FAQs

Many psychiatric providers transitioned to providing telepsychiatry services at the beginning of the COVID19 pandemic in 2020.  But telepsychiatry is not new and did not begin with the pandemic.  I am only offering telepsychiatry services at this time not only because of the pandemic but also because there are several advantages to telepsychiatry over in-person appointments.  Telepsychiatry appointments are just as effective and just as secure as being seen in person but they are more convenient, more efficient and easier to attend than going to an in-person appointment. Patients can "attend" their virtual appointments from any setting they choose as long as it is quiet, secure and private enough, free of the hassles of traffic, parking and the time spent getting to and from appointments.  There are certainly some patients who prefer to be seen in-person, but most patients are very satisfied with telepsychiatry services.  Also, I am able to see patients anywhere in the State of Washington, including patients from parts of the state that would be too far to drive.   I plan on continuing to only offer telepsychiatry services  for the foreseeable future.

Legal requirements are clear that patients must be physically present in the State of Washington for all appointments in order for me to provide treatment. I will ask you to verify your location at the beginning of every appointment. If you are someone who travels often or regularly spends time in another state, territory or country, we will need to schedule your appointments for when you are in Washington. 

 Please do not wait until your appointment to inform me you are in a different state because I will not be able to see you and you will be charged a cancellation fee (the full fee for the scheduled appointment).

I may open up my practice to patients in California and Nevada at some point in the future, but currently my practice is limited to patients in the State of Washington.

IF YOU HAVE AN EMERGENCY:

• If you have an emergency, you need to immediately do one of the following:

Call 911, 

Call your local 24/7 crisis phone line (866-427-4747 or 206-461-3222 in King County), or 

Go directly to the emergency department at a nearby hospital if you are able to do so safely.

• I DO NOT PROVIDE EMERGENCY OR CRISIS SERVICES.

• If you are an established patient of mine, please access emergency services before contacting me. Your safety comes first! Then, contact me when you are safe and able to do so (call me, send me a secure message or send me an email informing me that you have accessed emergency care and providing any additional details).

• It is NEVER appropriate for you to contact me by calling, leaving a voicemail, sending an email, secure message or text message as the first step in managing your emergency.  You must seek emergency care first before contacting me.

• If you are a current patient but you are unsure if your situation requires emergency or urgent attention, and you *are* sure you are able to stay safe and wait to hear from me, then please go ahead and contact me.  I do try to be as available as I can to my patients, but I am not available 24/7.  I do my best to respond within 1-2 business days, but I cannot guarantee this.  

• If you are being seen in an emergency department or if you are admitted to a hospital, I will do my best to be available to provide necessary medical history to your emergency/inpatient providers and to discuss aftercare needs and planning.  

There are many reasons people choose to pay out-of-pocket.  Some people are not satisfied with in-network options for mental health care or their insurance plan's rules, procedures and requirements (such as needing a referral, long wait times, limits on number of visits, etc).  Some people choose an out-of-network provider for privacy and confidentiality reasons (for example, they may not want there to be a record of obtaining psychiatric care with an employer-sponsored health plan).  Some people want their psychiatrist to be free to make recommendations and provide treatment free from restraints imposed by an insurance company.  Many people prefer the flexibility, freedom and confidentiality of seeing a psychiatrist who is not contracted with an insurance company.   Please keep in mind that sometimes patient's health information, such as their prescription history or lab results, will be shared between different pharmacies and labs, or between a pharmacy or lab and the patient's insurance company, even when the patient chooses to pay out-of-pocket for their prescription or their lab tests.  If you have concerns about the confidentiality of your pharmacy or laboratory information, you must discuss this with your pharmacy, your lab and your insurance company.   I cannot control what these other entities do.  

No, I am unable to offer a sliding fee or reduced fee schedule.  All patients are charged the same fees (see also Fees & Insurance).

