to do a wellness check even if you do not want the call to happen.
If you threaten to harm someone, that person will be immediately notified of the threat you made against them, even without your consent.
Communication
Pink Wellness, LLC is a small practice, but they will do what they can to be prompt in responding to you.
Calls and portal messages will be returned within 24 hours.
If you do not hear back promptly and have an urgent need (emergency contraception or PEP), please go to an emergency room or urgent care close to you.
Appointments and Cancelations
Appointments are made through the patient portal. Select the service you need and a time that suits you. You will receive an automatic confirmation, and online forms will be sent to you in the portal to complete before the visit.
Appointments may be canceled with 24hrs notice. If you do not show up to your visit or cancel with less than 24hrs notice, you will be responsible for the cost of the visit. Patients with Medicaid (OHP and CareOregon) do not incur any cancellation fees.
If you miss 2 appointments in a row or 3 appointments in a year, you may be discharged from the practice or be required to identify someone who can also receive appointment notifications to help you attend your visits. If you continue to miss visits, you will be referred to another clinic that may better be able to support your needs.
Declaration for Mental Health
In Oregon, you can create a legal document called a Declaration for Mental Health Treatment.
This form allows you to make decisions about your future mental health care in case you are unable to make your own care decisions in the future.
Only a court and two medical providers can determine if you can no longer make decisions.
This form allows you to designate someone to make mental health decisions for you and list the types of care you would be willing to receive or do not want to receive.
A Declaration for Mental Health Treatment form is good for 3 years and can be changed or canceled at any time as long as you are capable of making decisions for yourself.
If you have a Declaration for Mental Health Treatment, it is important to give it to your provider and the person you assigned to make decisions for your.
You can request this form by calling the State of Oregon at 503.945.5763 TTY: 800.875.2863 or download a copy here https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf
Pharmacy
You can select any pharmacy to have the prescription sent to as long as that pharmacy has a presence in Oregon.
The costs of the medications are your responsibility. However, you may be eligible for a patient assistance program for medications used for PrEP, PEP, or HIV treatment. Your provider can help enroll you in the program.
Medications can be more affordable for people without insurance through https://costplusdrugs.com or https://www.goodrx.com.
No Benzodiazepines
Benzodiazepines are sedating medications like Alprazolam (Xanax) and clonazepam (Klonopin)
Taking these medications daily can cause depression, impaired cognitive abilities, and accidents.
Benzodiazepines are also habit forming and easy to develop a physical addiction.
As these medications have limited use, they are not provided at Pink Wellness. We can help you get off of benzodiazepines but we are not able to provide long term benzodiazepines.
Laboratory
Certain services will require laboratory work to receive care.
Laboratory orders can be sent to a laboratory of your choosing in Oregon.
The cost of the labs is your responsibility to negotiate with the lab.
Payment
Payment and copayments are due at the start of your visit. Balances cannot be carried over between visits. Unpaid charges may result in rescheduling and incur a late cancellation/no-show fee. Payments can be made through the patient portal at the start of your visit.
Payments are made with Visa, Mastercard, American Express, or Discover. In-person visits may be paid in cash if needed.
Pink Wellness, LLC accepts MODA, Aetna, OHP Open Card, and CareOregon health insurance and is working to accept other insurance. All other insurances would be considered out-of-network and payments would be based on your benefits. Contact your health insurance company for questions about out-of-network coverage. If you are self-paying, you will be provided with an estimated cost summary under the No Surprises Act, and a superbill can be generated for you to submit for reimbursement if needed.
The cost of the visit is for the therapy and evaluation. The cost of medications, laboratory work, referral, emergency room, hospitalization, or other needed services is not included in this fee.
No Surprises Act/Good Faith Estimate Notice
Under the law, 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.
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical servcies, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.