Center for Multisystem Disease, LLC does not currently contract with any insurance provider. We deeply regret the negative impact this will have on patients but caring for our patient population using the insurance model as it currently exists is not sustainable. We do not submit medical claims on your behalf; however, we will (upon request) provide you with a superbill that you may submit to your insurance company for possible reimbursement. At least partial reimbursement may be possible if you have out-of-network coverage. Dr. Schofield no longer participates in the Medicare or Medicaid programs. If you are a Medicare or Medicaid member and wish to become a patient of the Center for Multisystem Disease, LLC, you are required to accept the terms and conditions set forth in a private contract between you and Center for Multisystem Disease, LLC. This private contract outlines that no Medicare or Medicaid payment will be made to you or to Center for Multisystem Disease, LLC for the services provided by Dr. Schofield, even if such services are covered by Medicare or Medicaid. Under this private contract, you acknowledge that you accept full responsibility for all charges for services provided by Center for Multisystem Disease, LLC and that payment is due in full at the time care is provided.
Laboratory, imaging and other testing as well as medications and infusion therapies ordered by out-of-network providers are covered by most insurance companies, but it is your responsibility to verify whether this is the case for your specific plan.
Our current fees are based on those of physicians across the country who care for similar patient populations. For more details, please contact Chandra Strohm, office manager, by email at: firstname.lastname@example.org.
Please note that we require prepayment for the new patient consultation and post-consultation visits one week before your scheduled visit as we have had patients not show up for these appointments after blocking many hours for them.
NEW PATIENT CONSULTATION:
- Includes 3 hours of face-to-face time with Dr. Schofield to review outside records, review your history, symptoms and perform a detailed or more limited physical examination (depending on your circumstances). She also tries to fit in as much education as possible during this visit and usually makes initial recommendations for management strategies.
- This does not include the POST-CONSULTATION visit, which is recommended for most patients (see below).
- Most of this visit will be to gather information about your case.
- In-office stand testing, if indicated, to evaluate for dysautonomia.
- Synthesis of the complex information with a detailed consultation report including impressions and recommendations.
- Exceptionally complex patients may require more time to address all issues; this will need to be scheduled as a separate visit.
- You are encouraged to organize and provide the most pertinent medical records in order to improve the efficiency and effectiveness of the record review process. E.g., provide key laboratory tests (both positive and negative), pertinent radiological and other tests and pertinent consultation notes from other providers. Weed out pages of your records that contain no useful information or are duplicates. The patient who provides a random stack of 1000 pages with multiple copies of the same results or a CD with years of provider follow-up notes unrelated to your current issues will result in a less valuable visit than the patient who brings an organized binder with Labs, Radiology studies, other studies, and consultations.
- Organizing your thoughts ahead of time to allow a focused review of your story is also helpful. For example, summarizing in 10-15 minutes all the medical issues you may have faced in your childhood years is more helpful than spending 15 minutes detailing one experience that happened when you were 5 years old.
POST CONSULTATION VISIT:
- Totals 2 hours of Dr. Schofield’s time.
- Face to face time: 60 minutes. If more than 60 minutes is needed, the extra time will be charged at the current hourly rate.
- This includes Dr. Schofield’s time to review the initial consultation note, review, and analyze--in the context of your personal clinical situation--all laboratory results and other studies ordered at the initial consultation and modification of the original consultation report to include any new diagnoses, suspected but not confirmed diagnoses and further recommendations.
We understand that these disorders cause many symptoms and that they may be severe and disabling, but they are chronic illnesses that take time, patience and trial and error to achieve improvement. Please note that our practice is small and is designed to provide chronic disease management, not acute care. If you have a new symptom(s), you should be evaluated by your primary care provider to be sure that you do not have a new, unrelated problem. If you have worsening and/or acute symptoms you are concerned about, you should call 911 or be evaluated by the nearest urgent care facility or emergency department. If you are having an exacerbation of your illness that cannot wait until your next scheduled appointment, we will schedule you for the next available appointment and/or add you to the cancellation list. Most medication changes and initiation of any new medication will be made during office visits after an appropriate evaluation and not over the phone, the portal or by asking our office staff to ask Dr. Schofield if she can prescribe a medication.