No.  Most appointments are held using Google Meet, which is secure for health care purposes, HIPAA compliant and generally reliable.  You can access this using most common web browsers from your computer, or through the Google Meet or Gmail apps on most Android cell phones and iPhones.  You do not need any special equipment.  As long as you have a reasonably up-to-date laptop or home computer with a webcam, a tablet or a smartphone, you should not need anything else.

No.  Washington is one of approximately 12 states that require 'all-party' consent to record private communications.  This means that it is illegal for either you or me to record appointments or phone calls without both of us agreeing to the recording ahead of time.  If you want to record your appointments or any phone calls with me, you must ask for my consent before doing so.  I do not routinely record audio or video from any appointment, but if there is a reason to do so, I will ask for your consent prior to any recording.   You can refer to RCW 9.73.030 if you wish to review the applicable law.  

If I learn that you have made an audio or video recording of any appointment or phone call without my consent, i.e. you make a recording covertly, this may be grounds for discharge from my practice.  

Your time is valuable and so is mine.  I therefore have a cancellation policy similar to that used by many other psychiatrists and other healthcare providers:

• Appointments must be cancelled by the end of the day (before midnight) 2 calendar days prior to the appointment, including weekends. Examples: If you are scheduled for an appointment anytime on a Friday, you must cancel before midnight on Wednesday.  If you are cancelling an appointment scheduled anytime on a Monday, you must cancel before midnight on Saturday, etc.

• There is no charge for appointments cancelled according to this policy.

• Appointments can be cancelled by leaving me a voicemail, sending a secure message via the patient portal, or by email, all of which automatically log the date and time.

• Appointments cancelled less than 2 calendar days prior to the appointment will be charged the full cost of the appointment.  For example, if your appointment is scheduled for anytime on Monday and you cancel anytime on Sunday, which is only 1 calendar day before your appointment, you will be charged the full fee for the cancelled appointment. You would need to cancel before Saturday night at midnight.

• Missed appointments (sometimes called "no-shows" or "DNKA"s for did-not-keep-appointment) are charged the full cost of the appointment.  

• If you are more than 10 minutes late for a 25 minute appointment, or more than 15 minutes late for an appointment that is 50-minutes or longer, we can still conduct your appointment but you will be charged the full cost of the original appointment, plus you may need to schedule another appointment sooner than normal to address any outstanding issues for which there was not enough time. 

• If you submit invoices to your insurance company for reimbursement, please keep in mind that few if any insurance companies reimburse patients for late cancellations or missed appointments.

• We will discuss repeated late cancellations, missed appointments and late arrivals. Problematic patterns of attendance at appointments interfere with treatment and may be grounds for discontinuation of care.

• I fully understand that "life happens."  If there are unforeseeable extenuating circumstances, I encourage you to please discuss these with me. I cannot waive or refund fees if you do not share with me what the circumstances are.

• If *I* need to cancel or reschedule your appointment, I will contact you at least 2 calendar days in advance, unless there are unforeseeable extenuating circumstances from my end.

• Confidentiality, privacy and security concerns must be kept in mind when you decide how to contact me.  The most secure methods is to message me securely through the patient portal in Sessions Health, or by phone. I discourage patients from disclosing personal health information in regular emails.  While my email is secure for health care purposes and complies with required patient privacy regulations, your own email may not be secure. Ultimately, you must decide what level of risk is acceptable to you if you choose to use your regular email. I discourage use of text messaging.

• Emails, secure messages, the content of voice messages and of phone calls, or a summary of these, generally become part of your medical record.

• I generally respond to any contact within 2 business days, but usually you will hear from me sooner.

• Please note that social media (such as Facebook or Twitter) is never appropriate for communicating with me.  I will delete any social media requests or messages I may receive from any potential, current or former patients on social media.

• Please also note that it is rarely appropriate for me to view your social media, so any requests for me to view anything you share on popular platforms such as Instagram or Facebook will generally be refused. If you believe there are circumstances that warrant you showing me something you have posted, we can discuss this during a scheduled appointment.  

