Return to Policies page                        Financial Policy of Comprehensive Heart Care, Inc. 

                                                                Medical Mutual of Ohio Insurance Company

Filing Your Insurance Claims
Dr. Roberts is not a preferred provider with MMOH. It is your choice (see attached sheet) to see Dr. Roberts as a non-preferred provider.  Your deductible and out of pocket co-pay may be higher than with a preferred provider. Our billing office will file your insurance claim for you, provided you have completed the patient registration form and signed a release allowing our office to forward to MMOH the information required to process your claim. Please bring your insurance card with you to your office visits.  If we do not have your current insurance information, you will be responsible for paying for services rendered.

MMOH may send you the payment for your visit with Dr. Roberts.  You are responsible for sending the payment and explanation of payment to us within one week from the time you receive it.  If you instead cash the check to yourself, you will be dropped from the practice.  MMOH will not pay Dr. Roberts directly, but our office will receive notification from MMOH that the corresponding reimbursement check was sent to you.  Sometimes these checks are for a great deal of money (fees for heart catheterization, stress echo, or for 35 hours of MME).  We have had patients who feel that it is their prerogative to profit off their illnesses; they cash the checks and keep the money for themselves.  This is fraud.  This is stealing - from Dr. Roberts, from his family, from his staff, and from his other patients.  Don't think that we will look the other way on this.  If you cash the check and keep the money you will be dropped from the practice and your account sent to collection for legal proceedings against you.  We don't like this system.  It makes no sense that the check be sent to you instead of to this office - but this system was forced on us by MMOH.  Our only alternative is to refuse to see patients with MMOH insurance.

Paying at the Time of Service
It is necessary that you pay all deductibles and office visit co-pays at the time of service. All supplements, patches, etc. must be paid for when you pick them up.  We will accept telephone or mail orders to send supplements/patches to you with valid credit card information.  You will not be able to purchase supplements/patches or schedule an office visit with Dr. Roberts if there is an outstanding or unaddressed patient balance on your account.  Basically, if you owe us money, and the amount is clearly defined, we want you to pay us before we provide you additional services. 

Collection Procedures
You will receive a monthly statement if there is a patient balance due on your account.  If you account balance is not paid within ninety days, collection action will be taken.  Please make every effort to keep your balance current and in good standing.  If special arrangements are required, please speak with the receptionist.  The receptionist will direct you to our Office Manager who can determine what arrangements are applicable to your situation.  If your account is transferred to an outside collection agency, you and your immediate family members will be terminated from care with Comprehensive Heart Care, Inc.  If you are terminated, you will be given a thirty day notice to seek a new physician.

I understand the above information and agree to comply with this policy.

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Patient/Legal Guardian/Parent Signature                                          Date

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Relationship to patient (if other than patient has signed)

Letter from Dr. Roberts to his patients with MMOH Insurance - Sept. 2005

Dear Comprehensive Heart Care patient with MMOH insurance,           

            On 6/1/5, I received a “Dear Provider” form letter, instructing me that as of 9/1/05 I would no longer be a MMOH preferred provider.  I wanted to know why MMOH had decided not to renew my contract, so calls were placed to MMOH, and I sent them a certified letter.  I am on several reading panels at St. Vincent’s (and have been for 20 years); here I contract with MMOH through the St. V’s PHO and an appeal for re-instatement was made via that route.  I have received no feedback or further information from MMOH, other than a form letter stating that I can be terminated without cause. 

            What does this mean to you?  If your contract with MMOH indicates that you can only see physicians on their preferred provider list, then you cannot see me after 9/1/05.  If this is the case, please get in before 9/1 so we can tie up any loose ends, organize your chart, and get you transferred to another doctor.  You can come to my lectures, listen to Heart Talk on the radio, and read my book (Reverse Heart Disease Now - John Wiley & Sons), but after 9/1/05 I will not be able to work with you. 

            Most of you have the same MMOH contract that my staff and my family have.  We can see whoever we wish, but if the doctor is a non-preferred provider, the co-pay is greater.  The check covering the portion of the provider’s fee that MMOH does cover is sent to the patient, and it is his/her’s responsibility to forward this sum to the provider. 

            How much greater will the co-pay be?  This is a good question, and one that I cannot answer.  It will depend on your plan, and how far along you are in meeting any deductible that may be present.  I can’t find out for you.  I can’t get MMOH to respond to my questions.  My understanding is that if at present you are responsible for 10-20% of a bill, under the new arrangement you will be responsible for more like 20-30%.  Please check with the benefits person at your work or with your insurance agent.  Hopefully they can give you the information you need to make an informed decision. 

