FREQUENTLY ASKED QUESTIONS:

PRESCRIPTIONS

Does Dr. Silva treat Adult ADD?  Yes, I evaluate and treat adults whose target symptoms include difficulty concentrating and problems with inattention, as well as associated cognitive symptoms that are not otherwise attributable to major mood disorders, or other identifiable psychiatric syndromes . A childhood history of being identified with, and treated for, ADD/ADHD is not necessary, and a prior diagnosis and/or documentation of psychological testing for ADD is not required.  To learn more, please see my Treatment Philosophy regarding Adult ADD.

Can ADD/ADHD medications be prescribed online?  Yes, all psychotropic medications, including controlled substances, can be e-prescribed.  All prescriptions are sent electronically to the pharmacy of your choice.  Certain medications cannot be refilled, and require a new prescription each time.  In Texas, it is not legal to provide pain management services via telemedicine, but I do not engage in the practice of pain management, regardless.

Does SPC charge for refills?  No.  Unlike some practices, SPC never charges simply to have a medication refilled, regardless of whether the refill is provided at an appointment, or between appointments.  Even refills that involve a slight dosage adjustment are not billed as separate services, although if the dosage change is significant, or there is another indication that a re-evaluation of the patient and/or the medication regimen is in order, the patient may be called upon to return to clinic for a formal, face-to-face evaluation before a medication dosage is adjusted.

DOES SPC OFFER 90-DAY PRESCRIPTIONS, AND CAN I USE A MAIL-ORDER PHARMACY?  YES.  TREATMENT MUST BE TEXAS-BASED, BUT MAIL-ORDER PHARMACIES AND 90-DAY SUPPLIES ARE PERMISSIBLE, WHEN APPROPRIATE.

Does Dr. Silva prescribe buprenorphine, or offer Suboxone or methadone maintenance treatments?  No, I do not prescribe Suboxone (or Subutex, et al.) nor methadone online; I do not prescribe opiates as a general rule.  For those patients who are taking daily buprenorphine or methadone for the treatment of opiate use disorder, I am happy to work closely with your prescribing facility/provider, with the additional understanding that I will manage all other psychotropic medications.

Please note: pain management via telemedicine is not a legal practice in Texas.

APPOINTMENTS

Is a full, hour-long evaluation necessary for all new patients?  Yes.  All new patients must undergo a comprehensive evaluation, which requires an initial visit of approximately one hour.  I am happy to review any documentation you might wish to provide, but documentation of prior evaluations and/or treatment is not required.

Can appointments be held over the telephone, or using Facetime, Skype,  etc.?  No.  All formal visits require a video component, and we must use the Advanced Telemedicine app (Zoom secure videoconferencing).  For more information on how it works, click here. 

NOTE: Due to the current COVID-19 pandemic, the State of Texas has suspended certain Medical Practice Act rules, and it is now temporarily permissible to resort to less secure audiovisual platforms, such as FaceTime, and even conduct visits over the telephone without a video component, but there are only a few situations in which that would become necessary, and would still provide me the opportunity to make an adequate and appropriate assessment (all of which involve established patients well-known to me), and I avoid that practice whenever possible.

How often do I have to return to clinic?  Patients who are doing well may elect to return to see me every six months; this is the maximum acceptable length of time between appointments for established patients who are actively engaged in treatment.  Refills will not be provided for any medication to last greater than six months' time. 

Patients who are taking Schedule II controlled substances (e.g., stimulant medications like Ritalin or Adderall for Adult ADD, and other medications that cannot legally be refilled, and that require a new prescription each time) will initially be seen in follow-up on a monthly basis, followed by eventual quarterly visits: once in the maintenance phase of treatment, these patients must return to clinic at least once every 3 months.  All patients are encouraged, however, to return to clinic on a quarterly basis for well-checks.

This policy also applies to patients taking Schedule III-V medications which can be refilled, such as medication for insomnia and other sedatives and calming agents, including anti-anxiety medications of the benzodiazepine class (such as Valium, Xanax, Klonopin, Ativan, etc.).  patients taking these medications infrequently (i.e., who are not taking them daily and who infrequently request a refill), who are otherwise doing well are encouraged to return to clinic on a quarterly basis, but may elect to return every 3-6 months if they continue to do well and require no more frequent re-evaluation, or changes to their regimen.  

while I always discuss, and often negotiate, the RETURN TO CLINIC date with the patient at the conclusion of every appointment, I certainly reserve the prerogative to require FACE-TO-FACE reevaluations at a frequency that is always based on clinical CONSIDERATIONS.  Conversely, patients are always welcome to RETURN TO CLINIC as often as they would like, to discuss symptoms, side effects, adjustments to the medication regimen, for therapy and counseling services, and well-checks.

