How much do you charge?
Rates for functional medicine vary, and in Austin, TX, the average cost per visit (with an allopathic-trained practitioner, i.e. one that can prescribe medications if needed) is extremely variable, ranging from $450 to $5000. But what is not factored in is the cost for labs and treatments.
Knowing this information, we set out to create our center with low overhead so we can pass the savings on to patients. We don’t profit off labs, and we aim to use fewer tests/pills. At CCM, the maximum total cost (for visits, labs, AND treatments) for patients ranges from $100 to $500 per month over the duration of a year, depending on complexity of the illness.
Click here for an article Meg wrote on the costs of functional medicine, and here for an article on why insurance typically doesn’t cover high quality functional medicine.
In functional medicine, details dictate many decisions in testing and care. On average, new patients can expect to spend 90 minutes face-to-face with our providers, but an additional 60+ minutes are spent on preparation for and documentation after the visit. Total time included in cost = 3 hours.
- New patient visit with Meg or Dr. Manzanero: $450
- New patient visit with Sara: $400
- Follow Up with Meg or Dr. Manzanero, 45-60 minutes: $225
- Follow Up with Sara, 45-60 minutes: $200
- Options for short appointments (<20 minutes) and longer appointments (>1hr) available
- Between visit correspondence is via secure messaging, and is part of patient care (i.e. no charge unless a detailed discussion is needed).
Do you take insurance?
Insurance-based practices are often “managed” by what an insurance company will/will not allow. Essentially, choices for medical care (including testing options, how long you see a practitioner, etc) are “filtered” by insurance.
Payment in full is expected at time of service. Click here for more information about why many functional medicine practices don’t use insurance.
- We are a fee-for-service practice and do not contract with any form of medical insurance. Many are able to get some reimbursement from their insurance company, and we are happy to give you the paperwork that you can file with your insurance.
- We encourage you to contact your insurance company to find out the process for covering “out of network” care, since some insurance companies do not cover out-of-network care.
- HSA and FSA dollars are accepted.
- ***With this in mind, however, many patients receive up to 50% reimbursement from their insurance (for visits with the providers) if insurance has out of network benefits (CCM creates the invoice, patient is responsible for submitting to insurance).
- **Also keep in mind that insurance is billed for laboratory tests, and the companies we utilize for functional testing are often able to bill insurance to assist in paying for your test (patient often only pays for half the cash cost of the lab).
What conditions do you treat?
We approach most conditions based off of what potential causes are contributing. We do not treat specific diagnoses (most of which are just “labels”), but we are particularly well-versed at treating:
- Autoimmune conditions
- Cardiometabolic conditions
- Preventative health and preconception care
- Conditions impacting the digestive system (SIBO, persistent parasite infections, bloating, etc)
What types of testing do you recommend?
WHAT: We utilize both standard blood work as well as in-depth specialty testing (involves evaluation of urine, stool, blood, saliva, and more). We utilize specialty companies including Precision Analytical, Genova, Great Plains Labs, Doctor’s Data, Cyrex, MicroGen Diagnostics, Diagnostic Solutions, and more. Test results can take between 5 days and 4 weeks to be returned to us for evaluation.
WHY: Testing helps us find the cause(s) of illness, but are only some of the “puzzle pieces” that help us construct a comprehensive picture of your health. Testing guides us in order to better inform treatment, and personalizes your treatment plan. All tests, however, are optional. No matter how much we want a test to tell us the answer to a question, no test is 100% perfect, which is why the expertise and experience of your health care provider is so important.
HOW: Most routine blood tests involve a requisition form for each company. Specialty testing often involves taking home a test kit, filling out a form, following written instructions, and sending it back with a pre-paid envelope/box (via FedEx, UPS, etc). Some tests can only be sent on certain days of the week. We do our best to provide resources (e.g. YouTube videos) that can guide you in how to obtain samples for specialty testing.