            If you wish to transfer to another physician, then please do so with my understanding and assistance.  You must sign a release to send your records to another physician.  We will then copy your chart and send it to the doctor of your choosing.  If you wish to stay with me, please let the office know.  The logistics of billing as a non-preferred provider will be new to us, and here your cooperation will be needed.

            New patients with MMOH insurance will be admitted to my practice only with the specific understanding that they must promptly forward the MMOH re-imbursement check to this office, and that they will be dropped from he practice and sent to collection if they keep the money for themselves.

             If you must leave my practice, or if you choose to leave, please think carefully when selecting a new physician.  Medicine is changing, certainly for the worse, and you may find it a different world out there.  Don’t choose someone whose goal is to impress the nurses and hospital administrators with his cath volume.  Rather choose someone who takes pride in a low admitting rate, while treating the sickest patients in town.  You chose to see me on your own.  You weren’t herded in by any insurance mandate.  You chose me based upon your understanding of my training, attitude, and track record.  Many of you chose me because your angioplasty sites kept renarrowing or your bypass grafts clogged, and no one else seemed interested in determining why, or what could be done about it.   

Why is MMOH doing this?  They won't say.  They will not respond to my calls.  They will not respond to the registered letter that I sent.  Remember, I have been in practice for 20 years and have never been sued or sanctioned in any way.  I have been the first cardiologist in town to do a number of things, beginning with doppler echo 20 years ago and not ending with EECP 8 years ago and MME today.  15 years ago I was the leading cardiology admitter to MMOH's primary hospital.  I followed the "standard of care" and sent an awful lot of people for repetitive procedures.  Now I spend my time, energy, and resources teaching patients, and the public, how to stay out of the hospital, but if you do require admission, I will ask you to go to the "other hospital", and I do the bulk of my heart catheterizations at the "other hospital".  Makes you wonder - and that's all that we can do, given that MMOH and its proxies will not respond to my requests for information.

As stated above, if you must leave my practice, or if you choose to leave, please choose carefully in selecting a new cardiologist.  If you can find a better doctor, then transfer to him.  If you can’t, then maybe you should look for a different insurance company.  I know that some of you are going to be hurt by MMOH’s decision, and if you get hurt, this will hurt me as well.  This is the only way that these people can get to me.

                                                                                                                                                  Sincerely,
                                                                                                                                                                                                                                                                                                                                                                                                                                    James C. Roberts MD FACC

If you are insured by Medical Mutual in 2008 

Why see Dr. Roberts in the 1^st place?

There are 50 other cardiologists in town.  All are MMOH preferred providers.  If you see these physicians, your co-pay will be less.  MMOH transferred me from preferred to non-preferred status in 9/05 and they will not tell me why.  My hunch is that their reasons for transferring me are the same as your reasons for seeing me instead of one of the other 50.  So what is different about me? 

Let’s see, I have been in practice for 21 years and have never been sued or subject to any disciplinary sanction.  In medical school, we all took a national board exam on basic science, and I scored at the 98^th percentile.  My track record as an innovative and scientific physician, providing new approaches for my patients and the community, often years before they became available elsewhere, suggests that at age 52 my brain is still functioning well.  I also have the personal strength to implement change, even when it is not economically advantageous or politically correct.  At age 35, before I knew better, I was tied with 2 older guys as the leading cardiology admitter at my primary hospital.  I was well compensated (assigned to read all the cardiac echo studies 2 days a week and half of the nuclear cardiac studies), and was well thought of and well treated in the medical community.  But now, at age 52, I see sicker people, with recurrent, far more challenging and diverse problems, but need to admit them or direct them to repetitive invasive treatments far less frequently.  My track record, to the best of my knowledge, is as follows: 

 Over 2500 people outran me in Cincinnati last spring; my legs are no longer that strong.  My interest in medical science still is.  In 2007 we participated in three IRB-approved randomized double blind studies – separate evaluations of MME in diabetic neuropathy and chronic low back pain, and the NIH sponsored Trial to Assess Chelation Therapy (TACT).  This spring we will lead a similar study of MME in chronic congestive heart failure.  More research projects will follow.