NO SCENT POLICY:
Many of our patients have mast cell activation syndrome (MCAS) and scents are a potent trigger for some MCAS patients, occasionally even causing anaphylaxis. For this reason, we ask all patients and visitors to our center to please avoid wearing scented products.
Please note that we require prepayment for the new patient consultation and post consultation visits one week before your scheduled visit as we have had patients not show up for these appointments after blocking out many hours of time for them. For all other visits, payment is due in full at the time of service. We do not require a retainer, but scheduling an appointment requires an active credit card be placed on file so that you may be billed for the services provided, including any cancellation fees if applicable.
We cannot guarantee your health will improve because of our care. We do have a very high success rate in making diagnoses and finding treatments that lead to an improvement in quality of life. This is always our goal, but as with everything in medicine (and life), nothing is 100% successful.
The disabling nature of the diseases we treat as well as the limited number of providers knowledgeable in these diseases has created barriers to care for many patients. To reduce these barriers to care, Center for Multisystem Disease offers remote follow-up care for patients that have been evaluated in person at the Center for Multisystem Disease. Telemedicine consultations are billed at the same rate as in-person evaluations. We are unable to guarantee that there will not be a data breach during telemedicine visits. By scheduling a teleconsultation, you understand and accept the small risk of a data breach. You also understand and accept that there may be some limitations to care due to the inability to perform a physical examination or complete vital signs. If you do plan to take advantage of our telemedicine services, please ensure you have given your preferred number to our office to avoid any delays. We try to keep on schedule, but there is always a potential for Dr. Schofield to be running late for remote visits and we ask that you allow a 45-minute window after your scheduled time in case there is a delay.
Dr. Schofield is able to see and evaluate patients from out-ofstate and out-of-country in person at her office in Denver, Colorado. For patients who maintain yearly in-person follow-up, she can communicate by portal, telephone, or video appointments; however, you are asked to have a local provider maintain prescriptions for medications that are found to be effective. Dr. Schofield will communicate with your local provider by telephone or email at no cost to help coordinate your care after you return home if you do come for an in-person consultation. This communication, however, must be initiated by your local provider.
NO SHOW AND LATE CANCELLATION POLICY:
Due to long appointment times, no-shows and late cancellations are particularly problematic and we ask for your help in avoiding missed appointments. For new patient initial consultation and post-consultation visits, any no-show or cancellation less than 72 business hours of the scheduled appointment time will be charged 50% of the visit fee. For follow-up visits, any no-show or cancellation less than 48 business hours of the scheduled appointment time will be charged 50% of the visit fee. For visits cancelled after the cancellation window, we will attempt to reschedule another patient into your time slot. If we can successfully reschedule another patient, then you will not be charged. This is not always possible with such short notice. If the reason for cancellation is your inability to get to the clinic, your visit can be conducted by telephone or using a surrogate if informed consent is provided.
If you are late for your scheduled appointment time, you will be seen for the remainder of your scheduled appointment time and billed for the entire appointment.
Our priority is to provide the best care we can to patients in our office or patients participating in telemedicine appointments. Portal and other messages are intended for non-urgent, noncomplex, and logistical matters. If you have an urgent or emergent matter, please go to the closest emergency department or urgent care. If you have a complex situation or question, please schedule a telephone or in-person appointment. Given the high level of illness severity in our patient population, we receive many portal messages that far exceeds that seen in other practices and we must charge for this service if provider time is required. Simple and brief questions that can be answered by administrative staff will not be charged. Questions that need to be addressed by a provider will be billed at the current provider rate in 1-minute increments of provider time required to address your question or concern.
Diagnoses will not be made over the portal and new medications will not be started over the portal. If you have new symptoms, you must be evaluated in person by your primary care physician or an emergency provider to be sure there is not a new condition unrelated to the condition(s) we are managing at the Center for Multisystem Disease. If you have increasing symptoms, we will make every effort to try to fit you into the schedule, but this is not always possible, and you may need to see your primary care physician who can contact Dr. Schofield if needed. We do attempt to address portal messages as soon as possible, but given our small office, there may be times when we cannot get to your message for 72 hours or even longer, especially over weekends or holidays or if there is a staff or provider absence.
