Established Patient Information 2016

DETAILS ABOUT OFFICE VISITS – ESTABLISHED PATIENTS

 

Follow-up Office Visits

The first follow-up office visit is typically scheduled about 4 to 5 weeks after the initial visit to allow time for all laboratory testing to be performed and lab findings to be received.  This timeframe also enables the patient to undergo some initial treatments and be able to report their effects in the first follow-up office visit.  During this visit, we will review your response to our initial treatments as well as all laboratory test results in order to fine-tune your treatment plan.  This is a more extensive visit which requires more time than a standard follow-up visit.  The charge for this extended office visit is $500.  Patients who have not been seen for more than a year will be required to schedule the Extended Follow-Up Visit. 

 

The next follow-up visit is approximately 4-5 weeks later which over time may be able to be reduced in frequency but for most patients who are undergoing more complex treatment plans, visits will be required on a monthly basis. Our goal is to get patients to a point of stability as quickly as feasible then develop a simplified maintenance program that they can easily follow. The charge for standard follow-up office visits is $362. 

 

A substantial percentage of our patients have multi-system illness, are more debilitated and require extensive therapies for stabilization and symptom management.  Many are receiving relatively poor care from their primary care physicians, often bouncing from one doctor to another having their treatment very compartmentalized.  Therapies provided are generally only for symptom management with no real effort being made to find the underlying cause.  As a result, we are often the last place where many come when nothing else has worked so we have an obligation to provide a level of care and service that they have never received. Providing this higher level of service creates significant challenges for our office and staff but it comes down to the fact that these complex patients need much more time in our encounters in order to cover the multiple issues often present. 

 

What are you getting for your investment? 

  1. A well-educated, dedicated and elite team of health care professionals who fully understand the nature of our patient’s conditions and have the education and experience to address complex problems. 
  2. Our attitude that “The Buck Stops Here” in terms of being willing and able to take on complex patients, many whom have been tossed back and forth between various specialists.  Our goal is to get to the bottom of the problem and provide meaningful treatments that lead to progress. 
  3. The most cutting edge new concepts from the functional medicine and chronic disease community. 

How to get the most for your money and be able to reduce frequency of office visits:

  1. Come prepared:
    1. Bring a list of all supplements and medications along with their doses.  Also bring the actual bottles with the supplements and medications in case we need to understand ingredients or strengths better. 
    2. Complete your follow-up visit form and questionnaire in advance. 
    3. Keep a journal, diary or calendar so you know exactly what is happening week by week between your office visits.  Being able to quickly provide useful information about your progress will allow you to get more out of your time with the provider. 
  2. Be punctual:
    1. Be aware that you are being charged for your appointment slot so if you are late, you will have less time to spend with your provider.   Your appointment time will not be extended as there are other patients scheduled after you.  You will still be charged for a full office visit. 
    2. Arrive at least 15 minutes prior to your scheduled appointment time so all forms can be completed and nothing will delay your start. 
    3. For telephone visits, be sure your telephone is turned on, the sound is turned up and you have it available to answer when we call. 
  3. Please be conscious of what you want to do with your time in the office visit:
    1. We are specialists and should spend our time figuring out how to use our special knowledge and therapies to help you.  Asking us to handle tasks that a non-specialist could take care of us costs you much more money than asking your primary care physician to do these things. 
    2. The more things you can get your primary care physician to do such as maintaining routine prescriptions, handling urgent issues unrelated to your care from our practice, and keeping up with screening tests like bone density scans and others will all reduce the need for our staff to handle such things, saving you time and money. 
    3. While we are willing to assist with disability paperwork, be aware that any forms completed must be done during an office visit and will take away from your office visit time.  These forms are best completed by your primary care physician – this will save you money. 
  4. Help us make your appointment as efficient and effective as possible
    1. Let us guide the office visit so that we can get the most important information about your progress that we need to know in order to assess your response to treatment.  You will have plenty of time to ask additional questions but most patients realize that we cover all their issues by following our process. 
    2. Try to avoid repeating your history from the beginning each time we meet.  Our goal in each visit is to document the details of your illness and how you have responded to treatment since the previous office visit.  We know your history unless something was left out. 
    3. Have your questions written down in advance but hold them until toward the end as we often will answer them in the course of the visit. 
  5. Know your treatment plan:
    1. Take notes in your office visit, ideally having your support buddy with you to do the same. 
    2. You will be given you Assessment and Plan – study this repeatedly.  Rewrite the plan expanding on what you are given adding in the information from your notes so you have more details that you can review on a daily basis.
    3. Make sure your appointments are scheduled as recommended in your Treatment Plan. 
    4. Keep a diary of your treatment and progress, bringing this to each visit so we can review everything in a chronological sequence. 
    5. Create a treatment calendar so you know exactly what you need to do each day. 
  6. Keep your appointments as recommended:
    1. Be sure to make your follow-up appointment as soon as able after your last visit as our schedule is extremely full and it is likely there will not be available slots if you wait very long. 
    2. Our most successful patients are those who follow their plans and maintain their appointments.  Cancellations will result in lack of continuity and reduced success.
    3. Often patients who cancel their appointments have gaps in their treatment plan and relapse having to start over, costing more money and time. 

