Global Medicine Office Policies
Welcome to my Integrative Medicine specialty practice.
First Visit
Your first visit with me is scheduled for 55-85 mins per your request. Visits with me are priced based on time not ICD-10 codes. Although an hour with a physician seems like a long time, it goes by very quickly. An hour is barely enough time to go over your paperwork, get to know you, examine you and address potential diagnoses and treatment plans. Please come prepared, have your forms filled out in advance, and bring your list of questions with you. Understand that whatever we are unable to accomplish in this appointment we can cover in the next appointment. This time is meant to discuss you, and although your family history is important, this appointment is not about them, so let’s not waste time talking about Aunt Betsy’s indigestion. I will do my best to cover as much as we can, however, know that an hour is usually not enough especially if you have already been to many doctors. Experience has taught me that complex issues require time. The first visit is usually scheduled as a New Patient Consult to discuss your issues. However if you would like a physical/wellness exam, please let us know, as you may need special documentation when you submit your superbill to your insurance company. A physical is merely a Routine Wellness Exam. It is meant to address prevention not illness.
During the visit, we will review your forms and paperwork together. I will ask you many questions. Understand that I am a consultant and your honesty and candor will provide the most insight into your health or disease. I will examine you and discuss treatment options regarding your concerns. You may wish to take notes or bring a family member or friend with you. At the end of your appointment you will receive written "Healing Recommendations." These entail the lab work I recommend, educational information and some treatments and homework. My assistant will review this sheet with you to reiterate and clarify any suggestions after our visit. Occasionally, I am able to extend the appointment at the end of the morning or day, but please understand you will be charged for overages.
Second Visit
Your first follow-up visit with me will last 55-85 minutes depending on what you schedule. During that time we will review the Healing Recommendations from the last visit, including the assignments you have completed. We will review lab work that you have done and we have received in the timespan available to us. We will discuss treatment options in addition to answering questions. Anything that cannot be covered in the allotted appointment time will be discussed at the next visit. If you have any forms you need me to fill out immediately on your behalf based on your lab results, please present these at the beginning of your appointment so that we have time to fill them out during your appointment, otherwise they will be saved for your next visit. Direct any FMLA, Disability or DMV forms to your PCP.
Follow-up Appointments
You determine the amount of time you wish to book with me. However, routinely we anticipate 25-30 minutes for subsequent visits. Acute appointments are 15-30 minutes. Please come prepared with questions, lab work, other records, etc. This is your time and we will cover as much as we can. If we run out of time, we will resume our discussions at your next appointment. Please be mindful of the next patient. Even though you have just a "few" more questions, so do they. There is no law dictating how often you can be seen.
Physicals
I need to see you once a year for a physical if you are receiving prescription medications from me. Please let the receptionist know that you are scheduling for a physical so she can allot the appropriate time. Make sure you fill out your paperwork in advance which can be downloaded from our website at www.drmoniquemartin.com under FORMS or come in 30 minutes before your appointment to to fill out the necessary paperwork in the office. Please bring a list of your current medications/supplements and the dosages with you.
Primary Care Provider
I cannot be your PCP. I do not regularly provide acute primary care services. I am a specialist in Integrative Medicine and focus and providing services where conventional medicine often does not. However, I have no problems working with anybody in your healthcare team.
Questions
Questions usually come in the form of phone calls, in-person visits to the office or rarely, emails. The front office staff handles administrative tasks & questions and makes appointments. The back office MA will address your medical questions and relay them to me. In the event that my medical assistant cannot answer your question, she will write it down and reiterate it to you and I will review it at my earliest convenience. This is usually at the end of the day when I'm done seeing patients or occasionally in between patients. My medical assistant will call you with my response to your question as soon as she is able, which may be the next business day. If your questions are complex or too many in number you will be directed to make an appointment with me to discuss your issues as I do not have enough time to adequately address them over the phone. I am sorry but I am often not able to answer your questions when you see me in the hallway or the reception area as I am usually in the middle of doing something that requires my full attention, I may need your chart to put your question in the proper context or to jog my memory as to why I recommended what I did or may be going to see my next patient. Please make an appointment to follow up with me. Calling frequently during the day to see if I have answered your question does not yield a quicker response. We do triage calls in order of emergencies and also answer them chronologically.
Emails
Our email address is globalmed499@gmail.com. We use our email for administrative purposes, not to provide emergency medical advice. Emails containing medical questions will be responded to by phone for additional clarification and may take longer to answer.