Due to confidentiality concerns, direct communication via unsecured email accounts is not considered a HIPAA-compliant method of communicating about your personal health and messages to personal email accounts of our staff or providers will not be answered. Our Center for Multisystem Disease emails are encrypted by Paubox and are HIPAA-compliant; however, we prefer that all communication go through the patient portal so that all conversations are documented in your medical record and there is access to your record when reviewing the message. Likewise, Klara (our patient communication platform) is intended for administrative, not clinical matters.
Some patients may choose to carry out 5–10-minute portal-based "visits" which will cost about the same as a co-pay and allow for discussion of concerns or review of medication trials in "real-time" rather than waiting for an appointment. This kind of visit has several advantages, but also has some limitations and may work great for some patients, but not for others. It can be a great way to follow patients with MCAS undergoing frequent medication trials. Periodic in-person visits are still recommended. Keep in mind that provider time involved in portal "visits" includes time to review your chart in the context of the questions or concerns raised and not just the time spent typing. If you communicate often, time spent reviewing your chart will be minimal due to regular involvement in your care and familiarity with your case.
PRIOR AUTHORIZATIONS, APPEALS, LETTERS OF MEDICAL NECESSITY POLICY:
There are no FDA-approved treatments for dysautonomia, mast cell activation syndrome, the antiphospholipid syndrome, Sjogren’s syndrome or the Ehlers-Danlos syndromes and these conditions are poorly understood by insurance companies. As a result, insurance companies often request extensive and timeconsuming documentation to consider approval of many of the treatments used for these conditions. The number of these requests for our patient population far exceeds that of most other practices and we must charge for this service. If your insurance company requires Center for Multisystem Disease to obtain a "prior-authorization," a "letter of medical necessity," an “appeal,” or a “peer-to-peer” physician consultation for medications, infusion therapy, laboratory tests, procedures, or other care, you will be charged a fee for this service. The fee for prior authorizations or other insurance company issues involving only staff will be charged $50 per medication, other treatment, or service. Provider time will be billed at the provider rate. An active credit card must be on file prior to the Center for Multisystem Disease acting on the insurance company request(s) and you will be contacted first to be sure you would like us to move forward. There is no guarantee that your insurance company will decide in our favor because of our actions, but we will make every effort to get the care you need approved. We do have a high success rate, but it is not 100%.
Forms that can be completed by staff and signed by a provider will be completed free of charge, e.g., handicap parking or simple work or school excuse forms. Forms that require provider time to complete will be charged at the provider rate, including disability, detailed school or work forms, public service requests, FMLA forms, etc. Fees must be paid to receive the form back. If the form is complex, involves detailed questions about your functional ability, etc., we recommend scheduling an in-person visit. Fees are based simply on the provider time required, so there is not an extra charge to arrange an in-person visit. We recommend asking your primary care physician to complete forms as most primary care providers get significantly fewer requests than we do given the high severity of illness of our patient population. If your primary care physician is not able or willing to complete the form, you are encouraged to complete as much of the form as possible to reduce the provider time required to complete the form.
We do have standardized letters for 504/IEP accommodations for students and employees and work/school appointment excuse forms which we provide free of charge. If you need a letter drafted for any other reason, you will be charged the provider rate based on the amount of provider time required to draft the letter. You may draft the letter yourself to reduce the provider time required. We will then edit the letter if needed and print the letter on letterhead. We will send the letter to whomever you request once payment is received. If you do elect to use this method and we are communicating electronically to generate your letter, we do not guarantee that there will not be a data breach during the letter editing process. We use G-Suite and encrypted email; however, if your email is not encrypted, we cannot guarantee the security of the personal information that may be contained in the letter.
Medical providers or staff:
Dr. Schofield will discuss your case by telephone or email if needed with an outside medical provider free of charge if this consultation is initiated by the outside provider and they provide a convenient way to access them (i.e. cell phone or email), rather than a generic clinic, urgent care of ED phone number. By signing this document, you consent to Dr. Schofield’s reply to any outside provider’s email or phone call on your behalf and understand and accept that email is not 100% secure and there is some risk of a data breach. If you do not wish for Dr. Schofield to respond to outside provider’s emails or telephone calls about you, please let us know in person and we will make note of this in your electronic chart.
