Psychiatry/Medication Management FAQ

1. I am not really interested in therapy but I need medication management. Is this available?

We strongly believe that optimal medication management includes ongoing therapy. Requests for medication management without engagement in ongoing therapy will be considered on a case by case basis.

2. I have a lot I need to share during my first appointment with the prescriber.  What can I do to prepare for my first visit? 

Your prescriber is interested in your entire treatment history and, in particular, your medication history.  If possible, write a list of all of your current medications including dosage, current prescriber, length of time you have been taking, and level of effectiveness.  Or, simply bring all of your pill bottles with you.  A separate list of all past psychiatric medications you have tried is very helpful; again, include dose, effectiveness, side effects, and what month/year you last took the medication. 

3. A lot was covered in my visit with my prescriber. What can I do to help me remember what we talked about? 

Your prescriber will review and discuss changes to your treatment plan. Make sure you leave your visit understanding what medications were prescribed, any changes to your regimen, and any special instructions.  A summary of your visit including your medications is available on your portal.

4. I was recently in a psychiatric hospital. What does my prescriber need from me? 

Bring a copy of your discharge paperwork, including discharge diagnosis and medications, with you to your visit.

5. How come my prescriber didn’t order me the medications I wanted? 

Your prescriber is bound by professional standards of conduct to prescribe medications indicated for your specific diagnosis in the context of your individual circumstances.  Your prescriber will listen to your concerns, but ultimately will decide what treatment to provide.  You are encouraged to discuss options with your prescriber.

6. Will I have enough medication to last until my follow-up appointment? 

Your prescriber will give you enough medication to make it to the agreed-upon time frame for your follow-up appointment (for example, one month or three months).  Make sure to confirm the timeframe for follow-up with your prescriber and make sure to schedule your appointment within that window. Remember appointments  fill quickly so you must schedule immediately after your visit.  Refills will only be given during face to face visits except in extreme situations.  See FAQ #6.    In some instances, certain medications are only prescribed in limited quantities.  Your prescriber will discuss this with you and you may need to be seen more frequently.

7. I am out of medication.  What should I do first? 

If you scheduled immediately after your last visit you and your prescriber have ensured you would have enough medication to make it to your agreed upon follow up date.  Thus, effective January 1, 2018 MABH will no longer be providing refills outside of scheduled appointments except if the shortage is due to our error or in a rare extreme circumstance.  If MABH agrees to provide a bridge script (limited # of pills) to get you to your next appointment this is a noncovered service by your insurance and will incur a service charge of $10 that must be paid prior to filling.  We find that many patients call for medication but actually have refills available so please before calling and incurring the $10 service charge 1.) check your prescription bottle to see if you have refill(s) available, 2.) call your pharmacy to see if you have a refill available or a prescription on file, and 3.) make sure you have a follow-up appointment scheduled with your prescriber that was set at your last appointment and you did not miss or change it.  If you have done those three things and still need a refill, call the hotline (302) 224-1400 ext. 546 and leave a detailed message.

8. Why did my prescriber only give me a 30 day supply of a medication with no refills? 

Certain medications, called controlled substances, are recognized by the Federal Drug Enforcement Agency as having a high potential for abuse, dependence, misuse, and diversion, and can be dangerous in combination with other controlled substances such as opioid pain medications.  The use and prescribing of controlled substances is restricted by state and federal regulations.  Controlled substances commonly used in psychiatric practice include 1.) Stimulants (such as Ritalin and Adderall) for ADHD and 2.) Benzodiazepines (such as Ativan, Xanax, and Klonopin) for anxiety.  For your health and safety, your prescriber maintains vigilance over monitoring your use of these and other controlled substances.  You may be required to come in every 30 days for a new prescription or be given written scripts for up to 2 refills.  If you lose those scripts or they expire you will incur a $10 charge to have it redone outside of your appointment.

9. Can my prescriber make changes to my medications over the phone? 

Medication changes are only made during in person visits and only by your regular provider.  Make sure to keep notes on how you are responding to the medication(s) in terms of both benefits and side effects. You should contact your prescriber between visits if you are experiencing significant (urgent) side effects which your prescriber or pharmacist alerted you to monitor for.  In this case your prescriber will set up an urgent in-person or telepsych visit to discuss the issue.  In most cases this would be a covered visit by your insurance.

10. My prescriber says he/she will no longer provide a certain medication for me. Why did he/she do that? 

Our prescribers use clinical judgment to determine the appropriate type and length of treatment.  MABH prescribers actively monitor the Delaware prescription drug database and work closely with pharmacists to monitor the dispensing of these medications.  Our prescribers reserve the right to refuse to initiate or continue controlled substances based on information obtained from these and other sources. We will make every attempt to offer suitable alternatives and/or discontinue medications in a medically appropriate manner.

