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Office Hours:
Office hours are 9:00 to 4:00 Monday through Wednesday -  Closed weekends and holidays.

The office phones are forwarded to my voice-mail after hours. If an emergency exists, then do not waste precious time with trying to reach your personal out-patient specialist physician, but go directly to the nearest Emergency Facility or call 911, your doctor can be contacted by the ER physician.

Patients are seen by appointment only. Referrals are required at the time of appointment or before. Co-payments are also due at the time of the appointment. We try to see all patients on time, and we ask that you extend the same courtesy to us. 48 hours cancellation notice is required.

Insurance Information:

The Doctor is a participating provider in many of the HMO's and PPO's in the area. If your plan requires a co-pay for office visits, we do ask that you pay it at the time of each visit. If your plan requires referrals for visits to specialists, it is your responsibility to obtain the referral from your primary care physician well in advance of the visit. We ask you to call our office 3 days prior to your appointment to confirm that we have your referral in place to cover the visit.
If you have an indemnity insurance plan, we will submit claims directly to your insurance company as a courtesy to you. Please be aware that the bill is ultimately your responsibility, and that if there is a problem with the insurance company we will expect you to pay the bill and deal with the company yourself. We will only bill you directly if the insurer has not paid us within 45 days. We do ask that you pay us at the time of the visit if you know that you have not met your insurance deductible.


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Third party free / cash pay - (if "allowed" by your insurance plan! - Medicare does NOT allow it!) also accepted and provides much added privacy and control of your own health care.


FAQs:
In order to be compliant with a National Quality of Care initiative, we have developed written answers to many of the common issues. These are available here and in the office. 

 


Office policies

the office hours are by appointment only.

Q: What are your office hours?
A: Office hours vary depending on the individual doctor's schedule. Office hours are (were) generally 9:00 to 4:00 Monday through Wednesday. Closed on weekends and Holidays, including Federal Holidays.

Q: How do you provide transparency?
A: Our office policies and procedures are provided on the internet and in the office. We have a written refill policy, telephone policy, etc.

 


Telephone and Email Message Questions


 we strive to return telephone calls in a timely manner.

Q: Is there a backup physician at all times?
A: Yes. Even if the office is closed, there is a physician available for urgent issues 24 hours per day, 7 days per week. The message is delivered to my voice-mail which I retrieve regularly. But remember, If a time sensitive emergency exists, then do not waste precious time with trying to reach your personal out-patient specialist physician, but go directly to the nearest Emergency Facility or call 911, your doctor can be contacted by the ER physician.

Q: Do I need to leave a voice message?
A: Yes. Being a small business instead of a huge corporation, we have a very small staff or none some days. We are not always able to answer the phone because we may be busy helping others. To solve this problem, we ask you to leave a detailed but brief message if you happen to get transferred to voice-mail. We check messages several times daily, and we can research your issue so that when we return your call, we will already have the information you need.

Q: Why didn't I get a return call?
A: We strive to return all calls rapidly. Please remember that we may be closed on Fridays, so messages left on Thursday afternoon typically may not be received until the next Monday. Occasionally, we find we are NOT able to return your telephone call. The most common reasons are listed here:

The #1 reason for no reply call is that patients do NOT leave their full name and phone number in the message. "Hey, it's Bob, give me a call!" We wouldn't know who to call in reply.

Other reasons include failure to leave a telephone number clearly, or waiting until the very end of the message and saying the telephone number too fast to understand,

Poor cellular reception from the caller so that we cannot understand the message,

Speaking so quickly that the message is not understandable,

Giving us the wrong telephone number,

Not having an answering machine/system and not answering the phone when we do call back.

We strongly recommend that you remove any caller ID blocking so that we have your telephone number; this will help us return your call in case the message itself is garbled. You can add our office to your phonebook as *82-then the number (for most phone companies); that will provide your number on our caller ID device.

Q: When do you return calls?
A: Please remember that we have one person who answers all messages and makes all telephone calls. We strive to return urgent calls as soon as possible. We try to return routine, non-urgent calls within 24 hours. Sometimes it takes a day or two to return non-urgent calls, especially at the beginning of the week because we have messages from the weekend to review.

Because we are closed on Fridays, telephone messages left on Thursday afternoon, Friday, Saturday and Sunday are not always reviewed until Monday. That means that on Monday, we have messages from late Thursday, all day Friday, Saturday, Sunday and early Monday to review BEFORE we begin returning telephone calls.