If you request Dr. Schofield perform a consultation with an attorney, school staff, or other non-medical personnel, you will be charged the current provider rate. These consultations must be approved and initiated by the patient or legal guardian. By signing this document, you consent to Dr. Schofield’s reply to any outside provider’s email or phone call on your behalf and understand and accept that email and telephone communication are not 100% secure and there is some risk of a data breach.
Dr. Schofield does not charge for anytime spent researching the medical literature or other resources to improve your quality of care.
Routine monitoring labs (CBC and CMP) for patients on infusion therapy or certain oral medications do not require an appointment if they are normal. If there are important laboratory abnormalities, however, a follow up appointment must be scheduled, even if a brief telephone appointment, so that these results and their potential implications may be properly communicated with you. It is your responsibility to schedule results review follow-up appointments. Dr. Schofield will review your labs when they are provided to her for urgent issues and you will be contacted if she has any urgent concerns, but she will reserve discussion of all other results for your follow-up appointment. If there is a test result that you are worried about and do not want to wait until your scheduled follow up appointment, you may send a portal message, but you will be charged at the provider rate for the time spent reviewing your concerns. Please be sure to schedule your results review follow-up appointment at an appropriate time interval that will allow all ordered tests to be resulted prior to your appointment. For some specialty tests, results can take as long as 6 weeks to be finalized.
LABORATORY, RADIOLOGY AND OTHER PROCEDURES:
We do not guarantee that recommended laboratory studies or procedures will be reimbursed by your insurance company. It is your responsibility to ensure that laboratory tests, procedures or other tests ordered by the Center for Multisystem Disease are covered by your insurance policy prior to these studies being completed. If your insurance company requires a different diagnosis code, we are happy to change the submitted codes if appropriate, to improve the insurance company reimbursement. If you request more extensive staff involvement to try to get tests covered after the fact, you will be billed $50.00. If provider time is requested for this reason, it will be billed at the provider rate.
Routine Prescription Refills:
Prescriptions are best ordered during your scheduled office visit. We will order enough refills to last until your next recommended follow-up visit. The frequency of recommended follow-up visits depends on the stability of your condition and the medication(s) prescribed. No medications will be prescribed for more than 6 months. Anticoagulants and antiplatelet therapy require follow up at least every 3 months for the first 6 months, every 4 months for the next 8 months and then every 6 months thereafter if stable during the first year. Prescriptions initiated by another provider should be refilled by that provider unless Dr. Schofield agrees to take over the prescription. It is your responsibility to be sure you do not run out of your medication by scheduling office visits at appropriate intervals.
A new prescription or one recommended by another physician requires an office visit or telemedicine visit.
We do not prescribe narcotics. Prescriptions for other controlled substances (tranquilizers, non-opioid analgesics, and stimulants) require an office visit at least every three months.
MEDICAL RECORDS RELEASE:
You are responsible for obtaining your medical records from other health care providers/facilities. Medical records from another physician or office can only be released to us with your authorization by completing a HIPAA authorization form. Please contact your other health care provider to obtain the records that you believe are pertinent to your Center for Multisystem Disease evaluation.
MEDICAL RECORDS COPYING:
Your Center for Multisystem Disease records are available on our patient portal. Laboratory and other study results can be obtained from the testing facility. We follow the National Organization of Social Security Claimants’ Representatives (NOSSCR) guidelines for the state of Colorado for fees charged if you request we copy your medical records. These guidelines (Colorado Revised Statutes § 25-1- 80) were last updated in April 2018. A fee is determined in accordance with HIPAA. “Reasonable fees” are currently defined as $18.53 for the first 10 pages, 85¢ per page for the next 30 pages, and 57¢ per page for each additional page. These costs do not apply to medical records that are stored on microfilm, which cost $1.50 per page, or radiographic studies, which cost the actual cost of reproduction for each radiograph copy. Additionally, the medical provider may charge the actual postage and electronic media costs, if applicable, and any applicable taxes as well as a $10 fee for certification of the medical records, if requested.