Policies of Comprehensive Heart Care

Comprehensive Heart Care and its affiliate practices, the EECP Center of NW Ohio and the Advanced Magnetic Research Institute of NW Ohio, address the health care needs of a large number of people.  Most of our patients live in NW Ohio, but many are coming in from out of town to receive treatments not available close to home.  You have certain expectations of us, and we have certain expectations of you.  It is thus important that we provide you with our policies in print and that you read and understand them.  We do not want to spend office time haggling over logistic, financial, and scheduling issues - we want to spend office time improving your health, so please review and take note of the following:

Office Hours:  Monday through Friday 8AM - 5 PM EST.  Patients are seen M, W, and F, so the best time to attend to non-medical issues (scheduling, obtaining supplements, non-urgent questions) is on T or R, when Dr. Roberts and his staff members are not involved with direct patient care.

Phone:  Comprehensive Heart Care   (419) 531-4235                             EECP Center of NW Ohio (419) 531-6254
             AMRI of NW Ohio              (419) 531-6256                              Fax for all three                   (419) 531-6256
Staff will be available to answer the phone during office hours; after hours emergency calls will ring through to our answering service. 
The AMRI line is open during the evening hours for calls pertaining to patients receiving MME treatment overnight.

New Patients:  We wish to spend 100% of your new patient office visit on your health evaluation.  We do not wish to spend this time struggling with insurance/referral issues or making last-minute calls for old records.  Please address these issues well before your first visit.  Dr. Roberts will review your prior records the night before he sees you, but not during your visit - do not expect Dr. Roberts to waste office time and overhead doing work that could have done the night before.  Please make sure that your records arrive well before your first visit - this is your responsibility.  We all hate to fill out forms, but by law there are certain forms that you must complete before we can see you.  Please do not expect us to waste time (our time and your time) watching you fill our forms that could have been completed earlier.

Timely Attendance:  We run a busy ship, but it is a tight ship, and we are usually ready to see you at the time of your visit.  If you arrive late, you will slow us down for the rest of the day.  It is thus critical that you arrive on time, and it is best if you arrive 5-10 minutes early; we might just be able to see you early or there might be some business/logistical issues to be addressed.  If you do not attend a scheduled visit, you not only use up a slot that could have been taken by another patient, but you waste the time that Dr. Roberts spent reviewing your chart the night before.  If you read the paper you know that reimbursement to physicians is going down, while our overheads are going up, just the same as your cost of living.  We are just not in a position where we can waste time and overhead.  New patients who do not attend their scheduled visit will not be re-scheduled.  Established patients who "no show" will be rescheduled, but will also be assessed a $50 "no show".  If this becomes a chronic problem I will ask you to leave the practice.   You can't expect us to bend over backwards for you if you cannot show us the courtesy of attending your visit.  Remember, we do not have health issues - you are the one who needs the help.  Likewise, if "pre-visit" labs were requested, get these done at least one week before the visit.  Don't expect us to scramble at the last minute calling for lab work done the day before your visit - and do you want Dr. Roberts to make snap decisions regarding your health care, under time pressure, after only a cursory look at your lab results, or in a relaxed, deliberate, and well thought out fashion?

Nutritional Supplements:  We buy certain nutritional supplements in large quantity from manufacturers who we trust, and then can sell them to you at a typically below-market price.  This policy has worked out well - we are reassured that you are taking supplements of high quality, and you are spending a little less money.  You are under no obligation to purchase your supplements from us.  We work closely with area health food stores and they do a good job of supplying my patients with high quality nutritional treatments.  If you do obtain supplements from our office than we request that you pay for the supplements at the time of purchase (yes-people have obtained their supplements on credit and then never paid, ruining it for those of you with integrity).  This policy applies to other consumables such as books and Bioresonance patches.  If you need a supplement, it works best if you come in for it on a Tuesday or a Thursday.  On Monday, Wednesday, and Friday we will be occupied with direct patient care.  Of course, you can obtain supplements in conjunction with an office visit.  Under special circumstances we can mail supplements to you, but there will be a charge for the time involved and the cost of postage.