HOW MUCH: Most labs ordered by CCM can be billed directly to your insurance. This is done by the lab, not by CCM. Some specialty tests and even basic blood tests may not be covered by insurance. Please note that some insurance companies will only cover testing at specific facilities, and at CCM we have no way of knowing this information. Please contact your insurance company before completing any lab work, so we can work with you and your insurance provider. Of note, we do our best to offer cash-based “direct” billing for instances when insurance won’t help. CCM has no control over lab pricing, and never makes any profit off of any test ordered for you.
INTERPRETATION OF RESULTS: Advanced testing involves more than just looking for abnormal results. A good practitioner doesn’t treat based off of looking to “normalize” a result, but looks at what the biomarker actually is, and what works for/against it (i.e. the patterns behind a result). Because numbers can be misleading, we cannot just order a test for you and provide you the results without a discussion. Thus, please plan on following up for a 20-40 minute visit with the provider who orders the test.
Testing costs are not included in the price per visit. The most expensive test that is offered is around $700, but most specialty tests cost around $200-$300 per test. We will make every effort to ensure that you’re fully aware of the full costs for each lab.
Can you prescribe medication?
Because we are licensed health care professionals, licensed through the state of Texas, we are able to prescribe pharmaceuticals. Pharmaceuticals can be very effective, and have a place in improving health. Our approach is to utilize pharmaceuticals when needed, maybe even temporarily, in order to get to a health goal.
We do not manage chronic pain conditions, and do not prescribe medications like oxycontin, hydrocodone, or other drugs that fall within these Schedule II categories.
Are you a primary care provider?
Our health care providers are trained as primary care providers, and we are able to treat all conditions that a primary care doctor would address. However, we ask that you establish a relationship with a primary care practitioner who can provide services such as vaccinations, urgent care visits, annual exams, and more. If you need to see a specialist (e.g. cardiologist, surgeon, gynecologist, etc), you will be referred appropriately. The costs associated with the services provided by specialists or any other healthcare provider outside of CCM are between you and the specialist.
Beyond visits, the primary mode of communication with CCM providers is through the patient portal. We do our best to answer messages within 24-48 business hours, but we will rarely check these messages on the weekends. We may be able to take care of acute issues without the need for a visit, but this is not guaranteed.
We are not typically available for same-day urgent appointments, and we recommend that if you have a medical emergency, that you visit an urgent care or emergency room for complete evaluation.
Why are there so many forms to fill out?
We hear you, and acknowledge that there are a lot! These forms serve a few purposes:
- Determine your dedication to your involvement in your health.
- Provide information that can guide your provider towards identifying potential triggers, roadblocks, and clues to your health history.
- Save you money, by filling out the forms on your own time (rather than having your health care provider go through the questions at your appointment). The 1-2 hours that you spend on the forms can save you more than $500!
It is imperative to the success of your appointment that your provider is able to review your intake forms several days prior to your first visit, so we can be informed of your health history prior to your appointment. We respectfully request that all forms are filled out to completion 2-3 days before your visit(s).
It is also very helpful if you:
- Upload any recent (aka, over the last 6 months) labs and relevant medical visits into your patient portal before any appointment.
- Include a complete list of every supplement, prescription, or over-the-counter medication that you are taking (with every appointment).
- Include the ingredients and milligrams of the dose. If it is a multi-ingredient bottle or you are not sure how to list it, you may take a photo of the label and upload that. Not all supplements are of good quality, and sometimes a supplement can be causing symptoms rather than helping your health.
What do I need to bring to my first appointment?
If you have entered everything into your EHR patient portal, you won’t need to bring anything other than some paper to take notes.
You should have a list of all of your current medications, hormones, and/or supplements, with the exact doses. You can also make a copy (or snap some photos) of the labels, and upload those into your patient portal. We highly recommend taking a photo of the label, so we know any “filler” ingredients as well as exact forms of your medications/supplements.
Ideally, any recent blood work and medical records from the last 6 months should be uploaded to your patient portal prior to your appointment, so that the practitioners can review them BEFORE your appointment, or you can bring them with you.
Am I required to have in-person visits?
We can learn a lot from an in-person care visit, and highly recommend at least one in-person visit per year. No test can substitute for laying a practitioner’s hands over a thyroid gland, or looking at the ear through an otoscope. Follow up visits can be over the phone or telemedicine.