• My mailing address is:  

Daniel Kodner, MD

4742 42nd Ave SW, Box #412

Seattle, WA 98116

Keeping in mind that I am a solo practitioner in private practice, please follow these guidelines for contacting me:

• I try to be as available as possible to my patients and I welcome questions or concerns.  However, if your question or concern is non-urgent and can wait until your next scheduled appointment, please wait. Do not be offended if I respond to a non-urgent query by confirming receipt of your message and asking you to wait until your next regularly scheduled appointment (or asking you to schedule an appointment if you don't already have one).

• If your question or concern cannot wait until your next appointment, or if you are unsure if you can wait, please contact me.  I generally respond to any contact within 2 business days, but usually you will hear from me sooner.

• One of the benefits of the technology in our contemporary lives is that it is much easier for me to handle matters when I am out of the office than it used to be.  On the other hand, vacation time and time away from work is an essential need for all of us. If I am going to be away or otherwise unavailable, I will usually share this with you at your appointment and include this in an email/messages auto-responder. Usually I am able to receive messages, emails and phone calls myself when I am away.  When I am not able to do this, contact information for a covering psychiatrist will  be provided. 

• If you have an emergency situation at any time, please follow the emergency policies as listed above, 'What are your EMERGENCY policies?

• An additional fee applies for clinical and administrative tasks outside of your dedicated appointment time which require more than 10 minutes of my time.  Please also see Fees & Insurance for details and examples. 

Yes.  I am pleased to offer evening or weekend appointments upon request.  One of my practice goals is to accommodate patients' scheduling needs.  We can discuss what times work for you given your schedule and life demands, and my availability.

As a physician, I think everyone should have a primary care provider (PCP) for routine wellness & preventative care and for management of acute & chronic illnesses.  Ideally, all of my psychiatric patients should have access to primary care.  I do recognize that finding a PCP can be difficult, and some people don't really think they need a PCP (for example, young healthy adults).  The primary purpose of communicating with your PCP is to coordinate your care.   My goal is to provide you the best possible care in the safest possible manner, and communicating with your PCP is often an important step. There are also times when I ask my patients to obtain certain services through their PCP as part of their care with me.  For example, it is sometimes easier for a patient's PCP to order certain tests, like blood tests or an EKG, than it is for me to order these directly. If you do not have a PCP and need help finding one, I can help point you in the right direction.  Ultimately, you will decide what personal protected health information is shared with other providers.  If there is information you do not want me to share with your PCP or any other provider, please discuss this with me. 

As of April 2024, I am using an electronic health record (EHR) called Sessions Health.  This is an EHR that provides many features for me as the psychiatrist and for you as a patient through your patient portal.  I am able to securely store your history and the clinical documentation of your evaluations and treatment.  I also use the secure messaging option for us to be able to send messages back and forth, the billing option and the electronic prescribing option for me to transmit prescriptions electronically to your chosen pharmacy.  You are able to message me, keep your billing and credit card information up-to-date, view and download invoices or "superbills," and view forms and other documents.  It's easy to set up a patient account and I will help you with this as needed.  

All of your records and protected health information (PHI) are strictly confidential.  You will be asked to review and sign my office privacy policies before you see me for an appointment. 

I will discuss any routine release of information (ROI) with you prior to any disclosure of protected health information.  You will be able to complete an electronic ROI that I send you via secure message.

There are some circumstances under which I am either obligated or otherwise allowed to release your protected health information without your consent.  Examples include but are not limited to:

• When an order or subpoena has been issued by a judge or court to disclose your information

• When ethical and legal factors require me to disclose your information for reasons related to your own safety or the safety of others

• If I become aware of  any abuse of either children or vulnerable adults, which I am required to report to Child Protective Services or Adult Protective Services

• For necessary continuity of care in emergencies or if you are hospitalized, when limited release of essential information is in the best interest of your health and safety

• Prescriptions for medications are generally transmitted electronically to your pharmacy of choice.  This can be a regular brick-and-mortar pharmacy or a mail-order pharmacy.  It is your responsibility to keep me up-to-date if you decide to change pharmacies.

