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 were 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, but response time is not guaranteed - may be immediate, may be within a day if I'm traveling and outside cell service. The message is delivered to my voice-mail which I retrieve regularly. But 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 are limited. We are not able to answer the phone because we are usually 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. DO NOT LEAVE SENSITIVE IDENTIFYING INFO - NO Birthdates etc. We check messages as often as possible, 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 are closed on Thursdays and Fridays, so messages left 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 only 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 Thursdays and Fridays, telephone messages left on Wednesday afternoon, Thursday, Friday, Saturday and Sunday are not always reviewed
until Monday. That means that on Monday, we have messages from 4 days 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. AS WE WILL IGNORE THAT REQUEST. YOU PERSONALLY NEED TO CALL US - even for routine refills due to scheduling changes.
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 ignore all pharmacy initiated refill requests due to errors and potential errors we have run into. 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. If the prior-authorization process is too burdensome, then we will have to chose a formulary equivalent.
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.
DIRECT ALL BILLING QUESTIONS TO MY BILLER -Care CLoud @ (602) 216-3022 or (732) 873-5133 - M-F 9:00-4:30
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 by our medical opinion for medical necessity. BUT - 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: (see above) If the prior-authorization process is too burdensome, then we will have to chose a formulary or contract allowable equivalent.
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.
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. In fact the latest research shows even 5 days of opioids increases the likelihood of still being on them in a year! 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
