Step-by-Step Guide for New Patients

1. Review our model of functional medicine.
2. Please read over the FAQs on the website, to address any potential questions.
3. Apply to become a new patient. We want to make sure we are a good “fit” for you!
4. Once accepted as a new patient –> Welcome to CCM!
5. Next register for your Patient Portal access
   • for secured email communication, appointment reminders, and more.
6. Complete questionnaires via your patient portal.
   • These will typically take more than 45 minutes to complete. You can save your progress, if you can’t complete in one sitting.

Initial Consult for New Patients

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 (yes, $5000!). But what is not factored in is the cost for labs and treatments! CCM does our best to inform you of all potential costs – visits, labs, and even supplements – so you won’t have any unexpected costs.

Knowing the above 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 less tests/pills. At CCM, the maximum total cost (for visits, labs, AND treatments) for patients ranges from $200 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.

****Although we are cash-based, many patients receive up to 50% reimbursement from their insurance if his/her insurance has out of network benefits (CCM creates the invoice, patient is responsible for submitting to insurance).

New Patients:

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 Meg or Dr. Manzanero, but an additional 30+minutes are spent on preparation for and documentation after the visit. Total time included in cost = >2 hours.

• New patient visit, 90 minutes: $450
• New patient bundled visit (available with Meg) –> 30-45 minute introductory call to order labs, 60-75 one-on-one visit to go over labs and history: $550

Other options with Meg

Meg knows that choosing a practitioner is personal. She offers a few options for those that are uncertain about proceeding with CCM for his/her healthcare needs.

• Elite concierge care, 4 months, up to 4 visits, 2+ hours per week dedicated to each patient: $3500
  • Limited availability (in order to provide high-quality care)
• Introductory visit, 20-30 minutes: $125
  • If patients choose to continue care beyond this appointment, the subsequent visit must be a comprehensive new patient appointment (for optimal detailed and thorough care, aka formulating the “big picture” roadmap for optimizing health).  $125 applied towards this new patient visit.

What to expect from a comprehensive new patient appointment:

This is a 60-75 minute appointment focused on discussing the underlying patterns identified in your lab results and in your intake forms. Treatment recommendations and prescriptions are part of this appointment, and further lab testing may also be advised. To optimize your time with your provider, please complete the following 3 requirements prior to attending your appointment (if these are not completed, we will need to reschedule your appointment):

1. Complete the detailed intake paperwork you were sent after the Introductory Consult. This paperwork is very important. The time it takes you to fill this out can save you hundreds of dollars (many practitioners ask these questions during an appointment, and the patient ends up paying for that time). Think of it like showing up to get a car problem evaluated, but you don’t bring your car!
2. If you have any previous medical records, we ask that you only include records rom the past year. Ideally, it is recommended to upload these test results to your patient portal 48 hours before your appointment, so we can review these prior to your visit.

FOLLOW UP APPOINTMENTS:

Follow-up appointments are for established patients, and can be done via telephone or in person. With Austin traffic, many prefer the convenience of telephones (or even telemedicine). The purpose of these visits are to determine response to treatment, continue to evaluate underlying causes of illness, and tweak treatment plans as needed.

Fees for follow up appointments:

• <1 hour with Meg/Dr. Manzanero = $225
  • $200 to see Sara
• 75 minutes with Meg/Dr. Manzanero = $325
• Each additional 15 minutes with Meg/Dr. Manzanero = $75
• Options available for short appointments, at the discretion of the provider(<20 minutes)
• Between visit correspondence is via secure messaging, and is part of patient care (i.e. no charge unless a detailed discussion is needed).  Limit of 2-3 follow up emails between appointments (per level of detail and amount of time required to respond to email).

If any labs or supplements are recommended, you will receive a link by email or via your patient portal for purchasing the supplements (which will show you the discounted costs). Estimated costs for labs will be provided at the time of the visit.

