We have been making structural changes to the practice to better serve our patients that are dealing with complex health issues. With these changes in place, not only will we be able to better serve our established patients, but we can again accept new consultative patients. A key component to these changes is all consultative services are cash-only—we will no longer accept any third-party payer reimbursement for our consultative services.Learn more about why we had to go cash-only in order to afford these changes.
What are our consultative services?
Our consultative services are a program of mentoring and teaching to render our medical counsel and expertise for the management of complex health issue(s) and/or illness(es). Our services cover patients with following:
- Autism Spectrum Disorder (ASD) or other complex neurodevelopmental disorders
- Lyme and other co-infections
- Other chronic illnesses including severe allergies, GI disorders, thyroid disorders, Chronic Fatigue Syndrome and fibromyalgia
- General wellness or nutritional counseling
How do I become a consultative patient?
For a new patient or an established, but not active, primary care patient:
Once you contact our office requesting consultative services, we will:
- Send you our Preliminary Questionnaire for Prospective Consultative Pediatric Patient.
- Our provider(s) will review the completed questionnaire and—at the provider’s discretion—make a determination if our practice looks to be a good fit for your need.
- If we make a positive determination, we will contact you to schedule the initial consultative appointment and provide you with the detailed historical questionnaire for you to complete prior to that appointment.
- If we feel we are not a good fit for your need, we will provide you with referrals, if possible, to other providers that may better fit your need.
For an established, but not active, consultative patient or an active primary care patient:
Once you contact our office requesting consultative services, we will:
- At the provider’s discretion determine if you will require an initial consultative appointment based on you existing relationship with us.
- If we determine an initial consultative appointment is required, you follow the procedures outlined above.
- If we determine an initial consultative appointment is not required, we will contact you to schedule your first/next consultative appointment. We may require—again at the provider’s discretion—that you complete the detailed historical questionnaire prior to that appointment.
For an active consultative patient:
You may continue as a consultative patient.top
Understand the terminology
Defined as any patient seen in our office at least once during the prior 36 months, and who’s account is in good financial standing, i.e. has no outstanding past due balance(s).
Defined as any established patient who has been seen in our office at least once during the prior 12 months.
Defined as any patient receiving consultative care.
primary care patient
Defined as any patient only receiving routine, primary pediatric care in our office.
Can Vibrant Kids Pediatrics remain my PCP?
The following rules shall determine if you are eligible, as a consultative patient, to retain Vibrant Kids Pediatrics as your primary care physician (PCP).
As of January 1, 2018:
- Any new consultative patient or any established consultative patient who is not an active patient must retain another physician as his/her PCP, i.e. you are not eligible to receive routine pediatric care in our office.
- Any active consultative patient will be “grandfathered in” and will remain eligible to receive routine pediatric care in our office. However, all such routine services will be scheduled only with our mid-tier provider; no routine pediatric services will be scheduled with Dr Dickerson.
- Any active primary care patient that develops a need for our consultative services will be “grandfathered in” as defined above.
Why are you moving these services to cash-only? Why are you no longer accepting my insurance?
The short answer is third-party payers have never adequately “reimbursed” for these services. We want to provide—and you are expecting—first-class service, but your third-party payer pays only enough to let you ride in the mailbag in the cargo hold—not even enough for a no legroom coach seat. Counseling/teaching is about spending time with the patient. Third-party payers have no interest in time, only in executing procedures—procedures that are to be completed in their entirety in the exam room in the 10-20 minutes allowed for per the payer’s reimbursement schedule. The harsh reality is third-party payers do not care about any patient’s good health or wellness; they are only concerned with the management of disease.
Consider that for the initial visit for a new consultative patient Dr Dickerson spends upwards of three hours on that one visit: an hour reviewing the prior medical history in preparation for the visit, an hour with the patient in the exam room, and an hour after the visit completing the charting and visit summary/plan of action for the patient. The only “reimbursement” we get from any third-party payer for this single visit is what is called a “Level 5 Office Visit,” which “pays”—at a steep discount—for only 40 minutes of a provider’s time. That is 40 minutes versus 180 minutes. When Dr Dickerson sees two new consultative patients in a single clinic day, two hours are spent face-to-face with the consultative patients and the other five hours of the clinic day must be spent seeing numerous routine pediatric patients—required to offset the loss in “reimbursement” for those other 280 minutes. And, those other four hours for the two consultative visits must be spent at some point, and that point is after hours at home late into the night at the expense of her own family.
The reality is we cannot provide the quality of service we want to provide our consultative patients because too much of our time and attention must be spent on routine patients to generate the “reimbursement” income needed to operate the clinic.
Can I submit a claim to my insurer for reimbursement for the consultative services I received?
You may certainly try. We will provide you with a super bill for the services rendered that you may use in filing a claim with your third-party payer. Understand that our office will not provide you with any assistance in filing a claim with your payer, beyond the providing of the super bill. If your payer requests additional documentation regarding any claim you have submitted, we will charge you a fee for the preparation and submission of that documentation.
As a consultative patient, why can we not see Dr Dickerson for routine pediatric care even though you allowed us to keep Vibrant Kids Pediatrics as our PCP?
Two primary reasons. The first being to create space in Dr Dickerson’s schedule for our consultative patients and to create separation between our cash-only services and our third-party payer “reimbursed” services.
And, secondly, we don’t want you to find yourself in the position of having a third-party payer “reimbursed” routine visit with Dr Dickerson, and then while in the exam room with her ask, “while we’re here can we discuss….” Doing this is immediate grounds for dismissal from the practice, and we really don’t want that. Simply put, we are not going to allow the situation for “cheating” to be possible.top