              Once stable and in maintenance, we require our patients to maintain regular follow-up visits at least every six months.  We understand that many primary care physicians are only concerned about an annual check-up; thus patients often assume that is all they will need at the Carolina Center.  However, because we embrace a more proactive and preventive approach to medicine, we require our patients to be seen every six months to ensure that we are staying on top of risk factors and adequately monitoring their health.

     

    Time Allowance and Staying on Time

    It is important that patients allow enough time to get everything done that is needed when they come for their office visits. Typically 15 to 30 minutes is needed prior to starting your office visit to obtain vital signs, review insurance information and demographics, and be sure all heath questionnaires have been completed and are ready to turn in.   These questionnaires are very important and we strongly recommend that patients complete these at home prior to coming in for their visit (see above).  Please arrive promptly so we can stay on schedule.    At most visits you will then be seen by one of our Medical Assistants to obtain additional information, the most important being a review of your current medications and supplements.  After this intake, you will then be seen by the Practitioner and typically every 2nd or 3rd visit will also undergo a Meridian Stress Assessment test.  Following the visit, additional time will be needed to review your plan with our Treatment Coordinator as well as purchasing any recommended products from Total Health Nutrition Center, if you choose to do so.  The last step at check-out involves paying for your office visit, scheduling your next visit and receiving Assessment and Plan.  Alternately, we may post your plan on our Portal within 24-48 hours.  Overall most patients should allow approximately 2 to 3 hours to complete all these steps depending on the type of visit.

     

    Preparation for Follow-Up Office Visits

    Your follow-up office visit time is very important and to get the most from this experience, it is crucial that each patient come prepared.  For each office visit, we request patients complete a Follow-Up Office Visit Preparation Status Form which is found on our website.  Please open this form to complete the questions which you can print to bring with you for your visit or e-mail back so we'll have it when you arrive.  In addition, we also request patients complete the Symptom Questionnaire for each office visit so that we can get an objective score of your symptoms.  This is an excellent way to track your progress.  Please open the spreadsheet and put in the numerical score for each question and it will automatically calculate the total.  You can also print this to bring in or e-mail it back to us. 

     

    Bring All Supplements and Medications to your Follow-Up Visit

    It is also very important for our medical staff to know all the medications and supplements you are taking including their strengths, frequency of dosing and how long these have been taken.  Regardless of whether these were provided by our office, please bring to each office visit all the medications and supplements you are taking.  If you have supplements you aren't taking but wonder if you should, bring those in as well so we can help you determine what to do with them.  For those patients may have completed a course of pharmaceutical medications but still have some left over, bring these in as well so we can determine if they can be used again.   

     

    Donation of Medications and Supplements

    If you have discovered you are intolerant of a medication you've been prescribed or a supplement you have purchased and you don't believe you will be able to take them again, you may donate these items to be given to those patients who are unable to obtain these due to cost or availability or even to use as a test dose to see if they can be tolerated.  Our patients have greatly appreciated this generosity in the past so we continue to try to provide this service as much as able.