11. My follow-up med check appointments are brief.  How can I make the most of them?

There are several things you can do to make the most of your med check appointments.  First, make sure to arrive early so that the full appointment slot remains available.  If you arrive late, your appointment may be delayed, shortened, or even lost depending on the provider’s schedule.  If there is less than half of the scheduled about of time left in your appointment it is likely that you will be given the option to wait to see if the provider finishes early or has a no show or reschedule.  As we attempt to keep to our schedule it is unfair to the next patients to have their appointments delayed or shortened if they arrive on time.  Second, make sure to think about the concerns you want to express about your symptoms and medication responses ahead of time.  You may even want to write it down.  Your provider wants to hear about any changes in the quality, frequency, intensity, and duration of symptoms, as well as medication response and side effects. Third, use your time with your therapist (as opposed to your prescriber) to discuss current stressors and coping skills in further detail since those appointments are longer and more frequent.

12. I have disability paperwork I need completed.  How will that be handled?

Established patients: MABH providers will complete disability paperwork for established patients. You should start the paperwork process with your therapist.  If additional information is needed from the prescriber, patients should schedule a specific appointment for paperwork completion with their prescriber and alert the scheduler of this need.  In addition, patients should make sure to bring all required forms with them to the visit.  Please be advised that other concerns may not necessarily be addressed during the visit depending on length and complexity of the paperwork. You may also choose to pay for the provider to complete the paperwork outside of a visit time.  Fees for this are described in your new patient paperwork.

New patients: For new patients with no established history at MABH, prescribers may require patients to be seen for up to 4 visits prior to completing the paperwork.  This time is necessary for prescribers to assess and monitor patient progress so they can accurately complete the paperwork. 

13. I lost my prescription or my prescription was stolen.  What should I do?

Controlled substances (such as benzodiazepines and stimulants) – Please contact the MABH medication refill hotline for guidance.  In most cases, you will be required to obtain a urine drug screen, and in cases of theft, a police report.  Duplicate scripts will be provided at the prescriber’s discretion and will incur a $10 service charge.

Non-controlled substances – please call your pharmacy to determine if you have a refill on file.  If not, call the MABH medication refill hotline to request a bridge refill.  Please be advised that refills are only provided at the prescriber’s discretion to those with scheduled follow-up appointments and will incur a $10 service charge.

14. Why is lab work required?  What happens if I lose my lab slip?  What happens if I don’t get my labs completed as instructed?

Your prescriber recommends lab work to monitor your body’s response to medication as well as its impact on other body systems. Failure to complete lab work as requested places you at risk for adverse events and complications.  If you lose your lab slip, call for a new one ( a service fee my apply).  In some cases, failure to complete required labs may result in the prescriber’s inability to refill your medications and/or discharge from care due to non-adherence to treatment recommendations.

15. Can I use the after-hours emergency line for medication refills?

No.  The after-hours emergency line is for established patients to get brief assistance in navigating psychiatric emergencies in which they are in immediate danger of harming themselves or someone els by connecting them to appropriate community resources.  Please use the steps listed above for medication refills.  Please be aware that medication refills are completed according to the guidelines above and only during regular business hours Monday through Friday and dependent on provider availability and may take up to 72 business hours to complete.

16. What will happen if I am a no show/late cancel for an appointment?

For first time evaluation visits – if you are a no show to a confirmed first appointment with a prescriber, patients must speak with a Clinical Director to discuss attendance prior to being rescheduled with another prescriber.  You may be prohibited from rescheduling with the practice.  Patients will be charged a no show fee (unless prohibited by insurer).

For med check follow-ups – Patients will be charged a no show fee (unless prohibited by insurer). Patients with a no show or repeated late cancels will be discharged from the prescriber.  Patients must meet with a Clinical Director to discuss attendance prior to being rescheduled with another prescriber.  Patients with continued no shows or late cancels with the second prescriber will be discharged from the practice.

17. Why do I work with two different providers here at MABH?

Clinical research suggests individuals have the best outcomes when they use a combination of medication and therapy to address most mental health concerns.  Your therapist will meet with you on a weekly, every other week, or monthly basis for sessions of 30-45 minutes to explore your stressors in detail and help you work on coping skills.  Your prescriber, on the other hand, uses a more targeted approach to address your symptoms through medication management.  After a 45 minute diagnostic evaluation, patients can expect brief follow-ups on a monthly or longer basis.  All patients must be seen every 90 days.

18. I received a discharge letter from my prescriber. Why did that happen?  What do I do now?

Patients are discharged for several reasons.  Through a mutual understanding between the provider and patient, those who achieve their stated goals and no longer require MABH services are formally discharged and may return in the future if the need arises.  In other circumstances, providers initiate patient discharge for treatment non-adherence, failure to adhere to MABH policies, and inability to establish or maintain an effective therapeutic relationship. 

Patients will receive a letter from MABH indicating they have been discharged.  Details are included in the letter.  Patients have the option of requesting a bridge refill up to 30 days from the date of the letter and if you disagree with your reasons for discharge will be given the opportunity to discuss this with the discharging provider (charge may apply).

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