Lab work
As an integrative physician I use a huge variety of diagnostic lab tests available. These include the standard labs offered through Labcorp and Quest Diagnostics Lab, as well as cutting-edge labs located throughout the country. Know that I am not familiar with your insurance plan and have no idea what is covered by them. The tests I recommend are based on what I would do if I had your condition. As a consultant I am not vested in whether you do them or not. I do not own stock in the labs and don’t usually up-charge the specialty tests I recommend to you. That being said, it is your responsibility to know what your insurance will and won't cover. I can guide you, but ultimately the responsibility is yours. If you are unsure or need to make absolutely certain that your tests will be covered, you need to research this with the independent labs and your insurance company. I am NOT liable for your medical bills and I do not base my medical recommendations on your insurance coverage although I do try to be mindful of costs. Insurance companies may cover one test today but not tomorrow. In the past I would write letters to the insurance companies appealing their denial of tests I ordered. However, not once has this made a difference. Unfortunately, if your insurance company has made a decision not to cover a certain test, no amount of letter-writing will make a difference. We do not draw blood for Labcorp or Quest Diagnostics tests. We will send you to a Labcorp or Quest Diagnostics draw station to have that blood work done there. However, we will draw some of the specialty tests as it is nearly impossible to get them done elsewhere. For this we charge a phlebotomy fee and a service and handling fee as the blood oftentimes has labor intensive requirements. We also charge a nominal fee for specialty lab diagnostic kits done at home to ensure compliance. In the event that we are unable to draw your blood, we have a list of special phlebotomists we can refer you to. The special tests may require prep work such as fasting or avoiding medications and/or supplements, certain foods and activities. You will need to schedule these tests with my medical assistant through the front office unless we are able to possibly do them immediately after your appointment.
We will have you fill out a self-addressed envelope so that we can mail you a copy of your results when we receive them. This allows you to have a copy of your medical results, research your results and prepare questions to ask me at your next follow-up visit. Please note that I will not call you to discuss these results over the phone unless a result requires immediate or serious attention. No news does not mean good news. No news means no news. If you have not received a copy of your lab results chances are we have not received a copy either. Please call us and let us know so that we can research what happened and get you a copy of your results. Some specialty labs take three weeks to complete their lab assessment, however, anything longer than that usual means something has gone awry. Hospitals and radiology centers are notorious for not sending us results. Please call us when you haven't received results or heard from us!
I usually order labs at your first visit with me, when you have an illness requiring labs, to follow up on treatment OR at a physical. I order the labs for the physical at the time of the physical to make sure I am ordering the proper tests that will be covered by your insurance and that will reflect your symptomology. I do not order these tests in advance unless we have discussed them at a previous visit in which case you will mostly likely already have a requisition form for them. When I order radiology tests, I will either hand you a prescription such as for mammography, bone density or chest x-ray, or I will fax the order to the hospital or radiology center of your choice as required by the facility. If you need to check with your insurance first or find the place you would like to go to, you will need to call us with the fax number of the place where you would like us to fax the order to. Many facilities may call you to schedule an appointment upon receiving the order, however if you have not heard from them in a day or two, please give them a call and schedule your procedure. When we receive the results of the test, we will send you a copy unless they have already given you one. If you do not receive a copy within 1 to 2 weeks after your test then we have not received it either. Please call us and we will research it. No news means no news. I will also recommend procedures such as colonoscopies, specialty consults, and tetanus shots among other things. These are your responsibility to carry out. You will not be called and harassed into doing anything I have recommended, other then follow up on lab results that I have received. I will not call you to remind you that you need bloodwork for your evaluation or check to see that you are eating a healthy dinner, or getting enough sleep and exercise. Although I care very much about you and your health, it is necessary for you to be in control of your own health and healthcare, just as I need to be accountable for mine.
Results
Upon receiving your blood results or other test results that I have ordered, we will mail you a copy of these results if you have not yet received them, including a cover letter with a recommendation. Usually it is to schedule a follow-up appointment so we can review the results together and discuss treatment options that are appropriate, I require your input for this and have found it takes up the entire appointment. This cannot be done in a quick phone call during my lunch or dinner. My medical assistant is not a physician and is not able to answer your questions. If you elect to follow up with someone else instead, please let us know when we call you so that we can leave you alone and don't have to harass you. I completely honor your ability to make decisions regarding your own health care. If you do not receive a copy within 1 to 2 weeks after your test then we probably have not received it either. Please call us and we will research it. We do have tickler reminders in place; however, we want to ensure that nobody falls through the cracks - ever.
Records
With each visit you will receive a copy of your Healing Recommendations which outlines your problem list, diagnoses, tests, consults and educational material recommended, as well as treatment options. I provide this written copy to you so that you will have a summary of the visit and my recommendations. As previously stated, you will also receive a copy of all your labs and tests ordered by me. It is absolutely imperative that you hang onto your own duplicate medical records so that you may copy and disseminate this information to other doctors or healthcare providers as you see fit. We do not send medical records to anybody unless ordered by a subpoena or requested by an insurance company with your signed release or as legally required. Please note that we have 30 days by law to furnish these records from the time of request. Please be aware that we may not legally remove any records that we have created or procured from your record, although we can put them in a confidential section which can only be accessed by subpoena. If you have lost your records or you would like your records sent to another healthcare provider, we will provide you a duplicate copy of your records at your expense based on fees set by the Department of Public Health and mail them to you after receipt of payment so that you may have a new copy to disseminate. Due to HIPPA laws we will only release records to you or those we are legally required to.