DO I HAVE TO BE IN TEXAS AT THE TIME OF MY APPOINTMENT?  YES.  YOU MUST BE IN TEXAS AT THE TIME OF YOUR VIRTUAL, ONLINE VISITS.  ALTHOUGH BRIEF EXCEPTIONS CAN BE MADE UNDER CERTAIN CIRCUMSTANCES, OR IN AN EMERGENCY OR OTHER UNFORSEEN SITUATION, PATIENTS OF SPC MUST RESIDE IN TEXAS AND TREATMENT MUST BE TEXAS-BASED.  YOUNG ADULTS WHO ARE TEXAS RESIDENTS BUT WHO ATTEND OUT-OF-STATE SCHOOLS WHO WOULD LIKE TO CONTINUE TREATMENT WITH ME ARE ENCOURAGED TO ARRANGE THEIR FOLLOW-UP APPOINTMENTS DURING HOLIDAYS AND HOME VISITS WHENEVER POSSIBLE, ALTHOUGH I AM ALWAYS AVAILABLE TO MY PATIENTS BY PHONE TO HANDLE REFILL REQUESTS, ANSWER QUESTIONS, OR DEAL WITH URGENT MATTERS, REGARDLESS OF A GIVEN PATIENT'S PARTICULAR LOCATION AT ANY SPECIFIC MOMENT (FOR EXAMPLE, IF A MEDICAL ISSUE ARISES WHILE ON VACATION).

PAYMENTS, FEES & CHARGES

How do I pay?  SPC accepts all major credit cards.  A valid credit or debit card must be placed on-file with the clinic and kept funded and unlocked; denied CREDIT CARD charges incur a $25 fine.
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Is there an annual concierge membership fee? No.  Although my practice follows the concierge model of medicine, with all of the added benefits of personalized, VIP medical care,  there is no annual surcharge, no membership fee of any kind.  Patients are only ever billed for actual appointments and/or services rendered, at the time of service.

Does SPC offer payment plans?  No, full payment is due at the time of service, and I do not offer payment plans.  However, all major credit cards are accepted.  Paid invoices are available upon request.

Does SPC charge for telephone calls?  No.  All communication with me between visits is covered by the fees paid at each visit.  I am always available by phone for brief questions or simple requests, and patients are never billed for any time outside of our formal video conferences.

DOES SPC CHARGE FOR REFILLS?  NO.  PATIENTS ARE ONLY EVER BILLED FOR EVALUATIONS AND TREATMENT SERVICES, BASED ON TIME SPENT: ACTUAL, FACE-TO-FACE ASSESSMENTS AND INTERACTIONS WITH ME.  PRESCRIPTIONS THEMSELVES ARE NEVER "FOR SALE" (THE PRACTICE OF WHICH WOULD BE ILLEGAL), AND UNLIKE SOME PRACTITIONERS WHO DO APPLY A FEE, I CONSIDER CHARGING PATIENTS FOR PRESCRIPTION REFILL "SERVICE" UNETHICAL.  ALTHOUGH ALL PATIENTS MUST RETURN TO CLINIC AT LEAST ONCE EVERY SIX MONTHS IN ORDER TO BE CONSIDERED IN ACTIVE, ONGOING TREATMENT WITH ME, PATIENTS ARE NEVER EXPECTED TO PAY TO RETURN TO CLINIC SIMPLY TO OBTAIN A REFILL (NOTE: FOLLOWING AN INITIAL PROBATIONARY PERIOD FOR ALL NEW PATIENTS, INDIVIDUALS TAKING SCHEDULE II CONTROLLED SUBSTANCES WHICH ARE NOT ELIGIBLE FOR REFILLS PER SE, AND WHICH REQUIRE NEW PRESCRIPTIONS WITH EACH TRIP TO THE PHARMACY, ARE REQUIRED TO COMPLY WITH MORE FREQUENT, QUARTERLY, VISITS AS A MATTER OF POLICY).  I MAY REQUEST, OR REQUIRE, AT MY DISCRETION, THAT A GIVEN PATIENT RETURN TO SEE ME MORE FREQUENTLY ON CLINICAL GROUNDS, IF I BELIEVE MORE FREQUENT VISITS ARE INDICATED, PRUDENT, OR OTHERWISE IN THE PATIENT'S BEST INTEREST.

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