APPOINTMENT CANCELLATIONS:

We understand and respect that events come up that necessitate cancellation of an appointment. However, please respect our time and contact us in an appropriate time period (at least 2 business days prior to your appointment), if you need to cancel or reschedule. Cancellation fees may apply (see billing policies).

Email Policies

We can answer many questions at no charge, but please respect our time and follow the guidelines noted below. We prefer written questions and concerns be submitted via the patient portal, which has a security system in place to protect your personal information. Traditional email and text messages are less likely to be secure.

Complimentary email response guidelines:

• We will respond to emails if we have conversed with you via a paid office appointment, within the last 6 to 9 months. Any time beyond 9 months requires an appointment, per pricing and time discussed in the billing section of this guide.
• Content must be relevant to your health situation, and what you have previously discussed with your health care provider.
• Please be respectful of our time, and limit email questions to 2-3 between appointments, allow follow-up responses within 48 business hours, and have patience with us if we are unable to answer your questions in a satisfactory way. It may take 3 minutes to write an email, but we must correlate your information from your medical record with the information in your email, and a response may take more than 15 minutes to formulate an appropriate response.
• If labs were ordered via another practitioner, and they are relevant to our work together, we will advise accordingly. If a significant amount of time and/or more information about your current health situation is required, and/or a new prescription or supplement is recommended, we cannot interpret/evaluate the results without a follow up appointment (priced per the billing section of this guide).
• At any time, it is a practitioner’s discretion to determine the actions or recommendations resulting from an email communication.

VISITS WITH PROVIDER

Payment is due when services are rendered. We accept all major credit cards, HSA/FSA debit cards, and checks. We do not carry cash in our clinic, so we can only accept cash payments if the amount is exact (i.e. no change needed).

We do not send invoices to patients or insurance companies, nor do we coordinate with insurance companies on your behalf. We prefer to focus on patient care, not on insurance care. We can, however, provide you with an itemized invoice at your request, so that you may work with your own insurance company for possible reimbursement.

CANCELLATION/REFUND POLICY

We understand and respect that events come up that necessitate cancellation of an appointment.

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

Refunds on appointments:

If an appointment is completed, we do not offer refunds. We do our best to provide the best coding for insurance coverage (not easy when all insurance companies have different rules!). If your insurance decides to assist in paying for the appointment, it is up to the insurance company to decide how much to reimburse you for our services.

DECLINATION OF CREDIT CARDS AND CHECKS

We will add a $25.00 charge or 3% of the total invoice, whichever is greater, onto your account for each credit card or check declination.

LABORATORY TESTS

We have negotiated lower costs for some lab companies, and refer patients to other companies where they can pay for recommended tests.

At CCM, we do not make any profit from lab tests. If you pay for a lab through us (versus paying a lab directly), it is because we get a significant “account discount” which we are able to pass on to our clients. If you are paying us for such an “account discount”, payment is due in full. If you do not follow through with that test, we may be able to refund you in full (depending on the lab).

Refunds on lab tests

• If a test has been performed, we are unable to provide a refund.
• If the test was not complete (which can happen via client mistake, or when a collection site doesn’t collect specimens correctly), any partial or full refunds need to be taken up with the lab company.
• Typically, test kits are provided at no charge. If a test company does charge for the kit, refunds for such tests (if not performed) will need to be determined. If you do not complete a test and have received a kit, we’d appreciate returning the kit (if unused).

OUR USE AND VIEW OF SUPPLEMENTS

Supplements are intended to “supplement” a diet that is deficient in certain nutrients. At CCM, we are aware that unless we are consuming 9+ cups of organic vegetables today, there are some supplements that are often required for maintaining health.

• Please note that although we provide patients with the opportunity to purchase supplements through CCM, patients always have the option and freedom to buy elsewhere, with the understanding that non-vetted retailers or supplement brands may not be as effective as those recommended by CCM.
• We do ask, however, that if you decide to buy them elsewhere, you purchase the specific brands that we recommend. If you purchase other brands, these may not work as well as, or may even be detrimental to your health (for example, there are over 10 chemical forms of magnesium, and not all do the same action).
• Supplements are not equal in quality, and multiple studies show that 4 out of 5 supplements sold over the counter don’t even have any of the substance they claim to have (but they’re really good at marketing!).

