How does the membership work?

Most people come to us after years of not feeling well. Reversing this trend doesn’t happen in a couple of visits, which is why we have designed a year-long membership with regularly scheduled appointments.  These appointments include 5 with me as physician, and 3 with a health coach. Depending on your needs, there are also options to meet with a nutritionist who can guide you through an elimination diet or specialized food plans, and a mental health specialist who can help with behavior change.  We are building a network of specialized care providers and among them is a life coach.  Should you want to work with some of these other specialties, we can provide you with an introductory meeting.  Additional meetings can be scheduled directly with them depending on your needs and goals.

Over the course of the yearlong membership, we will work on the key areas of health:  We will work on gut health and nutrition, brain and nervous system support, energy and hormones, your immune system, bone and muscle health, cardiovascular and metabolic health.  I will suggest functional medicine testing based on symptoms and lab findings.  We will treat what we find, and retest to see if we have made improvements.  You will utilize an online symptom questionnaire to track improvement.

After you have worked through the first year of your healing and wellness plan, you will have gained insight into how your body works, and how you can best support it.  However, health and disease are multi-layered, and for some of you a year is a good amount of time, and for others, it’s just the beginning.  You are welcome to continue to work with us.

Membership includes unlimited portal communication, renewals of prescriptions, and discounts on supplements.  We can offer suggestions for conventional or non-conventional specialist referrals.   As we build our network of integrative and holistic providers, we can also offer discounted prices on services.

Why do you work with a membership platform?

We find that working within a membership framework makes sense for our patients.  It typically takes 4 to 5 appointments, spread out over time to educate people on how to pay attention to their bodies, to demonstrate through experience how much food impacts their symptoms, and to upgrade nutrition and energy through the judicious use of supplements, botanical and other forms of therapies.  Every patient has an individualized plan that is the result of a collaborative process between the patient and the doctor and other team members, and this process doesn’t happen readily in a few visits, but rather happens over time.  Recommendations are also followed by testing for hormone levels for example, and those require careful attention until the ranges are optimized.  We have found that patients enjoy knowing they truly have a partner to work with on their healthcare goals and appreciate knowing they don’t have to worry about getting lost from one visit to the next.  The annual membership fee is broken down into monthly payments.  This is an important part of keeping the patients committed to their own healing process.  Healing takes time, commitment, and support.  Being a member of a supportive community is foundational.

Do I have to do labs prior to my Foundational Assessment?

Yes, you will need to schedule and complete your labs prior to scheduling your Foundational Assessment.  These must be early morning, fasting blood tests.

What if I already had labs done this year?

We are happy to review any labs completed within the three months prior to your Foundational Assessment appointment.  Anything older than 90 days may not be directly relevant to what we are looking for in this first appointment. 

Does the Foundational Assessment or the PFM Membership include any lab tests in the fee?

The fees paid to PFM do not include any lab tests nor any supplements. In some instances, there may be coverage  under a Health Savings Account, but this is dependent on the administrator of your particular HSA.

We will always discuss the costs of suggested tests in advance and wherever possible, offer options for tests, spreading them out over time, etc.  The kinds of information that we can find out through advanced testing is both relevant and frequently helpful for getting to the underlying reason for many conditions, however, it is not inexpensive.

Do you take insurance?

As a medical practice, we do not accept health insurance for our provider fees.  Thus, as a medical practice, we are considered an “out-of-network” provider.  Some private insurance companies may offer out of network benefits and in this case, it is possible that the initial fee for the Foundational Assessment may be partially covered.  This initial visit may be covered in part by a Health Savings Account (HSA), however this is highly dependent on the administrator of your particular HSA.  We can certainly provide you with a superbill, relevant ICD 10 codes and CPT codes for this initial visit.

Are your lab tests covered by insurance?

Most private insurance companies will cover lab tests when ordered from Quest or LabCorp.  We will provide a lab requisition (prescription) with appropriate ICD 10 diagnostic codes pertaining to your medical conditions.  However, in some cases a patient may not have any ICD 10 codes to apply to the labs we order, or some of the labs we order may be considered “preventative” or “experimental” and thus may not be covered by your insurance plan.  In all cases, we strive to give you this information in advance but the reality is insurance is complicated and we can’t guarantee what will or won’t be covered in advance.

 What if I don’t have any health insurance?

Labs can be expensive without insurance, however, if you tell us in advance, we can negotiate cash prices with a certain lab companies.  These prices are generally less expensive than the price that would be billed to insurance.  If a test is ordered purely as a preventive or wellness tool, in most cases insurance won’t pay for it anyway.

Are you my primary care physician?

While Dr. Pantelick is trained as an internist/primary care physician, this practice is NOT a Primary Care Practice.  This is a consultative specialty practice focused on complex chronic conditions, wellness, and whole-person health.  A requirement of being a patient here is that you have a primary care physician who can manage situations where you might need an urgent care visit for an acute illness.  It is also important to have a primary care physician for yearly physicals, wellness visits and for after-hours or urgent care purposes.

Do you take Medicare or Medicaid?

No, we do not take either Medicare or Medicaid.  If you are a Medicare patient, you will need to sign a “private contract” with PFM which states you are aware that our physician services are NOT reimbursable my Medicare.  However, Medicare has distinctly given us authorization to utilize any Medicare (not Medicaid) plan for routine blood work and medically necessary studies and therapies.

That said, many of the tests we will suggest doing to get to the ‘root cause’ of your chronic conditions such as stool testing for gut microbiome health, or food sensitivity testing for chronic inflammatory states will not be covered by any insurance.  This is because prevention, wellness, disease reversal and anti-aging medicine are not considered “necessary” by the medical insurance industry.  Exceptions include studies and tests that are conventionally considered preventative such as mammograms, pap smears, colonoscopies, etc.

If you don’t take Medicare, can you prescribe laboratory blood work, imaging and medications that I usually have paid for by Medicare?

Yes, Medicare acknowledges that though we as a medical practice do not accept Medicare insurance payments for our physician services, we can prescribe medications, lab work, imaging and other studies, as well as refer patients to specialists as necessary and if medically appropriate.  These referrals won’t be rejected for payment by Medicare purely because we are out of network.  They do have to be considered, by Medicare standards to be medically necessary however.