Testing Not Covered by Your Insurer:  Waiting for your insurer to catch up with what we are doing means practicing at a 10 year-old state-of-the-art, and thus we carry out many in-house diagnostic studies that will not be insurance-covered.  Much of your cost will includes a fee that we pay to the outside laboratory that analyzes the test result.  If you chose to undergo testing that is not covered by your insurer (testing for Heavy Metal Overload, Medical Bioresonance evaluations, determinations of vascular elasticity and heart rate variability), then please be prepared to pay for the test at the time that it is administered.  Testing covered by your insurer (EKGs, stress studies, cardiac echo, cardiac output determinations, anti-coagulant monitoring - basic testing that all cardiologists carry out in the office stetting) will be billed to your insurer, and you will be responsible for the co-pay, just as with your office visit. 

Medical Politics:  Leave this at the door.  We are interested in taking care of you.  We are not interested in dealing with name calling, personality conflicts, or issues of character assassination that emanate from others.  We are proud of our work.  We are helping people who no one else in our area can help and this pleases us.  There is a great deal of science and/or experience underlying what we do, and if other Doctors can't be bothered to learn about it, then they really don't have any business commenting about it.  We consult with other Doctors all the time, and every week Dr. Roberts refers patients to other Cardiologists for bypass surgery, angioplasty and stent placement, electrical cardioversion, pacemaker or defibrillator implantation, etc.  Do not expect us to cower, or to alter our decision making, just to curry the favor of another Doctor who just doesn't know what we know.  We do not want to waste any time even discussing such issues.  Please remember, the other Cardiologists in town don't know anything that Dr. Roberts doesn't know.  He's been practicing Cardiology for 20 years, and was the first Cardiologist in NW Ohio to do a lot of things (doppler and color doppler echo, intra-operative and transesophageal echo, nuclear cardiology, chemical stress nuclear and echo testing, EECP, MME, and something new 5 years from now).  The guys who criticize Dr. Roberts today for chelation therapy or EECP are the same guys who criticized him 20 years age for prescribing statin cholesterol lowering therapy to patients with only a (then) "mild" elevation in cholesterol, between 300-325 mg/dl.  Science moves rapidly and those who chose not to keep up just love to be critics.  Dr. Roberts does a lot of heart catheterizations, and there are no tests or diagnostic modalities available elsewhere that we do not do or refer patients for.  Doctors and other entities who criticize us or pejoratively describe this practice as "Alternative"  are not intellectually sharp or spiritually strong people and we do not want to waste time dealing with them.  Dr. Roberts receives 0% of his income from hospital panels or drug company grants.  90% of his patients are self-referred so he is beholden economically to no one - he works only for you - all decision making is an integration of what you want and what Dr. Roberts thinks is best for you.

Referrals:  As a medical practice, we ourselves do not require a referral from your primary care physician.  If your have Medicare insurance, you must have a primary doctor of record, as we need to submit his/her ID number to Medicare along with our charge for services rendered - this is Medicare policy.  If your insurance plan requires a referral to me from your primary care physician (in NW Ohio this refers to Paramount, the dominant HMO), then we cannot see you without a referral.  It is your responsibility to obtain that referral well before your first visit.  My contract with Paramount precludes me seeing you without a referral; without a referral you can't even pay me out of pocket.  The people at Paramount are more than reasonable about processing and expediting the referrals, but it is your responsibility to obtain the referral from your primary physician.  If we do not have the referral at the time of your first visit than your visit will be cancelled and it will not be rescheduled and we will all have wasted a good deal of time and energy - so please obtain the referral. 

Lab work:  We do not draw blood or perform laboratory testing in the office (except for Coumadin anti-coagulation monitoring).  If lab work is needed, we will provide you with a prescription that lists the lab studies needed along with the corresponding diagnoses or diagnostic codes (many insurers insist on a disease/screening diagnosis before they will pay the lab for the study test results).  It is then your responsibility to have the lab work done.  Most insurers do not care which lab you go to, but if you have Paramount insurance you need to go to a lab affiliated with Promedica/Toledo Hospital and if you have MMOH you need to go to a lab affiliated with the Mercy Health System.  If you have questions, please check with your insurer (we know the policies of our major insurers, but some of you have out-of-state insurers and we do not know what their lab policies are).