Q: What about caller ID and call blocking?
A: When returning calls from the office, we do not always provide a caller ID as we may call from a sensitive number. If you have blocking it can be a hindrance to getting a call back in a timely fashion.

Especially, in urgent cases, after hours, an urgent message may be returned via cell phone or home phone. In those cases, we cannot give out our private telephone numbers. If you do NOT accept calls with a blocked caller ID, then you will not be able to receive our return calls until the next time the office re-opens for regular business.

Q: Do you respond to emails?
A: Yes and No. Unfortunately, we no longer accept emails for all issues. Because we provided our email address to the public, either scammers or automated programs took our email addresses and signed us up for hundreds of inappropriate and junk emails. We no longer are able to accept open email because we simply are unable to determine which emails are legitimate and which are risky. However, email is utilized with the scheduling system online if utilized, and some limited communications via email are possible.

 

 


Prescriptions and refill issues


 we typically provide enough medication to last until the next scheduled office visit. Therefore, refills are NOT necessary, and there are NO REFILLS AFTER HOURS OR ON WEEKENDS, and NO NEW TREATMENT INITIATED ON THE PHONE.

As you may know, the Federal Government is taking steps to reduce the potential for medical errors. One of the major initiatives is electronic prescribing. This office will be using (in the near future) electronic prescribing for ALL medications that do not require a special type of tamper-resistant paper. Therefore, your prescriptions are sent directly to the pharmacy of your choice with the appropriate quantity and number of refills to last until your next appointment.

Q: Do you telephone or fax refills?
A: In all cases, we strive to provide enough refills to last until the next appointment and refill requests are not necessary. And as a matter of safety and quality of care, no prescriptions are refilled after hours or on weekends, and no new treatment is initiated on the phone.  If it is a matter of urgency, such as seizure medication, then pharmacies are obligated to give a 24-48 hour refill based on the last prescription to avoid medical deterioration, until the patient can be seen by their doctor.

Q: But what if I need something for (place new symptom here), and it's after hours?                                                          A: As mentioned above, we can NOT initiate any new treatment over the phone, as it would be medically ill advised and unethical to treat a new symptom without a thorough evaluation and physical examination. Also ''prescribing without a good faith exam" is a Federal and State ethical guideline restriction of prescribing that reinforces this safety and quality issue. If a new symptom arises, you can request an urgent visit and will be accommodated to the best of our ability. You also have the option of consulting your primary care physician, as we are a consulting specialty and not primary care. 

Q: The pharmacy says they need your authorization for the next refill.
A: Because we provide enough refills to last until the next scheduled office visit, the pharmacy should not require our authorization. Sometimes, the pharmacy does not include the refills on the prescription. Before leaving the pharmacy, you should verify that the appropriate number of refills is shown on the bottle. In terms of authorization, if we provided the prescription, we obviously have also authorized you to receive it.

Q: What about exceptions?
A: If there is an exception and you require a refill prior to the next scheduled appointment, please let us know directly. Please do not simply rely on the pharmacy to fax us.

Q: The pharmacy says you didn't reply to the fax. Why?
A: Again, we provide refills to last until the next appointment and therefore, the pharmacy does not need our permission to refill your medication. However, some major pharmacies have an automatic fax system that generates a fax request after a prescription is due to run out, EVEN IF a patient DID NOT call the pharmacy, EVEN when there are refills remaining. Therefore, we receive dozens of faxed requests daily for our patients and also for other doctors whose names are similar! If you require assistance with your prescription, please let us know directly. Again to re-iterate clearly:

We will ignore all auto-generated pharmacy refill requests due to errors and potential errors of this practice. If you need a refill for some unforeseen reason - call us directly - NOT the pharmacy.

Q: The insurance company says they need your authorization for the prescription.
A: If we provided a prescription, then we obviously authorized the prescription. What this really means is that the insurance company does not pay for the prescription and they will be requesting more information. With the additional information, the insurance company will decide, based on your written contract with them, whether they will pay for the prescription.

Q: Can you make an insurance company cover my meds?
A: No. We can provide the information requested to your insurance company. Hopefully that will work. However, in neurology and especially in pain management, many medications are used off label. Your specific financial contract with your insurance company may have an exclusion for off-label medications. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

 

 


Insurance issues

please remember that insurance billing is a courtesy to the patient. We are not a party to the financial contract you have between yourself and your insurance company and, although we will try to help, we cannot guarantee coverage for treatments or medications.