Electronic Health Records - EHR
I do not have them. They do not improve the medical care you receive from me. They take away face-to-face time spent with the patient, are frequently wrought with errors which become permanent, are easy to hack, expensive and can devastate a practice when the system is down. They also require much time to create, often involving the physician typing into the computer when she/he should be focused on listening to the patient. The one benefit is that they can be sent instantaneously with a stroke of the keyboard to someone else which may also be detrimental. Scanning in documents to an EHR is labor intensive and not necessary for me to do my job. However, I am most definitely not anti-technology, and if a user friendly system is developed that benefits everyone involved I will adopt it.
Forms
I am willing to do anything that can be written on a prescription pad and done in one minute. If you require a form to be filled out such as work releases, forms to the IRS or your HSA, adoption papers, etc. you will need to make an appointment and we will do this together. This also includes any formal letters you might need written to anybody even if they are only a few sentences long. See your PCP for FMLA, Disability & DMV forms, as well as the above-mentioned forms if you don’t wish to come in.
Prescriptions and Refills
I typically do medication refills at your appointment. If I give you a limited number of refills it is usually because you need lab tests to monitor your response to the medication OR because I need to see you to monitor your progress OR it is been a year and you are due for an annual evaluation. If that is the case, please spare yourself the hassle and make the appropriate appointment to see me and/or have your labs done. You may have the pharmacy fax us a refill request and we will respond to it in 1 to 2 business days. If the above conditions apply you will only be given a 30-day supply not 90-days. Please anticipate that you will be running out of your medications in advance to allow enough time for the refill so that you will not be without meds. I will never cut you off of life-saving medication such as heart medications or thyroid meds without notice unless you fail to follow up with me. However, if you have been notified that you need to see me and still ignore this request, I will no longer be your prescribing physician.
Narcotics need to be obtained from your PCP or pain specialist and are never refilled on Fridays or when I am out of the office. If I am prescribing you hormone replacement therapy and you wish me to continue to manage your hormones and continue to prescribe this therapy then you will need to schedule a physical with me which may include a Pap smear. This is so I have the benefit of examining you along with the liability of prescribing the hormones. If you wish to continue your PAP/Pelvic's with your PCP or gynecologist that is fine with me, but please direct your hormone refill request to that physician. I will not continue filling your hormones in this scenario. This ensures that the person who is prescribing the hormones has the benefit of examining you.
*Please note that I will not treat you for an illness without examining you. Please schedule an appointment. If you are unable to see me, then please see your PCP for your illness.
90-day and/or 1-year Refill Requests
I require an annual physical to continue filling your prescriptions, not just lab work. That means I need to see you once a year to refill your meds. If it has been beyond a year since you have seen me I will give you a 30-day supply of your medications to fill at your local pharmacy. I will NOT give you 90-day or mail-order prescriptions and I most certainly will NOT give you refills for a year.
When I give you a written prescription for your mail-order pharmacy, you need to MAIL it in, I repeat, MAIL it in, do NOT fax or scan, regardless of what they tell you, they will not send you your refill without the hard copy of the prescription or a fax from us. Since we have already given you the original prescription, the fax from us may take 2 weeks before it can be processed, which may mean a month before you get your meds. Please mail it in.
Oftentimes pharmacies will send us a refill request in anticipation that you may be needing a refill. If we have given you a prescription, then we will ignore these requests as we may have changed the dose, the medication, or you may have changed the pharmacy.
Billing
I am not contracted with any insurance company. That is because I wish to work for you and not your insurance company. It allows me to practice medicine on your behalf, not theirs. My charges are fee-for-service and are to be paid after the visit.
I also understand that you spend oodles of money for your healthcare insurance just like I do. However, insurance plans these days are often catastrophic plans. They cover severe illnesses, hospitalizations and discounted lab rates which is excellent. This maybe akin to your taxes covering public high school but definitely not college, especially not a specialty private college which may be a good analogy for my services. Therefore, I am here to provide services that your conventional healthcare provider does not.
I am also opted out of Medicare. The good news is that you are able to see any doctor of your choice regardless of whether they participate with Medicare. The bad news is that as an opted-out provider, both you and I are unable to bill Medicare to get the denial claim necessary for your secondary insurance should they require that. Thus your visit with me may not be covered however, many of the conventional tests I order frequently are.