• Medications are sometimes prescribed at an initial appointment, but usually I will want to discuss psychiatric medications with you in detail before prescribing.  Sometimes this is not possible after just one appointment. I may also want to review your prior treatment records and/or communicate with your previous psychiatrist or mental health provider before prescribing medications to you.  Please discuss any concerns about your supply of current medications and need for medication refills with me.  

• If you are transferring your care to me from another psychiatrist, I may or may not recommend you continue to take the same medications.  If I recommend changes in your medication regimen, we will discuss this in detail.

• It is your responsibility to inform me of all medications (prescribed and over-the-counter), supplements, natural remedies, etc, that you are taking whether they are for psychiatric reasons or not.  This is important for me to be able to prescribe medications as safely as possible.

• It is your responsibility to inform your primary care provider and your other health care providers of all of the medications you are taking whether they are for psychiatric reasons or not.

• Some medications carry higher medical risk than others. In order for me to prescribe medications as safely as possible, you may need blood tests or other tests (for example, an electrocardiogram or EKG) before prescribing, and/or to monitor your treatment while you are taking the medication.  

• Sometimes I cannot prescribe medications if you have not seen a primary care provider in the previous year for a general annual visit and physical examination. This applies on a case-by case basis depending on your age, medical history, and other factors.

• You agree that you will not seek and/or obtain prescriptions for psychiatric medications from any other provider while I am prescribing medication for you unless there are specific reasons to do so that we have discussed. For example, your PCP could certainly refill a psychiatric medication in an emergency where you could not reach me, or there might be situations where your PCP prescribes a medication you are taking is a controlled substance, but actively seeking psychiatric medications from other providers outside of your treatment plan is a problem.

• We will generally discuss changes in the dose of your medication during scheduled appointments. Some adjustments are more straightforward than others, so if you think you need a different dose of your medication, please discuss this with me.  An appointment may be necessary in order to make some dose adjustments.

• I routinely monitor Washington State's Prescription Monitoring Program's website as required by State rules. This is a database of records for prescriptions for controlled substances from many states.  Even though I do not prescribe controlled substances, information about any prescriptions for controlled substances written by other healthcare providers is available to me and will be reviewed.

• It is your responsibility to be familiar with your health insurance's prescription drug benefits, rules and restrictions.  I will do my best to work with you to ensure you can obtain medications I prescribe.  Sometimes this requires creative thinking or filling prescriptions outside of your insurance plan (this can actually be less expensive).  And some prescriptions require pre-authorization from your insurance company.  The pre-authorization process can be very cumbersome and time-consuming, and the fees for this additional time spent can add up fast.  I will often ask you to do the groundwork in these cases (for example, finding out what your plan's specific procedures and requirements are, obtaining any forms from your insurance company or a pharmacist, etc) so that any time I need to spend and bill you for are are kept to a minimum.  Sometimes I will access a website (covermymeds dot com) to obtain pre-authorization, but only with your consent.

• Regarding medication refills:

We will discuss any refills you need during scheduled appointment times.  

You should only need to contact me infrequently for refills outside of scheduled appointments. I will do my best to make sure you have an adequate supply of medications until your next appointment.  

Sometimes electronic prescriptions are not properly delivered or processed by a pharmacy, there is a pharmacy error, or some other problem occurs. Please feel free to discuss this with me so the issue can be resolved.

If you do need to contact me for a refill, please contact me directly.  Please do not ask your pharmacy to call me or send me a fax request for refills unless I have specifically asked you to do this.  Faxed requests from pharmacies are often inaccurate, and sometimes they are generated automatically without you even being aware or even when you do not need a refill!  I do not respond to faxed requests for prescriptions from pharmacies unless we have specifically discussed this in your case.  I will respond to phone calls from pharmacists if they have questions and need clarification of a prescription. However, I do not respond to phone calls from pharmacists if they are calling only to request a refill for you.

