Question 1

Are there conditions you do not treat?

Accepted Answer

There are a few.  First, I only treat people 18 yrs of age or older. I am trained in general adult psychiatry. Not child and adolescent psychiatry.

I do not treat dementia.  This is better handled by neurologists and geropsychiatrists.  Similarly, I don't treat severe eating disorders because they are best treated by specialized teams and I do not believe I have adequate training.

If you have a history of often needing after hours crisis care, I am not a good fit for your needs as I have limited after hour availability.   You would be better served by someone else most likely an agency with staff on call 24/7.

Where I believe more specialized or team care is important for a client's safety, I may only be willing to take a patient only if they are also involved in such treatment.

I don't do court ordered anger management treatment . I also do not do one-time evaluations for issues such as disability, L&I claims, ESAs,  or similar issues.  I will perform many of these for established clients as medically appropriate.

Finally, I also may choose not to see some clients if I feel that I am not a good fit for a client, or may not be able to provide the care the client needs, or due to liability or similar concerns.

Question 2

Do you take insurance?

Accepted Answer

I do not take any insurance as an in-network provider nor bill directly.  All charges must be paid by the client at the time of service. I will provide you with a superbill that you may be able to get reimbursed  through any out-of-network coverage you have.  Please check with your insurance policy about out-of-network coverage.

Question 3

Why don't you take insurance?

Accepted Answer

The reasons I don't take insurance are related to payment and conflict of interest.  Insurance reimbursement for mental health services has been poor in Washington state for many years.  This is compounded by systematically lower reimbursement (indexed to Medicare payments) for psychiatrists for all billing codes than for physician assistants and nurse practitioners despite our more extensive education and training.  Worse, insurance companies have adopted abusive practices that make it difficult to obtain reimbursement: delaying payments for months on end,  excessive documentation requirements, even demanding repayment of reimbursements from years prior.

In addition, health insurers, despite claiming not to make medical decisions, routinely interfere with patient care in ways that limit their costs to the detriment of your care. It has often been said that to know whose interests someone serves, look who provides their paycheck.  There is an inherent conflict of interest created by insurance payments, especially when a small number of insurers provide most of the coverage in an area.  These effects are far larger than other conflicts of interest that are considered unacceptable and unprofessional in medicine.  Yet the conflict of interest created by insurance company practices, and the collusion enabled by health insurer exemptions from anti-trust laws, are rarely considered.   Because I do not provide in-network services, my interests are aligned with yours and yours alone, not distorted by the often overt pressure insurance companies exert on mental health providers.  My paycheck directly from you. You know whose interests I serve.

For more information about why so few mental heath providers take insurance, see this excellent ProPublica report.  If the difficulty of finding in-network mental health care is something you are concerned about, consider calling your state and federal legislators to express your concerns.  Phone calls are much more effective than emails.

Question 4

What about Medicare and Medicaid?

Accepted Answer

The quick answer is that I do not take either Medicare or Medicaid.  People on either are welcome to see me, but have to pay out of pocket for services.

Neither Medicare nor Washington's Medicaid Apple Health fee-for-service option allow you to submit for your own reimbursement.  As a result, people with this insurance are  in the same situation as someone with private insurance that does not cover out of network services.

People on Medicare do need to fill out a Medicare mandated private contract to see me.  This is required by the law under which Medicare operates.

I am sympathetic to those who have no out of network coverage as well as those on Apple Health and Medicare.  My own exchange plan medical insurance pays nothing for out-of-network services, and I have to pay for some of my own care this way.

Question 5

Do you do teleheath appointments?

Accepted Answer

Yes, I do perform telehealth appointments for clients in Washington state for regular office visits.  I prefer to have the initial consultation in person and one in person visit is required before I will prescribe any controlled substance (such a stimulants for ADHD or benzodiazepines such as lorazepam for anxiety).  Although still suspended under pandemic rules, it is a federal law.

However, I recognize that for clients distant from my office, it may be difficult to attend an in person appointment even for the initial consultation. If controlled substances are not part of treatment, it may be possible to have all treatment online, so long as the client is in Washington state for all televisits.  This includes clients in eastern Washington

I am only licensed to see clients in Washington state.  You must live in and your televisit location must be in Washington state.
The cost for telehealth visits is identical to in office visits.

Question 6

What is your no-show/cancellation policy?

Accepted Answer

Cancellations must be made 24 hours prior to your appointment.  Failing to do so will incur a no show fee.

The no show fee for missing an initial consultation is $120 provided you contact me within 2 weeks to reschedule the initial consultation.  If you do not contact me within 2 weeks to reschedule the initial consultation, the fee is $350.

