Frequently Asked Questions

What kind of a practice is this?

At this time our practice does not contract with any insurance companies or third-party payers. Instead, we work for you! You can become the member of the practice, when you schedule your initial consultation or later. The membership includes: 

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- In-office and, when appropriate, remote appointments via video or phone call

- Comprehensive assessment of personal and family medical history
- Discussion of current symptoms and concerns

- Review of the currently prescribed therapies
- Development of a personalized treatment plan

- Communication between visits
- Assistance with the prior authorizations for tests and treatments ordered by us

- Adjustment of the treatment plan as needed

- Quarterly Health Assessments: a comprehensive review of health metrics and progress towards wellness goals.

- Personalized dietary recommendations and meal planning assistance.

- Access to educational materials, articles, and webinars on diabetes management, endocrine health, nutrition, and wellness. Members-only workshops on topics like stress management, exercise techniques, or healthy cooking classes.

- No copays, no surprise bills, no facility fees

- No referrals needed

- Treatment summaries for your entire care team

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What is the cost of membership?

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To receive weight loss services only, the membership cost is $99/month ($3.30/day) until cancelled. The current cost of the Diabetes or Endocrine Care membership is $150 a month ($5/day) with a one-time $150 setup fee. The setup and first month fee include the initial in-office consultation AND one follow-up visit, if needed,  within the first 30 days to review the test results and determine the further plan of care. The cost of the membership is a subject to change with the advanced notice to the current members. The membership can be cancelled at any time without penalty or cancellation fee. No refund is available upon cancellation, but the access to all member services remains active for 30 days from the last payment date. 

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Can I make an appointment without purchasing membership?

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Yes, if you require only episodic care, we offer an unrushed new patient consultation lasting up to 60 minutes AND one follow-up visit within the next 30 days to discuss the test results for a total price of $350. If later on, you wish to schedule a follow-up visit to discuss the same issue, the current price is $175 per follow-up visit. The follow-up visit can be conducted in-person or remotely, if there was at least one in-person office encounter within the previous 12 months.     

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Will my insurance company reimburse me or apply the amount of my payment toward my deductible?

 

Please contact your insurance company to find out whether your plan includes an “out of network” option. At the end of your visit, we will provide the patient with a billing claim that includes the procedure and diagnosis codes reflecting your care. The patient can submit this claim for reimbursement as for the “out of network” office visit. However, we cannot provide any assurances whether this claim will be reimbursed, in part or in full, by the insurance company. We are unable to contact or negotiate with the health plans on patient's behalf. All correspondence with the insurance company is entirely the responsibility of the patient. Third-party solutions, like a company called Reimbursify, makes this process extremely easy. 

What if my insurance plan doesn’t allow “out of network” visits?

The patients will need to decide whether they want to pay “out of pocket” for services knowing they will not be reimbursed by their insurance companies or that the amount paid will not be applied to their deductible (for those with high deductible plans).

If my insurance plan doesn’t allow for “out of network” office visits and I choose to pay “out of pocket” for the visit, can I use my Health Savings Account to pay for this?

Generally, yes. We will be providing medical services that are typically tax deductible and may be paid from a Health Savings Account or Medical Savings Account. Check with your plan administrator or tax professional to be sure.

If my insurance plan does not have an “out of network” option and I am willing to pay “out of pocket” to be a patient in this practice, will the insurance company still cover labs or imaging studies (x-rays etc.) that my doctor orders?

Usually, yes, but we recommend checking with your insurance company to find out where you should go for labs and x-rays and to make sure they can be ordered by an “out of network” provider.

What about Medicare and Medicaid?

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If your health coverage is provided directly through Medicare (the red, white, and blue Medicare card, also known as Original Medicare), please select the "Medicare New" or "Medicare Follow-Up" visit type when requesting an appointment. We will bill Medicare directly, which typically covers 80% of the cost for eligible services. If you have secondary insurance, it may cover the remaining 20%. However, if you do not have secondary insurance or the service is not covered by Medicare, you will be responsible for any outstanding balance.

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If you are covered by a Medicare Advantage plan (offered by private insurers like UnitedHealthcare, Humana, Aetna, and others), please note that we cannot bill your insurance directly. We recommend contacting your health plan to confirm whether they offer reimbursement for out-of-network services, either partially or in full.

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Additionally, federal regulations prohibit us from entering into private contracts with patients who have Medicaid coverage. We sincerely apologize for any inconvenience this may cause and deeply appreciate your understanding. Please know that we are actively working to explore new practice models to expand access to our services in the future.

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The practice membership is not covered by Medicare. Please do not purchase it online, but feel free to discuss it during your appointment. 

Will you become my primary care provider?

No, this is a specialty practice and not a substitute for the services offered by a primary care provider. 

How do I reach a doctor after hours in the event of an urgent problem?

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In the event of an emergency, call 911. If urgent medical attention is needed, other resources include nearest hospital emergency department, Urgent Care and walk-in clinics as well as your primary care provider office. To contact the practice after hours regarding non-urgent matters, please call us, leave a voicemail or send a message via secure patient portal. 

Will the doctor treat problems over the phone?

Yes, if the doctor determines that it is appropriate to treat the problem in question without an office visit.

Will my doctor see me in the hospital?

We will be able to communicate with your emergency room or hospital doctor over the phone as needed. However, if you are admitted to the hospital, the practice will continue using a hospitalist service which provides inpatient care at each hospital in town. This has become the standard of care throughout the country. Hospitalists are board-certified specialists who only see patients in the hospital for acute care.

Will it be easier to schedule an appointment and receive adequate time at each visit to address my needs?

Yes! Our practice is designed to make scheduling appointments easier and allow more time for each patient. We look forward to providing you with exemplary personal care.

What if the practice fills to capacity but I decide to join as a new member?

We use reasonable efforts to limit the size of the practice in order to assure same-day scheduling and quality time with patients. Therefore, when the practice fills to capacity, a waiting list will be started, and as patients leave the practice, new patients can be added on a first-come, first-served basis.

Do the doctors fill out disability paperwork?

At this time we do not complete any disability paperwork.