Timing of Lab Work:  If you are begun on a drug that might interfere with liver function (a statin cholesterol lowering drug for instance), we will likely ask that you have your liver chemistries checked in 4 weeks, and then again with a repeat lipid panel before a follow-up visit in 3 months.  This means that the liver chemistries should be drawn in 4 weeks, and again at 10-11 weeks, along with the lipid panel, such that the information is available to Dr. Roberts the night before your follow-up visit.  The 4 week liver chemistry results will be checked when they come in and you will be notified if the results are problematic.  If you do not have the lab studies done, then obviously this information will not be available to the Doctor.  We cannot track who was supposed to have what blood work done at a given time - it is your responsibility to get your lab work done.  If the time comes around for your follow-up visit and the lab work is not back because you didn't have it done, then your visit will likely be cancelled (as what would be the point of it?).  Please do not wait until the last minute; there is nothing more frustrating than having lab work arrive 15 minutes after the patient's office visit - this doubles our work load and does not enhance your care.

Out-of-office cardiovascular/radiology testing:  For certain cardiovascular tests (carotid ultrasound, nuclear stress testing, and a few others) we will direct you to specific testing sites/physicians who we feel do the best work.  For other tests (CT and MRI scans) we do not have a preference.  Your insurer may have a preference, and that will trump ours.  We can assist you in scheduling the studies, but just as with the lab testing, it is your responsibility to get the testing done in a timely fashion.  We will respond to the report, but not until it reaches us.

Anti-coagulant (Coumadin) therapy monitoring:  Anti-coagulant monitoring is a tricky business - so many things - changes in diet, drugs, nutritionals, and you health condition can rapidly affect your anti-coagulant level.  If your level of anti-coagulation falls too low (referred to by patients as "too thick"), then you will be at risk for clot formation, the problem that led to the recommendation for Coumadin anti-coagulation in the first place.  Conversely, if the level of blood thinning is too great ("too thin") then you are at risk for bleeding.  Close monitoring is obviously critical, and best carried out by the physician who is making the changes in your medications/supplements/health condition that are most likely to affect your anti-coagulation level (and that would be Dr. Roberts).  If Dr. Roberts is to manage your Coumadin anti-coagulation, then we are going to insist that you have your anti-coagulation monitoring carried out in this office.  Testing here is fairly simple; a finger-stick blood sample is obtained and the result becomes available in a matter of minutes.  The result is placed on your anti-coagulation flow sheet and then brought to Dr. Roberts attention - we will get back to you with his recommendation within 48 hours.  If the result is markedly abnormal and Dr. Roberts is not in the office (doing heart catheterizations in the hospital) then we will contact him.  This policy has worked out well.  What has never worked out well was to have patients have their anti-coagulation labs drawn at an outside site, processed at some lab that we typically don't work with, then to have the results sent to us, either by mail or by fax.  Different labs have different normal ranges, and with Coumadin monitoring, test consistency is critical.  Often the labs would be sent to the wrong Doctor (the lab might miss-spell my name or send your results to my Dad's office).  Faxed reports can stick to the sheet on top of it in the copier (we get over 100 faxes/day) and get misfiled.  There are just too many opportunities here to drop the ball.  Thus, if you want Dr. Roberts to monitor your Coumadin anti-coagulation, then it must be done through this office.  If your anti-coagulation is being monitored elsewhere, that is fine with us, but if Dr. Roberts makes a med change that might alter your anti-coagulation level, he will direct you to have your anti-coagulation levels checked by your monitoring physician.  If you are undergoing EECP or MME, then Dr. Roberts will take over (over the short-term) control of your Coumadin anti-coagulation as these treatments will affect your levels (better blood flow to the liver will increase the metabolism of Coumadin).

Financial Policies:  My father is a physician; he enjoyed the practice of Medicine and I grew up wanting to be just like him.  In those days, physicians worried only about their patients and let others worry about the money.  Those days are gone; all physicians must worry about the money, but the smart physician of today sets out financial policies and then follows them, without exception.  Ambiguity is eliminated.  Our general financial policy, and one designed for individuals with MMOH insurance, can be accessed with the links below.  We will follow these polices to the letter.  You must sign these policies before we will see you and we will insist that you follow these policies.

                 Financial Policy of Comprehensive Heart Care                           Financial Policy for MMOH Patients