Policies | Emily Garber APRN, P

Office Policies

MEDICAL EMERGENCIES: Medical emergencies should be handled by calling 911 or 988 (for psychiatric crises). My office does not have the capability to provide emergency care offsite and calls indicating a medical or psychiatric emergency will be directed to these numbers. Email and text messaging are not appropriate for medical emergencies.

URGENT ISSUES: If you have an urgent clinical issue and need to speak to me immediately, please call 203-551-4173. This is an office phone number, not a cell phone, so please do not text; If you text, I will not receive the message and you will not receive a response.

If we do not answer, please leave a voicemail stating the issue is urgent. We will return your call promptly.

If no voicemail is left, we will not call back.
Non-urgent calls will be returned during office hours.

Note: Refill requests, form completion requests, telehealth link requests, appointment cancellations/rescheduling requests, and insurance matters are never considered urgent and will be handled during office hours only.

APPOINTMENT/MEETING REQUESTS: Call the office at 203-551-4173 during business hours to schedule or modify appointments. Messages left outside office hours will be addressed when the office reopens. Again, please do not text this number as it is not a cell phone. If you text, I will not receive the message and you will not receive a response.

INITIAL VISIT REQUIREMENTS: Initial visits must be conducted in person.

After 9/30/2025, many insurances (particularly Medicare) will require in-person visits for initial visits and every 6 months thereafter as congress did not renew the exemption to this requirement that went into place during the COVID pandemic.
Limited exceptions for commercial insurance and Medicaid may allow video visits initially if agreed upon with the provider at the time of scheduling the appointment; this is subject to change if the insurance rules change. We cannot accommodate last minute (less than 24 hour notice or notice given on a weekend or holiday) requests to change initial appointments to telemedicine.
For telemedicine initial visits, intake forms, consents, and insurance/ID cards must be submitted at least 24 hours before the appointment. Failure to comply will result in cancellation and rescheduling. Repeated failure to complete these forms and submit insurance and ID timely will result in the patient not being accepted as a new patient in the practice.
For in-person initial visits, bring your insurance card and ID to the appointment. If a patient does not have their ID or insurance card at the appointment it will lead to cancellation and rescheduling. Forms can be completed in person immediately prior to the appointment.

VIDEO VISITS: Video visits are allowed at the provider’s discretion.

If deemed inappropriate by the provider, the patient must come for an in-person visit.
Refusal to attend in person when required may result in discharge from the practice.
Lack of video access or poor internet connection means in-person visits are necessary.

MEDICATION ISSUES: Medication refill requests, insurance issues, and issues with your pharmacy should also be addressed by calling the office during office hours at 203-551-4173. Refill requests will be addressed during office hours only and any request received outside of office hours will be addressed when the office reopens. Please note this phone number is an office phone number and not a cell phone so please do not text. If you have not been seen for some time, did not show to the previous appointment or are requesting refills of controlled substances outside of appointments, the refill request will be denied. The patient is responsible for updating the office on any change in pharmacies. In the event a pharmacy is out of stock of a medication, the patient is responsible for calling us and advising which pharmacy they would like their prescription to be sent to in lieu of their regular pharmacy.

INSURANCE ISSUES: Insurance issues should be addressed by calling the office during office hours at 203-551-4173. Refill requests will be addressed during office hours only and any request received outside of office hours will be addressed when the office reopens. Please note this phone number is an office phone number and not a cell phone so please do not text as I will not receive the text and you will not receive a response if you do so. Patients are responsible for updating the office on any changes in insurance coverage and failure to do so may result in receiving a bill for the total cost of service.

Patients are responsible for understanding the insurance contracts they have with their insurance company and understanding any deductibles, co-insurance or co-pays that are a part of that contract. The insurance company is responsible for explaining their coverage directly to their members. Any questions surrounding deductible costs should be directed to the insurance company. Common codes for reimbursement (CPT codes) that the office submits for reimbursement are:

99204: New visit up to 60 mins
99205: New visit over 60 mins
99214: Follow up visit
99213: Follow up visit
90833: Psychotherapy up to 30 mins
90836: Psychotherapy up to 45 mins
90838: Psychotherapy up to 60 mins.

Patients can contact their insurance company with these CPT codes and the insurance company should be advising the reimbursement (or cost) for the visit code. The current out of pocket cost for services is $225 for an initial visit and $125 for follow ups. The cost of visits may change over time.