My goal is to integrate the best of invasive/pharmacologic/surgical medicine with the principles of detoxification and nutritional optimization.  This is why I might carry out your heart catheterization and coordinate stent placement/bypass, and then organize a program of nutritional supplementation, metal detoxification, and reverse cholesterol transport to help keep you from plugging up again.  This is why I took criticism 20 years ago for recommending statin use for cholesterol control, 15 years ago for treating heart failure patients with beta-blockers, and 10 years ago for recommending antioxidants, fish oil, and treatments aimed at homocysteine, fibrinogen, Lp(a), and inflammation.  This is why I brought the concept of Doppler cardiac echo to St. Vincent’s, and with a colleague established the Nuclear Cardiology reading panel at the same institution.  I brought EECP to town 11 years ago and helped 800 people when no one else could, and now we are using MME to accelerate electron spin and stimulate stem cell activity, helping people for whom standard medicine has little to offer, ranging from kids with Cerebral Palsy to adults with Cardiomyopathy and Nervous System injury.  Nutrigenomic testing is the future of Medicine and we are doing it now.  I speak not infrequently at the meetings of the professional societies that I am affiliated with (ICIM, ACAM, IAOMT).  Just who I am and how I approach Medicine is discussed in Reverse Heart Disease Now, (John Wiley & Sons, publisher), a patient oriented book on Integrative Cardiology written by myself, Stephen Sinatra MD FACC, and Martin Zucker. 

Critics attempt to marginalize me with the “Alternative Medicine” label.  This is because they do not have the brains or drive to be innovative, nor the personal strength to bring on line a new approach that might help people but ruffle the feathers of others.  They can’t do these things so they apply labels, throw verbal stones, and occasionally try to make trouble for me.   

If you, on the other hand, want this approach for your medicine, then I am the physician for you.  But I want to spend my time helping you, not arguing with others, and not arguing with you.  I particularly do not want to spend my time and my staff’s time ensuring that you and your insurer pay us for the services that we provide to you. 

You will have to pay your bill promptly.  If you are going to pay your bill, why not pay it on time?  If you cash your MMOH check and spend it on yourself, I will drop you as a patient.  I also am going to insist that you respect the value of my time and that of my staff.  If you do not attend a scheduled visit, you not only waste a time slot that could have been used by another patient, but you waste the time I spent going over your chart (we get a lot done in a visit because I review your chart and prepare the night before), and you waste the time of my entire staff.  If you do not attend a scheduled visit or if you cancel at the last moment you will be charged $50, as per our “no show” policy.  If this becomes a chronic problem or if I feel that you behaved irresponsibly or callously then I will drop you from the practice.   

I will not spend time apologizing to you or anyone else why my practice is different, nor why your insurer will spend $100,000 for a high-risk second bypass but not a few dollars a month for nutritional supplements known to help prevent graft closure or improve outcome in CHF patients.   

Twice a year I give a lecture series, 10-12 two hour presentations that detail the science behind my approach and the treatments that I employ.  I can provide you with DVDs of these presentations, but if you cannot be troubled to attend these lectures or view the DVDs, don’t expect me to give you an individual lecture over the phone or during an office visit.   

I will not practice medicine based upon the information given to you by drug companies or TV adds.  I will not recommend things just because “all the other doctors are” i.e. “you have to take a statin”, “you have to take Premarin”, “you should eat margarine”, or “a high carbohydrate diet is good for heart patients and diabetics”.  I will not follow scientifically unsound “you have to’s”.   

I will listen to the recommendations of other practitioners, but I will not acquiesce to the wishes of a less knowledgeable or junior provider simply because he/she is your gate-keeper.  If your other doctor trashes an idea simply because he/she hasn’t read the appropriate medical literature, please do not expect me to respect that position.  I am 52 years old, have already graduated 3 kids from college, have a soul, and have no reason to ever compromise for political or economic reasons. 

I will carry out your heart catheterization and my beeper is on 24 hours a day, but I will not manage your care in the hospital (I just can’t be in 2 places at once, so 2 other cardiologists cover my hospital patients for me), but I will knock myself out to keep you out of trouble and out of the hospital.  I view an unplanned hospital admission as a failure on my part, and I do not like to fail.  

If this is what you want from a doctor, then please see me.  If this is not what you want, or if you do not feel that you can work with me within the above framework, then please see one of the 50 other Cardiologists who are MMOH preferred providers.                                                                                                                           

                                                                                                                                                                    James C. Roberts MD FACC                                                                                                                                                                                  1/10/08                                                                                                                                                       

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