Behavioral Care Policies and Procedures

Initial evaluation 

At the time of your initial evaluation, we will gather pertinent information relating to your presenting problem so we can determine the most appropriate treatment and make recommendations for you. If at any time your clinical needs require a level of care not provided in the clinic, you may be referred to alternative services or programs.

Treatment and available services 

Each patient comes here with a unique set of circumstances. The purpose and goals of treatment, as well as the type and length of treatment will, therefore, vary with each patient. Your active participation in your treatment is important and no decision about your treatment will be made without your involvement. It is important that you openly discuss your expectations, concerns or questions regarding your treatment with your therapist, nurse practitioner or doctor. The services available to our clients include: diagnosis; referral; and individual, marital, family and group therapy. Psychological testing and evaluation, and psychiatric assessments also are available. Prevea Health Behavioral Care is licensed under DHS 35, and 75 whose providers are licensed under Statutes Chapter 440, 448, 455, or 457. Prevea Behavioral Care providers act as a team, and do consult with other skilled staff, as required by State Statute regarding the best treatment plan for care. Some providers may treat patients under the supervision of a provider in your insurance network. All providers participate in ongoing clinical collaboration within the department to allow for the review of treatment with other skilled staff.

Referral services 

If we cannot provide you with the type of services you may require, we will make referrals to other agencies and help you with accessing these services.

Follow-up communication

In an effort to evaluate and improve our services, we may contact you by mail, email or telephone following your treatment to ask you to critique the services you received. If you require future services, you may return for treatment. 

Informed consent 

Prior to beginning any treatment, you will be asked to sign an Informed Consent for Treatment. This is intended to assist you in understanding your treatment and your consent to treatment. 

Confidentiality 

Confidentiality of patient information is maintained in accordance with state and federal regulations (HIPPA and 42 CFR Part 2). Information to those outside Prevea Health will only be released with your written consent. Per Wisconsin mental health law, information provided will be kept confidential with the following exceptions: 1) if I am deemed to present a danger to myself or others; 2) if concerns about possible abuse or neglect arise; 3) if a court order is issued to obtain records; or 4) situations of acute care where medical information is needed for treatment planning.

Insurance 

As a state certified mental health and substance use clinic, we are eligible for mandated insurance benefits. It is recommended that you contact your insurance company to determine if your insurance will cover outpatient mental health services, and/or substance use services as well as what the limits are on this coverage, prior to beginning treatment. As a service to you, we will submit assigned insurance claims to your insurance carrier. If special claim forms are required, please provide these to us. You are responsible for payment of charges not paid by your insurance. It is expected that you pay any portion not covered by insurance at each session. Co-pays are due at the time of service. If you do not have insurance that covers services at Prevea Behavioral Care, and will be paying cash for services, you will be eligible for a 30% discount of the listed fees. If you have commercial insurance, or Medicare that covers Behavioral Care Services, and choose not to use that insurance you will be responsible for the full fee, and not eligible for the discount. If your provider is listed as an out of network provider, you will not be eligible for the discount. If you have Medical Assistance, your insurance must be billed, and all Medicaid billing policies will be followed. For billing or insurance questions, please call Patient Accounts at (920) 496-4775 between 8 a.m. and 5:30 p.m. Monday through Friday. 

Fee for service 

Our fees are determined based on the type of treatment provided and the length of time needed for each session. Your treating provider has detailed fee information available at your request. The range of fees for each service depends on the provider seen. 

• Diagnostic evaluation $354-$597 (50 minutes) 
• Psychotherapy $165 (16 to 37 minutes) $219 (38 to 52 minutes) $328 (53+ minutes) 
• Family therapy $296 (50 to 60 minutes) 
• Psychological testing (PhD) $251.25 (per hour) 
• Medication management $143-$345 (with psychotherapy +$169) 
• Group therapy $86.25 
• Drug Screens $57-$61 
• MISSED APPOINTMENTS (without notice or late cancellation – within 3 hours)*   
  • Psychotherapy and Medication Management $90
  • Psychological Testing ½ testing fee

*Two missed appointments or late cancellations in a 12-month period may result in discontinuation of all Behavioral Care services

Medication management and prescription refills 

If you are prescribed medication as a part of your treatment plan, you will be advised of the nature, risks and benefits of the medication. If you are a minor, your legal representative or guardian will need to consent to the use of any medication. Please call at least a week before your prescription runs out. When you call for a prescription refill, your refill may not be ready for a minimum of 72 hours. This may also take longer if a prior authorization is being requested from your insurance company. For best service, call as early in the day as possible. In many cases, your provider will have instructed you to come for an appointment before your prescription runs out. Your provider also may call your pharmacy and provide only enough medication until your regularly scheduled appointment. If you have less than a one-month supply remaining on a medication you take regularly, please ask your provider for a refill during your appointment.

Prescriptions for any controlled substances, such as stimulants, narcotic pain medications or certain antianxiety medications, will not be refilled after clinic hours, nights and weekends. Due to the nature of these medications, there will be no exceptions to this policy.

Grievance procedure 

You have the right to register any complaint or concern about your treatment or care, and the complaint will be processed by the Client Rights Specialist in Prevea Behavioral Care. There are informal and formal procedures in place to deal with client complaints. You also have the right to have any grievance reviewed by the Division of Quality Assurance, Behavioral Certification Section.

Discharge policy 

Prevea Behavioral Care seeks to provide quality care to all patients. Patients may be discharged from the clinic immediately if they are deemed to be abusive or threatening to the staff. Patients may also be discharged for the following reasons, but not limited to: failure to follow the treatment plan, the inappropriate use of controlled substances, not following the financial policies of the clinic, being in violation of the no show policy, or the inability to build/maintain patient/ physician relationship. In the event a discharge occurs, you will be provided a letter with information related to the discharge, and the effective date. At your request, you will have the right to have the decision reviewed by the Clinic Manager, Prevea Quality Resources and the Wisconsin State Grievance Examiner.

Prevea Care After Hours

In case of emergency after normal working hours, you may call Prevea at (920) 496-4700 or toll free (888) 277-3832. Prevea Care After Hours offers a convenient way for Prevea Health patients to seek the medical advice they need. Prevea Care After Hours is staffed by our experienced medical team to ensure the continued care of our patients after the office is closed. When calling Prevea Care After Hours, the triage nurse will be able to individualize your care by having access to your medical records. This also enables us to keep your provider aware of any concerns you have after clinic hours. Your insurance will not be billed unless you are seen by a provider. 

In case of a mental health emergency, you can also call Brown County (920) 272-1200, Sheboygan County (920) 458-5557 or 988 to access the Crisis Intervention Center. 

Testimony and court proceedings

We collect data for the purpose of helping you in treatment. Legal hearings have different goals than treatment or therapy. We do not usually testify in custody cases, divorce proceedings or criminal court unless we are hired for that purpose from the start. If we saw you with your spouse, we cannot ethically testify without permission from both partners in any divorce hearing.