Psychiatric Evaluations & Fees

Dr. Pagnani is no longer able to accept new patients into his private practice. However, he is offering one-time 3 hour Psychiatric Evaluations with family & significant other involvement, complete with an individualized report of the patient’s medical and psychiatric history, applicable diagnosis and recommendations for the patient’s long-term provider. Evaluations focus on evidence based care and holistic treatment. Evaluations also include Dr. Pagnani discussing findings with a patient’s current or future provider (see below for more details). Conditions evaluated include Anxiety Disorders (Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and PTSD), Mood Disorders (Major Depressive Disorder, Bipolar Affective Disorder Types 1 and 2, Dysthymia, Pre-Menstrual Dysphoric Disorder and Postpartum Depression),  ADHD & Substance Use Disorders (see below). He is also trained in the “de-prescribing” of Psychiatric medications, and can evaluate and provide recommendations on tapering off of medications such as SSRIs (Paxil, Prozac, Zoloft, Lexapro, Celexa), SNRIs (Cymbalta & Effexor), benzodiazepines (Xanax, Ativan, Valium, Klonopin), and sleep medications (Ambien, Lunesta and others). Individuals struggling with substance use disorders may be appropriate, if they are not physiologically dependent (under the influence, intoxicated or in withdrawal) at the time of the evaluation. If patients are under the influence, or in significant withdrawal, it may impact the accuracy of the evaluation, and detoxification would be recommended before an evaluation. 

Policies and Fees: 2 to 3 Hour Evaluations w/ Report & Provider Collaboration

Fee: 2,100 Due at Time of Scheduling & Subject to Change

Full Fee is Non-Refundable within 72-hours of the Appointment (No exceptions).

Evaluations are one-time, typically lasting 2 hours, but not to exceed 3 hours, from the scheduled start time. Reports may be incomplete if a patient is late, has technical difficulties, or if the visit has to stop short of a full history (this would be unusual, but can occur). Reports will be provided within 2 weeks of the evaluation and are included in the fee. Addendums or changes to the report are not made after the report is completed. This is why medical records, neuropsychological testing reports, and any collateral information from family or friends is required before the evaluation, or at the time of the evaluation. Information presented after the evaluation will not be included in the report. A summary of diagnosis, findings and recommendations is not given at the time of the evaluation, and patients will receive this information in the final report. 

Family, significant other or friend involvement only occurs at the  patient’s request and participation of those individuals is limited to the first 30 minutes of the evaluation. If a patient disagrees with the information that others present, they are asked not to correct, until patient and provider are one-on-one. This allows for both complete reporting from the collateral informers and also a full history from the patient. 

All evaluations are virtual, utilizing “ring central.” Patients are required to download any required software and test logging in before the visit. Refunds are not made due to a patient’s technical difficulties and the visit end time (3 hours after the scheduled start time) will not be extended due to these technical difficulties. Direct Link to virtual waiting room: https://v.ringcentral.com/join/pagnani.

We are not responsible for a patient receiving reimbursement from their insurance provider. Patients are to call their insurance’s member services, and inquire about reimbursement for CPT code 90792, should they wish. We will provide patients with a receipt (patients with Medicare excluded, even if they have secondary insurance) and the patient is responsible for filling out and submitting any required forms to their insurance company. We are not responsible for a patient’s insurance failing to reimburse for the evaluation. We CAN evaluate patients with Medicare, but again, they cannot submit to their insurance for reimbursement.

If a patient cancels within 72 hours of their scheduled evaluation, they will be charged the full fee. If they wish to then reschedule, they may do so, for an ADDITIONAL full-fee, discounted by 50% (depending on availability and not guaranteed). If a patient misses or late cancels 2 appointments, they will not be scheduled for a third visit, and neither the full initial fee, or the additional second visit fee, will be refunded. 

We recommend that patients provide the following items to our office, more than one week ahead of their visit. It is not required, but can be very helpful for the evaluation, report and recommendations. 

1. Any previous psychiatric records from their current or past providers. We recommend that patients ask previous providers for a “summary of care.” 
2. A list of previous medication trials, including medication name, strength used, effect, any side effects, how long they took the medication, what approximate dates they took the medication, and if the medication was taken at the same time as any other psychiatric medications.
3. Any blood work, scans (for example, CT or MRI scans of the brain), genetic testing, or results from medical workups.
4. Summaries from any neuropsychological tests (including testing from childhood). 
5. Typed collateral information from family, significant others or friends, who cannot make the evaluation.