Failure to pay copays, deductibles, coinsurance or visit fees timely for services rendered will result in discharge from the practice.

Please note I am in network with traditional Medicare but NOT with managed Medicare plans. If you have a managed Medicare plan, contact your plan to see if they allow for out of network billing

FORMS: We require at least 3 business days (longer forms will require more time) to complete forms. Forms will only be completed during office hours. Any requests placed outside of our business hours (nights, weekends, holidays, etc) will be addressed during business hours only and I cannot complete last minute requests during those times. We may require you to come in for an appointment depending on what the form requires. Disability and FMLA paperwork will be done by appointment only. Patients are responsible for obtaining the forms that they wish to be filled out by this office directly from the other institution- this office does not obtain school forms, disability forms, FMLA forms or other forms from other institutions. We do not write letters or endorsements for emotional support animals in the practice.

EMAIL: Email is only monitored during office hours and we may take up to three business days to reply. Email is intended non-urgent for quick messaging and communication. Please be aware that the time and thought that when emailing regarding new symptoms, requests for referrals or imaging, requests for lab work, issues with chronic conditions, requests for new prescriptions, or for medical counseling can equal or exceed an office visit and we may bill your insurance company as a result. You may be responsible for any co-pays, deductibles or non coverage if your

insurance company does not reimburse for this communication medium. For communication that requires multiple emails, it is more appropriate that we discuss the issue in an appointment, and if the issue requires this, I ask that you call the office and schedule an appointment. Please note I do not make medication adjustments of psychiatric medications by email and this should be discussed in an appointment. Email is not appropriate to communicate medical emergencies. Refusal to schedule an appointment or to be seen in person rather than email on the request of the provider will result in the provider referring to an urgent care or other appropriate venue. Furthermore, if the issue is deemed urgent and there is no availability for same day appointments, your provider may refer you to the appropriate urgent care or in person venue. Chronic disease management requires periodic visits and cannot be solely completed via email. Persistent refusal to be seen for appointments and demands for email only care in lieu of follow up visits may result in discharge from the practice.

TELEPHONE COMMUNICATION: As a general rule, the practice does not issue antibiotics, antivirals, new prescriptions or make major psychotropic medication adjustments by phone as this should be discussed in an appointment. If patients are feeling unwell or have a new complaint, it is medically appropriate to be seeing them and I am unable to provide phone only care as this can result in misdiagnosis, mismanagement and generally poor outcomes for the patient. Depending on the complaint that is being called in, you may be asked to schedule an appointment. Refusal to schedule an appointment or to be seen in person on the request of the provider will result in the provider referring to an urgent care or other appropriate venue. Furthermore, if the issue is deemed urgent and there is no availability for same day appointments, your provider may refer you to the appropriate urgent care or in person venue. Chronic disease management requires periodic visits and cannot be solely completed via phone calls. Refusal to schedule an appointment or to be seen in person rather than via telephone on the request of the provider will result in the provider referring to an urgent care or other appropriate venue. Persistent refusal to be seen for appointments and demands for telephone only care in lieu of follow up visits may result in discharge from the practice.

TEXT MESSAGING: Text messaging is used only for appointment reminders and video visit links. Please do not text the office phone; messages will not be received or returned.

ACCEPTABLE BEHAVIOR: Our practice maintains a strict zero-tolerance policy for violence, intimidation, harassment, and abusive behavior. Any violent acts or threats—whether direct or implied—are strictly prohibited. Abusive behavior includes shouting, swearing, derogatory remarks, and name-calling directed at staff. Such behavior will result in immediate discharge from treatment and, when appropriate, may lead to criminal prosecution.

CONTROLLED SUBSTANCES: Effective April 17, 2023, I have decided that due to the risks and potential drug interactions associated with benzodiazepines (including Xanax, Klonopin, Ativan, Valium, and similar medications), I will not prescribe these medications to new patients joining this practice.

This policy also applies to patients transferring care from another provider who were previously prescribed benzodiazepines.

If controlled medications are lost of stolen, they will not be replaced before they are due for refills and the patient will be required to supply a police report or I will not be able to refill them. If patients are found to be diverting their prescriptions, they will be discharged from the practice.

