Frequently Asked Questions

Do you offer same day appointments?
Do you provide urgent care?
Why can’t I renew my prescription over the phone?
What insurance do you accept?
Do you take self-pay patients?
What if I need a referral?
Why should I have an Annual Health Exam?
Why do I sometimes have to wait for my appointment?
Why are some visits more expensive than others?
What is insurance ‘coding’?

Why do some medications require prior authorization?
I only saw the doctor for ten minutes. Why did I still have to pay my co-pay?
Which labs require fasting?
What is fasting?

Do you offer same day appointments?
Yes! There are always a certain number of same day appointments available. Just give us a call.

Do you provide urgent care?
Yes! You can read about our urgent care services here. (link) Call us now and we’ll fit you in.

Why can’t I renew my prescription over the phone?
Prescription drugs are not available over the counter for a reason—they are dangerous.

Prescription drugs must therefore be monitored at regular intervals:

  • to make sure they are having the desired effect
  • to make sure they are still necessary
  • to make sure they are prescribed at the right dose and frequency
  • to make sure they are not having dangerous side effects.

We therefore do not renew prescriptions over the telephone. If you need a refill on your medication, you may book an appointment.

What insurance do you accept?
We accept all insurance except any Medicaid product, and we are not currently accepting new Medicare patients.

Do you take self-pay patients?
We sure do. Click here to read about our self-pay options.

What if I need referral?
We are able to refer to all forms of specialists as needed. You will first need to book an appointment where you will be evaluated in order for the most appropriate referral to be made, whether for further testing or consultation with a specialist.

Why should I have an Annual Health Exam?
The Annual Health Exam is a key part of having a medical home. Click here to read more.

Why do I sometimes have to wait? How come the doctor isn’t always on time?
We do our best to keep on schedule, and we sincerely apologize for any wait you experience. The best explanation we’ve seen as to why good doctors run late is from Kevinmd, an online medical blog:

As a patient, it is critical for you to understand why your doc is never on time.  Here’s my typical day.  I get up at 5:30am to get to the hospital at 6:30am.  If all goes well and my patients don’t have any medical crisis, I get to the office on time.  On a bad day, Mr. “MI” decides to drop his blood pressure, stop breathing and “code”.  I can’t tell Mr. “MI” that he’s not scheduled for a “code” situation; I have to do what I have to do.

I’m lucky, Mr. MI recovers quickly and I get to the office only 15 minutes late.  However, I’m behind schedule.  For the sake of this article, assume I make appointments like most docs.  I walk into Mrs. Ulcer’s room 15 minutes late.  I apologize.  Mrs. Ulcer is scheduled for a 15 minute appointment for stomach pain.  She is 42 years old and has been having intermittent stomach pain for 3 months.  When she scheduled the appointment, she told my staff she thinks she has an ulcer.  At 2 am, she developed a fever (103 degrees) and severe pain.

Mrs. Ulcer does not have an ulcer.  She has an infected gallbladder.  Mrs. Ulcer needs surgery.  She is alone in the office and can’t drive to the hospital.  I call the paramedics, the ER, and the surgeon.  I’m now an hour behind.

I apologize to the next 4 patients for being late.  They are relatively easy and I’m now 1 hour and 15 minutes late.  I walk into Mr. Aged’s room.  He has a 15 minute appointment to follow up on his diabetes.  Mr. Aged is sitting with Mrs. Aged; she appears concerned.  There is a faint smell of urine in the room.  Mrs. Aged says, “His blood sugars have been high over the last 2 weeks.  He’s more forgetful than usual, stumbling a lot and dropping things.”  Mr. Aged’s 15 minute appointment takes 45 minutes.  Mr. Aged is on his way to the hospital.  He’s had a stroke.

I’m 2 1/2 hours behind, I have to go to the bathroom, my patients are mad, and they are taking it out on my staff.  I value their time, but I value their health more.

Your doc cannot be on time and take care of your needs.  Your doc cannot tell Mr. MI to schedule his “code.”  He cannot tell Mrs. Ulcer to come back in the morning as her appointment time had expired.  Mr. Aged needs lots of attention, now!

