extended, half-hour appointments at a discounted rate are offered for those patients who require, or prefer, more face-to-face time with me, and not infrequently, family meetings in which i meet a spouse, or parent, or other first-degree family member / caregiver / significant other for the first time, especially when i discern the need to enlist an ally, or obtain less subjective, and/or corroborative, information often require more time than the standard 15-minute visit allows, and individual, brief counseling sessions are always available upon request.
importantly, follow-up visits are approximately of 15 minutes' duration, and i pride myself on punctuality; patients are rarely kept waiting more than five minutes, but i routinely spend up to, and even beyond, 20 minutes when there is a lot to discuss, and patients are never charged for an extended visit without prior notice, unless we agree at the time that a 25-30+ minute appointment is warranted. infrequently, if there are no other appointments pending, or my schedule permits it, I have been known to spend up to 40 minutes in follow-up, but patients are never charged more than the extended visit fee for any follow-up appointment, no matter how much time is required to fully reassess the patient and address all outstanding concerns.
All other communication with me outside of the context of a formal appointment time, including telephone calls, e-mails and brief text exchanges regarding clinical matters (such as refills and minor dosage adjustments), as well as administrative matters (such as appointments, billing and documentation requests, etc.) are non-billed services that are part of the concierge-level of service offered to all patients who are incurring out-of-pocket costs in receiving treatment at Silva Psychiatric Care. I regularly schedule pro-bono follow-up calls, actually reserving time in my daily schedule to check in with patients who are undergoing major revisions to their treatment regimen, to touch base briefly and to monitor for complications or difficulties transitioning while avoiding the cost of an extra formal follow-up visit, when a face-to-face reassessment is not necessary, and all patients are always encouraged to reach out to me between visits with questions, concerns, requests, or just to let me know they are doing well (those messages are actually the most gratifying). 24/7, 7-day/week texting is encouraged as the fastest, simplest and most reliable way of getting a message to me, and if you need to send a longer message, or an e-mail with an attachment, notification texts are always a good idea. These exchanges are never billed, no matter how much time they require. i am always just a click away, and messages are always answered in less than 24 hours, but on average 2 hours or less.