SUPPLEMENT PURCHASES THROUGH CENTER FOR COLLABORATIVE MEDICINE:

• CCM has vetted various supplements, and determined the best quality options for which patients have an option to purchase.
• Providing supplements to patients at a discount is a service that CCM provides, to ensure patients have the option of choosing a supplement that meets professional standards. CCM chooses to sell these supplements at a signifiant discount, and patients are never required to purchase these.
• CCM is an affiliate of professional supplement retailers, sold either directly or via Fullscript, which means we make a small profit off of supplements sold (for example, CCM profits around 10% of each supplement sold via Fullscript, compared to 40-50% profit that would come from selling these at “MSRP”). These profits contribute to continued practitioner education in functional/integrative medicine, which serves to benefit patient care at CCM.

Refunds on supplements:

• If you purchase supplements in person from CCM, unopened supplements with expiration dates 6 months from date of return are eligible for a full refund. If you purchase via Fullscript, please contact Fullscript for information on their return policy.
• We cannot issue a refund for opened supplements that were purchased on site from the CCM clinic.

INSURANCE RESPONSIBILITY AND CLAIMS MANAGEMENT:

• In a perfect world, insurance premiums would not be so expensive, and/or insurance would reimburse better for time-based services!
• At CCM, we do not contract with insurance companies so that we are able to provide personalized services. We also do not participate in health plans or government payers, nor do we accept assignment from any other payer, including employers.
• CCM strongly recommends that all patients maintain health insurance coverage.
• The patient is responsible for all charges and fees incurred for treatment or services rendered, regardless of any insurance coverage.
• Insurance reimbursements vary significantly, and CCM makes no representations as to what services may or may not be covered under any insurance or health plan, or by any government payer, such as Medicare or Medicaid.
• CCM will reasonably assist the patient, when feasible, with documentation for submission for possible reimbursement.
• Ultimately, the decision to reimburse is determined by the individual companies that provide insurance or health plan services.
• ***With the above information in mind, however, many patients receive up to 50% reimbursement from their insurance if insurance has out of network benefits (CCM creates the invoice, patient is responsible for submitting to insurance).

NATURE OF SERVICES PROVIDED

Please note that CCM does not function like a traditional doctor’s office. CCM’s services include medical care, related health care and/or nutrition services, and treatments or procedures provided by health care professionals. Although our providers are trained in primary care services, we do not provide many of the services that a primary care provider can provide (e.g. vaccines, insurance-covered yearly health exams, etc). We highly recommend that you have a health care team beyond our services. In particular, we find that most patients will benefit from having a primary care provider, a counselor/psychologist, a health coach, and alternative practitioners such as massage therapists and acupuncturists.

We do not have a receptionist on staff to answer the phone. We do return voicemail messages during specific hours each day, and our web-based Electronic Health Record is the primary means of communication.

We do not handle emergencies and it may take us up to 48-72 business hours to respond to your inquiry. If you are not comfortable with this, CCM will probably not be a good fit for you.

If you experience an emergency, please call 911 or visit the nearest emergency room.

After evaluation, please let us know about your situation, so we can advise the next best step. Communication between health clinics/pharmacies is often not efficient or reliable, so please realize that we may not receive any documentation of your visit with another health care provider.

Place of Services

CCM is a professional limited liability company, organized and practicing under the laws of the State of Texas. Members of its clinical staff are licensed to practice their respective health care professions in Texas, and in no other jurisdictions, pursuant to the laws, regulations and standards of practice of the State of Texas. Patients treated or serviced by telecommunication, or other electronic modality, are deemed to receive treatment or services in the State of Texas, and not in any other jurisdiction. Any disputes concerning the rendering of services will be subject to the laws, regulations and standards of practice of the State of Texas, and any suit against CCM must be brought in Texas, pursuant to the Agreement between CCM and its patient.