Deciding how much time to allot for an appointment is like divining what the weather is going to be like next Monday.  Either your doc gives you the time you need and is perpetually late, or your doc cuts your appointment short and moves on.  If timeliness is of essence, then chose a doc who is in and out on time; and don’t expect him/her to meet your medical needs.  If your medical needs are important, then don’t expect an on-time appointment.

You can help us stay on schedule by specific and thorough about your medical needs when you book your appointment.

Why are some visits more expensive than others? What is insurance ‘coding’?
This is a great question, and a great answer to it comes from KevinMD.com:

Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes. So it is natural that patients have a hard time understanding it as well.

Therefore, I decided to summarize a conversation I had with a patient in an effort to help other patients understand, at the very least, a portion of how medical health insurance works.

At a restaurant, generally you’ll get an itemized check that shows all the things you’ve ordered. Doctors do the same thing, but they do it in the medical chart.

Virtually every doctor who accepts health insurance uses codes called CPT codes that are assigned to every task they and their staff performs. Everything from a simple blood draw, to immunizations, to the ear check, to specimen handling — all these services are “coded” separately.

These codes are used by the patient’s health insurance company to determine the payment amount that the doctor will receive for his or her services. In other words, the health insurance company (the one actually paying for the services) wants to see what was done during a patient’s appointment. Hence, everything the doctor and the staff does has a code.

For example, if you are coming in for a child’s well visit, the pediatrician will submit a “claim” to the insurance company using the following codes:

Established Well Visit – 99392
Developmental Testing – 96110
Hemoglobin – 85018
Finger/heel/ear stick – 36416
Lead Testing -83655
Hearing Screen – 92587

If the child gets immunizations, the vials have codes too.

DTAP-IPV – 90696
Flu – 90660

Vaccine administration also uses a distinct set of codes.

Admin – 90460
Admin – 90461

Let’s say while you are in the examining room with your child and you ask the doctor, “Ya know doc, little Lisa has been pulling on her ear lately… she may have an ear infection. Can you check that for me really quick?”

This question requires the doc to perform an entirely different assessment than the well visit the child was getting.

The doctor, in order to show the insurance company that she did a completely different assessment, codes the ear pain diagnosis and adds a 99213 – which is an evaluation and management code that documents in the chart and on the claim to the insurance company that the doctor also checked the patient’s ear.

Parents often think when they are looking at the bill that the doctor is nickel-and-diming parents, when in reality, it is the insurance company that requires the doc to show their work in this matter.

The health insurance company doesn’t accept the doctor telling them, “I did a well visit — pay me our agreed-upon fee.” They want to know all the things the doctor did during a patient’s visit so they can decide how much they ought to pay the doctor for his/her services.

Since most patients don’t pay the doctors directly, but rather the health insurance company, they want to know what took place during the visit so they know how much they ought to pay the doctor.

It is the same as going to the restaurant and getting billed for all the side and extra orders. Although the main meal is accompanied by other things, like french fries or a salad, refills, side orders, substitutions and additions to the order are billed as extra.

Why do some medications require prior authorization?
We agree that prior authorizations are often a huge and unnecessary hassle. This article from KevinMD puts it very well:

Welcome to my day from hell.  It is 2 p.m. and I’ve just logged my fifth prior authorization denial of the day.  In simpler terms, five patients will either change their medications or pay for them out of pocket.  Personally, I’m sick of this crap.

When it comes to prescribing medication, I am very judicious in my prescribing habits.  According to one of the largest insurers, my percent of generic prescriptions is higher than the national average.  I carefully weigh the benefits of one medication over another and prescribe what is right for the individual I am treating.  I discuss the medication choice with my patient.  My patient then goes to the pharmacy where the information is recorded and transmitted to the patient’s insurer.  Since the first of the year, insurers have been aggressively denying care.  You would think they were losing money.

Instead, insurers’ rates are rising, their profits are rising, and patients are being told they must fail on cheaper alternatives.  Yes, you must fail before you can succeed (assuming your failure does not kill you).

