At Foresight we strive to prescribe medications safely and effectively. Our clinicians follow practice guidelines developed to provide consistency as well as room for clinical judgment.
Our Policy On Prescribing Medications
If you are prescribed medications at the first visit, it will usually be a 1-month supply, occasionally with 1 refill. Once we gather relevant lab work and other reports, (and they are kept up-to-date) we may prescribe up to 90 days of medications. These guidelines may be limited by your insurance company, for example it is not uncommon for them to limit you to 30 pills when we are trying to titrate your medication 1 per day, 2 per day, 3 per day; the pills won’t last the month. They may also limit your prescriptions to 1 month at a time when we would not.
If visits, labs, and reports are up to date, and you are clinically stable, we may prescribe up to 3 months without an office visit. After that we will require a visit in order to continue your prescriptions. The visit can be telemedicine, which your insurance may or may not cover. If the 3-month visit is telemedicine, a face-to-face visit at 6 months would be required in order to continue. Our clinicians have some flexibility, but not much beyond 6 months without in-office session. If you are so stable that you don’t need minimum visits at this level, please consider asking your primary care MD to prescribe your medications. Sometimes a consultation at Foresight can aid in this decision.
The State of California requires clinicians to check a state databank (“CURES”) before prescribing controlled substances such as benzodiazepines (i.e. Xanax, Ativan, Klonopin), some sleeping meds (i.e. Ambien), and stimulants (i.e. Adderall, Ritalin, Vyvanse). Foresight does not prescribe opiates or treat pain. However, inform our clinicians if you have pain issues as many of the medications we use in psychiatry can help pain.
If you have recently been prescribed a controlled medication from another provider, or from an emergency room, our clinician may not prescribe the medication without additional information, such as a discussion with the other provider who is prescribing (with your written consent only).
We see many patients previously diagnosed with Attention-Deficit Disorder (with or without hyperactivity). Some have had actual testing for it, others none. Many people who have been tested only had screening tests. While we do not require all the formal testing prior to initiating treatment, we do require thorough neuropsychological testing in order to continue medications beyond 3 months. You may be placed on “Provisional Diagnosis” until all testing is received. While on provisional status, prescriptions will be limited to 30 days each time. Our staff will try to assist you in finding a Neuropsychologist who can do the proper testing, but you will likely want to go through your insurance panel to find the clinician, and there may be hurdles to deal with.
Prescribing controlled substances can be much more time-consuming for the clinician, as they have to check the CURES, previous prescriptions, last visit, etc. It is simplest for all to keep up with routine visits, take care of refills then. While we do not charge for common refills between visits, if controlled medications have to be filled between visits there may be an additional charge. This additional fee may not be paid by your insurance.
If you have any other questions please ask office staff or your clinician.
Missed Appointment Fees
As soon as you schedule your appointment when leaving our office, you are confirming your appointment time. We are holding this time and day in our provider’s schedule. By not showing up, you waste providers' valuable time that could be spent helping other members who are in need.
We send reminder texts and emails purely as a courtesy to our members; it is still your responsibility to make the appointment. If you cannot make the visit, you have to let us know with at least 24 hours notice.
I hope you understand that we are not able to make excuses for this policy, as that would be unfair to other members who have paid missed appointment or late cancellation fees.