The above applies to Texas residents only. Our practitioners are only licensed by the state of Texas to provide medical services in Texas. We do not hold licenses in other states. If you reside in another state, we must see you in person before initiating any treatments. Follow ups may be done via telemedicine after the initial visit, for up to a year after the initial visit. If you are unable to come to Texas for an appointment, we can provide consultation services (please contact us for more information on this service, which does not include prescription services).
For international clients, the same rules apply as for those from other states. First visit must be in person. We can prescribe testing and medications if performed in Texas, but we cannot continue these services when outside of the country. All follow ups would be on a consultative basis.
What are your policies for cancelations, tardiness, or rescheduling?
We know that many allopathic doctor’s offices run behind, but we do our best to stay on time and respect your time. We typically see only 6-8 clients a day, and we reserve a significant amount of time for you. We ask that you reciprocate the respect, and if you cancel or reschedule at least 2 business days prior to your appointment, there is no charge. If you cancel or reschedule less than 2 business days prior to your appointment, or you miss your appointment without providing notice, you will be charged as follows:
■ First occurrence: Subject to provider discretion
■ Subsequent occurrences: 25% of scheduled appointment fees
What if I leave my appointment and have questions?
Whenever possible, please utilize the “patient portal” for communication with us. There is a security system in place through the portal, which protects your personal information. Email and text messages are not secure.
We acknowledge that questions will always come up after a one-on-one appointment with your health care provider. We will answer brief, appropriate questions at no cost. However, if an answer to your question(s) involves a significant amount of our time, it would be irresponsible of us to offer recommendations without knowing more details. Thus, a follow up appointment will be recommended.
Emails should never replace face-to-face, or direct conversations with us, so we can best address your concerns.
More details for email policies are covered in the patient guide.
Why don't you have regular office hours?
We maintain a low overhead, in order to keep things simple and keep the costs for care down for you. We do not have any ancillary staff, so all transactions and communications are performed by our providers. Our office is only open for scheduled visits, thus we do not have set office hours.
If you call during business hours, you will likely need to leave a voice message. We ask that you provide 2-3 dates/times that work best for a return call (up to 7pm M-F), and we will do our best to call you back at a convenient time for you.
What is a PA vs a NP?
“PA” stands for “Physician Assistant”, and applies to healthcare practitioners that are trained in the medical model (the same model that trains physicians). During their training, they rotate alongside medical students and take similar end-of-rotation written and clinical tests as medical students.
- All training is done at a university or school setting (i.e. no online programs for PA training at this time).
- Upon graduation, PAs can work in any speciality.
- The PA profession is overseen by the American Medical Association, which is headed by physicians.
- PAs are required to complete 100 hours of continuing medical education hours every two years, and must retake “boards” (national testing) every 10 years (just like most physicians).
- Often times, physicians get caught up in the semantics of the profession, interpreting “supervising” physician as “under supervision” (vs “with supervision”, meaning that PAs have the support of a physician if they need assistance with a case).
- Currently, since the PA profession is governed by physicians, PAs cannot work “independently” of their supervising physician (this mainly pertains to the ability to prescribe certain medications and 100% own a clinic).
“NP” stands for “nurse practitioner”, and applies to healthcare practitioners that are trained in the nursing model (a more holistic model of healthcare).
- Every NP is first trained as a nurse, and training programs vary (many NP programs are available in a school setting or online).
- Most training programs tend to focus on a speciality, such as primary care or pediatrics. This can limit the speciality that an NP can work in upon graduation.
- NPs are required to complete continuing medical education hours each year, but do not need to retake any national test after passing the initial boards.
- Most states require NPs to have a “collaborating” physician (similar to “supervising” physicians for PAs).
- However, due to the support and lobbying by nurses (a large group of individuals!), many states now allow NPs to own their own practice and work independently of their collaborating physicians.
In summary, PAs and NPs are trained in similar models as physicians, and thus practice similar to physicians. If fact, most patients will not notice any difference between the care they receive from a PA/NP vs a physician. The primary differences between NPs and PAs comes down to schooling and training models. When polled, most patients don’t have a preference for either profession.