     

    Meridian Stress Assessment (MSA) Testing at Follow-Up Office Visits 

    The MSA is an optional non-invasive computerized test for assessing the overall health of organs and systems, as well as factors that may be adversely affecting your health or interfering with normal functioning. During the MSA test, degrees of imbalance found in each meridian are analyzed and evaluated against various substances to identify possible allergies, infections, and toxicities. The test also helps identify effective strategies that may include a variety of treatment modalities, such as herbal and nutritional therapies, homeopathic, pharmaceuticals, and avoidance of allergic triggers.

     

    All new patients except those undergoing Group Visit will undergo MSA testing either the day of or shortly after their initial visit which helps us direct initial stabilization therapies.  At the first follow-up, the focus is on reviewing lab testing and initiating therapies based on those findings, therefore the MSA test is not performed.  Going forward, this procedure will typically be performed every 2nd or 3rd office visit.  The practitioner will determine if an MSA should be scheduled for your next visit and this will be reviewed at check-out.  If an MSA is not recommended at the next visit, patients may schedule separate MSA visits outside the office visit to test supplements.  The charge for this visit is $105.

     

    Requirements for MSA Testing

    The MSA is reading energy patterns in the body; therefore one must be well hydrated and have eaten within a few hours of the procedure.  It is important that unusual stressors have not just occurred such as a blood draw or receiving an IV treatment.  It is not possible to do an MSA when undergoing an IV therefore is you wish to do an IV or have labs drawn the day of your follow-up office visit, these will either have to be done after the MSA is complete or you will need to select a non-MSA office visit slot if you wish to get the lab or IV treatment prior to the office visit.  We require patients to bring all nutritional supplements to each office visit with this being especially important when doing the MSA.  Supplements can be tested to determine if they are appropriate for you at that time so this can be helpful in revising your regimen. 

     

    Be aware that the charge for office visits is the same whether or not an MSA is performed and no deductions or refunds will be made if the MSA isn’t performed for any reason.  If the MSA is not performed with an office visit and one wishes to undergo testing at another time, the charge is $105 for a one hour session. 

     

    MSA Availability 

    MSA’s are performed in the Raleigh and Wilmington offices but are not able to be provided in the Greenville office at this time.  For patients seen in Greenville, there may be circumstances when Dr. Pittman recommends obtaining the MSA outside the office visit in which case this can be performed in Raleigh within the subsequent four weeks at no additional charge.  This will need to be arranged at the time of the office visit with Dr. Pittman and is exclusively for patients seen in the Greenville office. 

     

    Returning Patients

    Any patient who has not been seen for a follow-up office visit in at least three years will be considered a “New Patient” and complete all the steps noted above for new patients.   

     

    Telephone Office Visits


    All initial office visits must be in person; however, subsequent visits may include consultations with Ms. Yerkes and/or Dr. Pittman over the telephone.  These are primarily done for patients who live out of town or those who have special travel restrictions or other logistical challenges.  A telephone office visit can also be substituted for an in-person visit if it has suddenly become inconvenient to come to the office.  Be aware that such visits cannot be coded as a standard face-to-face office visit but instead as a telephone consultation; therefore, most insurance companies will not reimburse for these visits.  When telephone office visits are scheduled, it is important that patients provide us with the specific telephone number they wish us to call.

     

    It is our intention to place that call at the scheduled appointment time.  Please understand, however, that we may be late due to unforeseen issues with other patients in our office.  It may even be necessary to reschedule the visit if there has been an emergency in the office and the medical staff has gotten too far behind.  Patients who have a scheduled telephone office visit should be ready to receive that call anywhere from right on time to as long as 20 or 30 minutes after the scheduled time.  If you cannot make this additional time available, then you should select another time when delays will not be a problem.  Please be ready to answer the telephone when the call is placed; otherwise, if we get voice mail or no answer, you will be subject to a “no show” fee and must reschedule the appointment at another time.

     

    While telephone office visits are acceptable from time to time, it is required that all patients be seen in person at least every third or fourth office visit although for some this requirement may be greater.  Patients who have not been seen in that time period will not be allowed to schedule additional telephone visits and must come into the office in person to remain an active patient. 