No show fees for office visits are the same as for the scheduled office visit.

There is no charge for appointments converted to telehealth less than 24 hours before an scheduled office visit (see "What do I do if I am sick and it is too late to cancel the appointment?").

Question 7

What do I do if I am sick and it is too late to cancel the appointment?

Accepted Answer

I do not want you to come to the office if you are sick and potentially infectious.  I am happy to change an in office visit to telehealth less than 24 hours before your exam at no charge.  If you do not have capacity for a video appointment, a regular telephone call is possible.

Question 8

How can I contact you securely on line?

Accepted Answer

On the top horizontal menu, got to Client Portal.  I will provide you with information about how to register when you have your initial consultation.  You can contact me, make appointments and pay bills through this secure encrypted system.

Question 9

What do I do if I have an emergency  after hours and on weekends?

Accepted Answer

First, if you are having a medical emergency, call 911 immediately.

If you are concerned you may harm yourself or others, go to the nearest emergency room or call 911

If you can wait at until the next business day, contact me via my office phone or via the patient portal.

If you are hoping to contact me more urgently, it is best to call and state your message is urgent.  Be sure to leave your contact information, even iuf you are sure I already have it.  I will do my best to get back to you as soon as possible, but I cannot monitor my phone 24/7 outside of business hours.

If you are in crisis and need to speak to someone urgently, the King County Crisis line is available 24 hours a day at 1-866-427-4747 https://www.crisisconnections.org/24-hour-crisis-line/.

There is also emotional support available from peers who understand mental health difficulties from Monday-Sunday 9 am to 10 pm on the Washington Warm line  at 1-877-500-WARM (9276) https://www.crisisconnections.org/wa-warm-line/.

Question 10

How does treatment start?

Accepted Answer

You start by contacting me in one of two ways to set up a 15 minute call.  There is no charge for this call.  This call can be arranged  by leaving a message on my office phone, or via the form under the contact me page (see note below) where you should tell me some times that you can speak with me.

During that call, we will talk briefly about the issues leading you to seek mental health care and  see if I am likely to be a good fit for your needs.  If so and you wish to see me, we will make an appointment for your initial consultation.

Before your initial consultation,  I ask that you download  and fill out some paperwork before this visit. I will also provide you with what you need to register for the client portal.  You will be able to contact me securely, schedule appointments and receive information through the portal.  The initial consultation will be about 75 minutes long but I book 90 minutes in order to have time to get you established as a patient.  I do ask for a credit card on file with the patient portal when possible.

At the initial consultation I will conduct a psychiatric assessment to start the process of diagnosis and develop a treatment plan.  I may also perform a brief neurologically focused physical exam, as well as get some baseline data such as blood-pressure and heart rate as appropriate for the treatment plan under consideration. I may also request laboratory studies depending on diagnosis and treatment plan.  I may prescribe medication or make other recommendations in accordance with the treatment plan. Finally, we schedule your next office visit for followup.

NOTE: Please keep in mind that communications via email over the internet, such as the contact form are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed. Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send or the contact form on this web site.   If you choose to use this form rather than call, you are accepting the risk that this information could be intercepted and the privacy of any information provided breached.    The contact form should only be used to arrange for a phone call to discuss and set an initial consultation, or ask general questions about the practice.

Question 11

How does treatment end?

Accepted Answer

You may terminate treatment at any time and for any reason. In fact, if you feel that we just don't 'click' you should consider seeking treatment elsewhere as the therapeutic relationship is important in mental heath care.  This is also true if you feel you have gotten as much out of treatment with me as you can. This is not a statement on me or you.  I can be a perfectly good psychiatrist and you a perfectly good patient and still not connect.  You owe it to yourself to find a therapist you do connect with or can get more from.  In cases where I am performing both psychotherapy and medication management, you are also welcome to find a different psychotherapist and have me continue to manage your medications.  If you do decide to end treatment, please let me know rather than just disappear so we can properly transfer care.

In some very rare cases, I may decide to terminate treatment with you.  This will typically be due to persistently not attending scheduled appointments, not paying bills without making arrangements for later payment, or for serious breaches of trust such as diversion of scheduled medication or doctor shopping to obtain such drugs, making personal threats to me or others in my office space, in-office disruptive behavior, or other developments suggesting I can no longer treat you safely or productively.  In such a case, I will send a letter to let you know that our physician-patient relationship is ending and that you have a month to find new treatment.

Dr. Michael Clark
MD PhD, Psychiatry

FAQ

Frequently asked questions