Patients must have their evaluation while seated in a state that Dr. Pagnani is licensed in. At the time of last edit, this included New Jersey (NJ), Pennsylvania (PA), New York (NY), Delaware (DE), Maryland (MD), Florida (FL) and California (CA). Patients must verify when scheduling that this list has not changed. 

Dr. Pagnani’s private practice is full, and he is unfortunately not able to take new patients into his caseload at this time. Therefore, patients must understand that these one-time evaluations do not enter them into a patient doctor relationship with Dr. Pagnani. They should be thought of as one-time consultations or second opinions. Having this evaluation does not result in an open chart with our practice, which means that Dr. Pagnani will not be available at any time for appointments, medication fills, urgent or emergency situations, FMLA forms, disability forms, custody letters or forms, weapons permit forms, accommodation letters or any other items that are generally handled by a patient’s long-term provider). Dr. Pagnani additionally does NOT write for any medications at these consults (or after). Patients may take Dr. Pagnani’s report to their current, or future providers, who may utilize the information within, for future medical decision making, at their professional discretion. Dr. Pagnani is not responsible for any medical decision making, consenting, side effects, or any morbidities or mortalities that occur, due to another provider’s actions, even if his report or collaboration is taken into account by the patient’s provider. 

Dr. Pagnani will make himself available to discuss his report and evaluation with an individual’s current or future provider, as a one-time courtesy with one provider. Individuals would need to sign a release which can be provided by our office. 

If patients are assessed at the time of the evaluation as being in crisis or requiring emergency services, Dr. Pagnani will ask the patient to call 911 or go to the nearest emergency room for immediate intervention. Patients will still be responsible for the consultation fee, even if the evaluation cannot be completed. Dr. Pagnani will not prescribe medications, even in cases where a patient is assessed as being in withdrawal. In these instances patients may be asked to go to their nearest ER or urgent care, and they are responsible for doing so. If a patient discloses child abuse, elder abuse, or homicidal ideation with a specific target, Dr. Pagnani will call local police and disclose all information he assesses as applicable, even without patient consent.

If a patient would like enter into long-term care with a provider at Rittenhouse Psychiatric Associates (where Dr. Pagnani serves as The Medical Director), they may contact scheduling approximately 2 weeks after their evaluation. Patients will undergo the practice’s screening protocol (which is in place for safety reasons, as their providers do not have inpatient admitting privileges or true emergency coverage). Patients will also be scheduled based on provider availability and state and federal regulations. In-office visits may be required. Waiting 2 weeks from the consult allows time for their report to be finalized, and allows Dr. Pagnani time to discuss the case with potential providers. Having an evaluation with Dr. Pagnani does NOT guarantee the ability to establish long-term care with a provider at Rittenhouse Psychiatric Associates. Patients who are scheduled with another provider in the practice are seen for a 45-minute visit (at that provider’s 45-minute rate) for their initial visit (and then they likely will move to “medication management” visits). Patients may also inquire about psychotherapy services with the practice as well. A patient’s chart is “closed” with our office, until they meet with their new provider for their first visit. I.E. even if an individual who has a one-time evaluation is planning on becoming a patient at Rittenhouse Psychiatric Associates or schedules an appointment, no care, appointments, forms, additional follow-up, prescriptions, urgent or emergency calls or care, or recommendations are made by Dr. Pagnani or any provider at our office, until they establish care at an initial visit, with their new long-term care provider. Dr. Pagnani will not be responsible for the patient, as the new long-term provider will be their provider. Dr. Pagnani does not interfere or triangulate with a patient’s care. He does not have discussions with the patient, their family, spouse or friends, or respond to emails or calls from individuals whom he previously provided one-time evaluations for. He WILL make himself available to the providers at Rittenhouse Psychiatric Associates, per the provider’s request. 

The providers at Rittenhouse Psychiatric Associates do not have inpatient admitting privileges, true emergency coverage or on-call social workers or medical residents. Therefore, if a patient has a history of inpatient psychiatric admissions, psychosis, suicide attempts, or is assessed as high risk, we will be unable to schedule them for follow-up within our practice for safety reasons (this is not a complete list of exclusions). Substance use disorders may also not be appropriate, if a patient is assessed as needing a higher level of care, or providers with additional resources than we can provide. 

Information on Rittenhouse Psychiatric Associates (and the Psychiatrists, Psychiatric Nurse Practitioners and Psychotherapists that Dr. Pagnani works with) can be found at www.RittenhousePA.com.