Patient #1 must stop taking the medication that is controlling his neurogenic pain.  Pain produced by a malfunctioning nerve can be extremely severe.  Patient #1 must go on an older version of his current medication.  In its day, gabapentin was a good medication.  Unfortunately, doses capable of relieving significant pain made people groggy.  Patient #1 can save money and be groggy, suffer with pain, or pay out of pocket.  I assume the insurer is betting that Patient #1 can’t afford to be groggy (he is employed and has a life to live) and will pay out of pocket rather than suffer in pain!

Patient #2 has a truly horrible history of heart disease.  His cholesterol profile is just as horrible.  He is on a high dose statin (for the control of HDL and LDL) and still has markedly elevated triglycerides (another dangerous fat in his blood stream).  He has taken over-the-counter fish oil to no avail.  His insurer denied my request for Lovaza, an FDA approved medication for the treatment of his disorder.  In this case, there is no generic nor similar medication.  There are other generic medications that treat high triglycerides, but they all have the potential to adversely interact with his statin.  Patient #2 can either pay out of pocket for his Lovasa or risk a ride in an ambulance or hearse.

I won’t bore you with the particulars of patient #3, 4, and 5.  They all get the pleasure of attempting to fail or spending hard earned cash on both insurance premiums and medications.  Every year this situation gets worse.  Insurers grow stronger, seeking ever increasing profits at everyone’s expense.

As your doctor, I can only do so much.  My staff fills out seemingly endless forms, only to get denials.  As a patient, you have multiple recourses.  Most patients fear insurers and will not challenge them.  They simply pay up. Others go to their HR department and fight.  Those who are self insured should contact their agents or brokers and fight for the right not to fail.  Brokers make their living selling insurance and, when their livelihood is challenged, can accomplish what doctors and patients cannot.

Until the public demands value for their money, insurers will continue their plunder.  Take control of your health.  Do everything you can to maintain your body.  It’s yours for a lifetime.  The healthier you are, the less you will need insurers and medications.

I only saw the doctor for ten minutes. Why did I still have to pay my co-pay?
You may not have been in the office very long, but a lot of people were involved in making that visit happen. If you think your visit was expensive, please read the following excerpt from KevinMD.com carefully:

I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation.  If you haven’t worked your check-in and check-out desks recently, I highly recommend it.

An insured patient that I checked out was shocked when I said the charge for her visit was $100.  She said, “But he was only in the room for ten minutes!”  I was briefly at a loss for words.  I recovered, we agreed on a payment plan, I made a note on her encounter form for the billing office and she left.

I’ve been thinking about our conversation, and thinking about what that $100 is supposed to cover…

  1. First, we scheduled the appointment, which was a work-in, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
  2. When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID for red flags.  An encounter form was generated at the nurse’s station to notify her of the patient’s arrival.
  3. The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief chief complaint, review the medications she is taking and check to see if she needed any chronic medication refills while she was there.
  4. The physician came in to see her, asked about any changes since she’d last been seen, reviewed her history of present illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.
  5. He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.
  6. He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.
  7. He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled.  The chart was filed, and the encounter form was sent to the billing office.
  8. At the billing office the charges and any payment was posted and the claim was filed.  If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.
  9. If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.
  10. Since the patient did not pay at the check-out desk, the patient-responsible balance is billed to the patient.  If the patient pays on the first statement, it has taken 45 to 60 days to receive complete payment.  Since the patient has BCBS, there is a negotiated rate, so the payment will not even total $100.

I know that patients often say “But he only spent 10 minutes with me.”  Checking back with the provider, I find it was typically longer.  Patients tend to underestimate the time as it goes very fast.

The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller.  It took 8 people, and at least 45 minutes of work to make that appointment happen.  Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable. It’s what we all want. And it ain’t cheap.

Which labs require fasting? 
Blood sugar (glucose) and lipid/cholesterol require fasting.

What is fasting? 
Fasting means you cannot have anything to eat or drink for the 12 hours before the lab is drawn EXCEPT water and black coffee (NO CREAM OR SUGAR).