If a controlled medication is prescribed in this practice, you must not obtain that medication or a similar medication in that class of medications from other prescribers. If a patient is found to be obtaining controlled medications from multiple prescribers, then no further refills of the medication will be issued from this office, the patient may be referred to addiction or substance abuse treatment, and may be dishcharged from the practice.

The provider reserves the right to order drug testing at random and request pill counts for any patient being prescribed a controlled medication in the practice. Failure to comply will lead to no further refills of the medication being issued from this office, the patient may be referred to addiction or substance abuse treatment, and the patient may be discharged from the practice depending on the circumstances.

CANCELLATION, LATE AND NO SHOW POLICY

Thank you for trusting your care to Emily Garber, APRN, PLLC. When you schedule an appointment with us, we reserve time specifically for you to ensure the highest quality care.

Missed appointments and late cancellations not only disrupt the schedule but also prevent other patients—some of whom may be seriously ill—from receiving timely care.

If you need to cancel or reschedule your appointment, please contact our office at least 24 hours in advance. This allows us to offer the appointment time to another patient.

Please see our Appointment Cancellation/No Show Policy below:

Effective January 1, 2022:

New patients who no-show or fail to cancel at least 24 hours in advance for their initial visit will not be rescheduled or accepted into the practice.
Any established patient who cancels, reschedules, or fails to show without at least 24 hours’ notice will be charged a $50.00 fee.
A second late cancellation or no-show by an established patient will also result in a $50.00 fee.
If an established patient no-shows or cancels without 24-hour notice for two consecutive appointments or three total appointments, they will be discharged from the practice.
Patients arriving more than 5 minutes late for a follow-up or 15 minutes late for an initial appointment will be asked to reschedule.
The no-show/late cancellation fee is the patient’s responsibility and is not billed to insurance. It is due at the time of the next office visit.

Reminders and Emergencies

As a courtesy only, we attempt to send reminders via text and/or email. However, not receiving a reminder does not excuse a missed appointment or late cancellation and even if a reminder is not received the above policy remains in effect.
We understand that emergencies happen. If you experience extenuating circumstances, please contact the office. In some cases, the no-show fee may be waived.

You may contact Emily Garber, APRN, PLLC 24/7 at 203-551-4173. If it is after business hours or we are not able to answer at the time you call, please leave a voice message.

Telemedicine visit expectations:

To ensure patient safety, privacy, and compliance with state and federal laws, patients are expected to adhere to the following guidelines during video visits:

No Driving: Patients must not operate a vehicle or heavy machinery during a video visit. If you are driving while on a video visit, you are placing yourself, anyone else in the car with you and others on the road at risk for injury or death from distracted driving. Visits may be conducted in a stationary vehicle for privacy. If a patient is found driving during the visit, it will be terminated immediately for safety reasons and will count as a “no show” or late cancellation. Repeated instances of driving on video visit will result in discharge from the practice.

Privacy and Acceptable Conduct: Visits must be conducted in a private, quiet location. Public spaces such as malls, restaurants, parks, as a passenger in a car or ride share with others present, or public transport are not acceptable, as they compromise confidentiality and communication. Visits held in public areas will be ended immediately and will count as a “no show” or late cancellation. Repeated instances of login in from a public location will result in discharge from the practice.

It is also not acceptable to conduct your visit while napping or not fully awake in bed, using the bathroom, or while partially dressed. An exception is made for patients who are bed bound due to chronic illness, who are permitted to conduct their visit in bed. In the same way you would not present to an in person visit in this manner, you should not be coming to your telemedicine visit without being prepared to fully and meaningfully participate and without being fully clothed.

Other people should not be hidden off screen in the room at the time of the visit. Failure to disclose that others are present may result terminating the visit immediately or discharge.

Video Requirement and internet requirement: The video must remain on during the visit for proper assessment. Phone-only visits are not permitted. If video is not available, the visit will be rescheduled as an in-person appointment. Patient are required to have an adequate internet connection for video visits and, if the patient does not, they will need to come to in person visits.

Location Restrictions: Patients must be located in a state where the provider is licensed (CT, NH and NY only). Visits conducted from other states or countries will be terminated to comply with legal requirements and will count as a “no show” or late cancellation.

Appropriateness of Telemedicine: The provider may determine that certain issues require an in-person visit for safety and accurate diagnosis. Refusal to attend an in-person appointment when required may lead to referral to urgent care or discharge from the practice.