     

    In our years of operation, the Carolina Center has offered telephone office visits as a service to our long-distance patients although we found it necessary to charge a higher rate for these calls due to a variety of factors that increased the work time for our staff.  The lower rate for the in-person office visit also serves as an incentive for patients to come to the office which is always the most effective setting in which effective communication and teaching occur.  Be aware these are the rates charged when payment is made at the end of the office visit.  If payment is not made at that time, patients will be billed a higher rate.   The charge for the telephone office visit is $525 for an Extended Visit and $380 for a Standard Visit. 

     

    The first follow-up office visit is approximately four weeks after the initial visit, at which time numerous lab tests are reviewed and a comprehensive treatment plan is developed.  We strongly encourage patients to be present in-person for this visit, either in our Raleigh, Greenville, or Wilmington office, as there is a great deal of complex information to review that is harder to convey over the telephone. 

     

    Charges for all telephone consultations are due at the time of service.  Therefore, at the end of the call, the patient will be transferred to the front office to arrange for payment and to schedule the next office visit.  If payment is made at that time, a 20% cash discount will be given and the rate charged will be that which is noted above.  Telephone consultations are not covered by insurance; thus, the encounter will not be filed with insurance even if the patient has out-of-network benefits.  If payment is not made at the conclusion of the telephone call, then the patient will be billed a higher rate that does not reflect the payment at time of service discount.  Telephone office visits not paid for at the time of service will not be given the 20% discount and will be billed at a higher rate. 

     

     

    Office Visits in Greenville

     

    As a service to our many Eastern North Carolina patients, Dr. Pittman is in Greenville on Saturdays, typically every eight weeks where he does in-person office visits and IV infusions.  In most cases, the office visits are only follow-up visits, although it is sometimes possible to do New Patient visits (please ask our New Patient coordinator about this option).  This helps many patients who live toward the northern coast so that they do not need to drive all the way to Raleigh and do not have to do the higher cost telephone follow-ups.  Be aware that Dr. Pittman will not perform telephone office visits from the Greenville office as the Carolina Center simply rents a room from another health care practitioner and does not have access to their telephone system to carry out such a visit.  Patients may not substitute a telephone visit for an in-person visit in Greenville—these are only scheduled for the Raleigh office. We reserve the right, however, to change an in-person visit in Greenville to a telephone visit at the last minute if there have been cancellations resulting in a reduced number of patients that would be seen making the trip to Greenville no longer cost effective.  In this case, patients will not be responsible for the higher telephone office visit charge and will be charged as if the visit was in-person.  We realize some patients do prefer an in-person office visit and in this case if they wish to cancel the telephone visit, there will be no cancellation fee assessed as long as the in-person visit is carried out in the Raleigh location within the subsequent two to three weeks. 

     

    Also be aware that Meridian Stress Assessment testing is not available in Greenville and cannot be provided as it is in the Raleigh office.  The charge for the office visit in Greenville is still the same as it is in Raleigh however and if Dr. Pittman recommends that you receive this additional service, it will provided at no charge in the Raleigh office if performed within four weeks of that visit. 

     

    Treatment Coordinator Visits

    Treatment Coordinator Visits are not just for New Patients, but are available to all patients at any time they feel they need additional assistance in organizing and implementing their Treatment Plan.  These visits can be performed in person (preferred) or by telephone and can vary in length based on need. We strongly encourage our patients to take advantage of this service at least at their first follow-up and the next few after that, as we have found this improves the outcomes of our patients.  

       


      General Office Policies and Procedures

      Once a year, we ask our patients to review of our General Office Policies and Procedures which outlines our operational policies encompassing the full scope of issues regarding fees, office visits, insurance and many other topics pertinent to our practice. We ask all patients to sign and Acknowledgment of Policies form indicating that they have reviewed this information.

      Click this link - General Policies - read carefully, then print and save for your records.

      Once you have read the General Policies, then click this link - Acknowledgement of Policies – please read and initial each box, electronically sign and date the form at the bottom, then use your “save as” function to save the document to your computer.