Sometimes I will prescribe a limited supply of medications, for example, only enough to last until your next scheduled appointment, or I may decline to refill your medications. Please ask if you unsure why I am doing this.

If you repeatedly miss appointments and need refills as a result, we will need to address this during an appointment.  I may decline to provide refills to you, depending on the circumstances.

Lost prescriptions will be refilled on a case-by-case basis depending on the circumstances.  While I do not generally prescribe controlled substances, lost or stolen prescriptions for controlled substances will not be refilled. 

Some prescription medications are considered controlled substances.  These are categorized by the Federal government into 5 different schedules, with Schedule 1 including substances that are illegal or illicit (like heroin, for example) and Schedules 2-5 including medications that are prescribed by physicians but which carry some degree of risk of addiction or misuse.  Some commonly used psychiatric medications are controlled and are listed in these categories.  Examples include stimulant medications (such as Adderall or Ritalin) and medications for anxiety and sleep (such as Xanax, Klonopin and Ambien).  

There is a Federal regulation called the Ryan Haight Act, short for the Ryan Haight Online Consumer Protection Act of 2018.  This regulation requires any practitioner issuing a prescription for a controlled substance to conduct an in-person medical evaluation before prescribing, with subsequent in-person examinations at least once every 24 months.  Since my practice is limited to telepsychiatry at this time, I do not conduct in-person medical evaluations, so I am not be able to prescribe controlled substances.  This requirement was suspended due to the Covid-19 pandemic and the official state of emergency, but this exemption is ending at some point in 2023.  I do not want my patients to be in the position of receiving a controlled substance prescription from me and then not being able to continue that prescription when the state of emergency ends.  

Fortunately, there are almost always medication treatment options that are not controlled.  In the infrequent circumstance that a controlled substance is truly indicated for one of my patients, we may be able to coordinate prescriptions with your primary care provider.  Any exceptions will need to be addressed on a case by case basis.

It is important for me to know all of the prescribed medication you take from other providers prior to and during your course of treatment with me in order for me to safely and appropriately prescribe medication for you.  Sometimes patients think I have access to their pharmacy records and that I will know automatically. This is not true. The information I have access to from your pharmacy/pharmacies is highly variable.  It is your responsible to keep me up-to-date about all the medications you are taking.

As noted above under "What are your policies about medications and prescription refills?"  I routinely check and monitor the Washington State Department of Health's Prescription Monitoring Program database (PMP).  This allows me to view any prescriptions for controlled medications you have filled in Washington and in many other states.   Medications which are not controlled (most medications) are not listed.  

Yes, I am board certified.  Many people believe this means their physician is a better physician than one who is not board certified.  My opinion is that this may have been true in the past.  But these days, board certification is less meaningful than many people think.  

I have been board certified in adult psychiatry since 2001 by the American Board of Psychiatry and Neurology (ABPN).  This is a private organization that administers examinations to psychiatrists for a hefty fee.  In order to become board certified initially, a psychiatrist needs to have completed an approved, accredited, post-graduate residency training program in psychiatry and then pass an examination process. When I became certified, the first part was a written, multiple choice examination.  The second part was an oral examination in which the psychiatrist must interview and examine a patient while being observed live by a panel of psychiatrist examiners.  Passing the 2 parts of this initial examination is a teachable skill.  In fact, I used to teach psychiatry residents the skills needed to pass these examinations.  In my experience, I met psychiatrists who were truly excellent psychiatrists in whom I would entrust the care of a personal friend or family member, yet they had difficulty mastering the skills needed to pass these board examinations.  And in contrast, I also met psychiatrists who were able to pass these examinations easily but in whom I had doubts about their ability to practice psychiatry.  In any case, that initial certification was valid for 10 years (it used to be good for a lifetime).  In order to remain board certified, the ABPN requires Maintenance of Certification (MOC).  This process has changed dramatically in recent years.   In 2011, I completed my first MOC by taking and passing one required, written, multiple choice examination.  A written examination every 10 years is still an option.  But currently, the ABPN has moved towards an Article Based Continuing Certification option with recertification every 3 years.  I have chosen this pathway.  Every three years, I am required to read a set of 30 psychiatric journal articles and pass a multiple choice quiz on each article.  These quizzes, along with continuing medical education (CME), maintaining my medical licenses and a few other requirements, allow me to remain up-to-date with board certification.   I and many other psychiatrists question whether this process really signifies anything meaningful to a prospective patient about a psychiatrist's abilities and competence.  But systems are slow to evolve, and there are hospitals, insurance companies and other bodies that still continue to require board certification as a condition of employment.  Many of us see it as a very expensive hoop that we must jump through but which really means very little.  But to make a long story short(er), my board certification with the ABPN in Psychiatry is up-to-date.  I completed the MOC process in 2022, and I will probably complete all of the requirements again when this current cycle ends in 2025.  Please know that I feel much more confident when I recommend a psychiatrist or any doctor to any patient, friend or family member if the psychiatrist is well trained with a strong reputation and with no history of significant difficulties or sanctions from any state medical board than I am by checking to see if the psychiatrist is board certified or not.

