CONSULTATIONS, REFERRALS, AND NON-COVERED BOUTIQUE SERVICES.

The doctor wants to do the best procedure for you. In complicated cases, the “best practice” or “best procedure” often requires a consultation, and occasionally requires a referral.

In the absence of a referral, Pre-Surgical, Post-Surgical or Intra-Surgical consultations are appointments where the doctor will meet with you and review your case history and discuss additional or alternative pathways. This is a specialist service, and is considered a “Boutique Service”. These are applied in specific situations – typically slightly complicated cases dealing with multiple providers or interventions, when pathways have already been defined or begun. Sessions like this may or may not include manipulative therapy.

When you began your most recent therapy, for example – a neurological or orthopedic surgery procedure or a surgical consult or referral –  that provider has responsibility for your case. It might be inappropriate to introduce another care pathway on top of that, until the first one has concluded or has been formally withdrawn. This is the healthcare equivalent of “Too Many Cooks Spoiling the Broth”. We do not want to corrupt or confuse your recovery pathway. In this case, we “consult”, but do not “treat”.

The only “consultation codes” that are reimbursable under insurance are those that come by referral. Most consultation appointments will be self-pay, non-covered services and could range from a simple scenario to a more complex situation where the doctor will take your information, research your case, request records, and in some cases request an actual referral. Not all requests are approved.

Self pay charges range from a simple consultation boutique fee of $35 to a more complex pricing structure that is typically not more than our self-pay intake charge, with one level of complication added.  As of 2016 that charge with one level of complication is $103. This charge might be applied on top of your co-pay if applicable, and also typically does not apply towards qualifying for a deductible. All of this is done with your best interests considered.

It’s important that you give us as much information as possible, and have the identities, addresses, and any available reports from other recent providers available for us when you are requesting care in multi-provider cases. It’s the “best practice”.

 

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