Q: What insurance plans do you accept?
A: We try to accept as many insurance plans as possible. Please contact the billing office, because insurance contracts can change very quickly.

Q: Why won't my insurance cover the medication?
A: Many of the medications are off-label. That means that they are being used for a purpose other than what they were originally invented for (a good example is using aspirin for heart attack when it was originally invented for fever). Although ethical, legal and the standard of care, most insurance plans do NOT cover such medication use.

Q: The insurance company says you need to authorize the treatment.
A: If we planned the treatment, then we obviously authorized the treatment. What this really means is that the insurance company does not cover the treatment and they will be requesting more information. We are happy to provide the information. Your specific financial contract with your insurance company may have an exclusion for certain treatments. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

Q: The insurance company says you need to authorize the medications.
A: If we provided a prescription, then we obviously authorized the prescription. What this really means is that the insurance company does not cover the prescription and they will be requesting more information. We are happy to provide the information. Your specific financial contract with your insurance company may have an exclusion for certain medications. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

 


Controlled substances


We Do Not Prescribe Narcotic Medications, NOR AMPHETAMINES / STIMULANTS 
as a matter of Course. This is elaborated on below and linked to articles in the education section. You also may wish to refer to the New Patient Questionnaire, which includes many of the risks of controlled substance use.

As an alternative I do support the use of Medical Marijuana - as there is good evidence of it's utility in certain conditions. See AAN guidelines on CAM for MS.

Q: Will I become an addict?
A: Addiction has genetic, social and environmental components. A person who does not have the propensity for addiction is less likely to become addicted to pain medications; however, there is no guarantee.
The risk is related to a family or personal history of addiction to drugs or alcohol and even tobacco. Some signs of addiction include increasing the dose on your own, seeing multiple prescribing physicians, running out of medication early and getting extra medication from friends and family. If you feel that you may have become addicted, you will need treatment for that medical condition; and will be appropriately referred.

Q: Is it true that pain medication can cause pain, or make it worse, and last persistently where otherwise it would have gone away?
A: Yes indeed, it is called opioid induced hyperalgesia (see education section for references). It tends to occur at higher doses and protracted frequent use, but is now being seen to occur in people using pain medications as infrequently as 8 times a month. This is being written about in the medical literature very often of late, and is a topic of much discussion. In fact many doctors no longer prescribe narcotics for non-malignant pain, as the latest literature review proved there to be "scanty" or no evidence for it's use in chronic non-malignant pain. We are one of them. The latest reports are quite convincing that pain medications, narcotics especially, can indeed make pain persist and get worse, and thus a thorough work-up for treatable causes, and a conservative multi-modal approach to pain is the best option.

Q: So, you do not prescribe narcotics?                  

A: There are of course certain malignant conditions, such as cancer, where narcotics are the only humane option - and a specialized narcotic based pain treatment program would be in order, such as implantable morphine pumps etc.,  and the appropriate referral would be made. We would do all we could from a non-narcotic perspective, and remain part of the treatment team, and will assist with evaluation for risk and trials of intrathecal morphine for cancer pain if requested. But we are not equipped in this office to run a narcotic based pain treatment program.


Driving and machinery

one of the most common questions involves the issue of driving a vehicle.

Q: Can I drive (or operate machinery, etc)?
A: We don't know. Many neurological conditions and their treatments affect the ability to drive. Conditions such as Alzheimers, Parkinsons, epilepsy, pain, arthritis or headache can impair the ability to operate a vehicle or operate machinery. Therefore the medical condition alone could prevent a patient from driving safely. Certainly, medications can impair the ability to drive or operate machinery. Many medications cause sedation or decrease reaction time. We see you for a very brief time of your life (just a few minutes per month). In that time, although we assess fatigue and tiredness, we cannot obtain enough information to make conclusions about your function outside the office. You must assume responsibility for your own behavior: patients are instructed not to drive or operate any vehicle or machinery if there is any impairment whatever, whether related to the underlying disorder or to the medication intended to treat the underlying disorder. If in doubt, do NOT drive.

You should NOT DRIVE if you have disorders that cause:

  • lack of consciousness (seizure, for example)
  • lack of rapid thinking/reaction (Alzheimer's, for example)
  • certain visual issues (loss of half of vision, for example)
  • any condition or treatment that impairs concentration
  • these are just a few of the possible conditions

 

 
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