,Ideally, treatment ends when we decide together that treatment should end.  During your course of treatment, if it is my opinion that continuing treatment with me is not in your best interest, or if I cannot continue to provide treatment to you for any other reason, I will discuss my opinion with you and I will offer recommendations accordingly.  Similarly, if you do not want to continue treatment with me, it is best if we discuss this.  The important point is that we should discuss any concerns about ending treatment or termination, as it is called, together.

Some examples of reasons for ending a course of treatment include but are not limited to:

• Mutual agreement that your goals of treatment have been met and you no longer require psychiatric specialty care.

• I determine I am not able to provide the best, appropriate treatment for your condition; you may require a different treatment setting or you may need a psychiatrist with different expertise, etc.

• You want to transfer and continue your treatment with another psychiatrist or psychiatric provider for any reason, or you may want to stop psychiatric treatment entirely.

Sometimes a course of treatment needs to end without having an opportunity to discuss the situation during an appointment; this is not ideal but it does happen.  I maintain the right to discharge or terminate from care any patient when necessary even without an opportunity to discuss the reason(s) beforehand.

Some examples of situations that may lead to termination of a course of treatment and discharge of a patient without discussion include but are not limited to:

• Repeatedly failing to follow the cancellation, missed appointment and late arrival policies to the degree that treatment is disrupted.

• Repeatedly failing to present for an appointment at least as often as recommended (usually at least once every 3 months, occasionally less often).

• Repeatedly failing to follow treatment recommendations or failing to obtain necessary, recommended studies (such as blood tests or an EKG) to the degree that the expected benefit and/or safety of your treatment is compromised.

• Seeking psychiatric prescription medication from any other provider without discussing this with me ahead of time.  There are times when we may decide that you should see another psychiatrist or other provider for a "second opinion" consultation, but obtaining psychiatric or psychoactive medications from another provider without discussing this with me and while I am prescribing psychiatric medication for you is not safe and undermines your care.

• Using illicit drugs and/or failing to disclose any illicit drug use.

• Failing to keep me up-to-date with other medications, supplements, etc, whether prescribed by another provider or taken on your own, to the degree that the safety and efficacy of your treatment is compromised.

• Behaving in a hostile, threatening, aggressive, intimidating or otherwise unprofessional manner with me.

• Repeatedly failing to keep an up-to-date credit card on file to pay the fees for your treatment, or filing a dispute with your credit card company for legitimate charges you are responsible for (such as disputing no-show or late cancellation fees, etc).

• Improperly using your medications (such as sharing your medication with someone else).

• Asking me to commit any type of fraud for the purpose of trying to obtain some sort of benefit or financial compensation.

The key point here is that direct communication is important and really necessary for treatment to end in the safest and most appropriate manner.  Please discuss any concerns you have about your treatment, or about your ability to abide by the requirements and responsibilities that apply to all of my patients, with me at any time.