Comprehensive Heart Care
Policies of Comprehensive Heart Care
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Office Hours: Monday and Wednesday 8 AM - 5 PM EST, Friday 8-4, and Tuesday & Thursday 8-2. The waiting room is open but staff are not available between 12 & 1 PM. 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 Call Policy - Basic Points:
2. The office phone number is 419-531-4235. This is the only number to which we will respond. If I am in communication with you outside of office hours (Tuesday AM phone consults or responding to an urgent page when I am running) I will call you from my cell phone. This is not a number for you to store or share or call in on; here I only answer calls from family and friends
3. Calls coming in outside of office hours will role over to our answering service. In an urgent situation they will take your name and number and page me. I call them back and they connect me to you. In a non-urgent situation, they will record your message and fax it to the office, such that we can take action later that day or the following morning. Your discretion and judgment here is important. If you are in crisis, first call 911, then call 419-531-4235, and I will get back to you as soon as I can (it is going to take at least five minutes for the back-and-forth call hook ups). If the situation is not a crisis but is time-sensitive (BP or HR variation not responding to your planned meds, an adverse treatment reaction, or an issue that you don’t think can safely wait) then have me paged. However, it is inappropriate to have me paged for non-urgent or convenience related issues (prescription refills or scheduling issues). Remember, I am in solo practice with a beeper glued to my waist 24/7. Please respect my time as you would want others to respect yours.
4. I see
patients, and we provide IV infusions and EECP, on M, W, & F. We take calls
8:30-12 and 1-4 (stopping at 3 on F), but for non-time sensitive matters,
this is the worst time to call.
5. There will be times when we simply cannot answer the phone (a staff member is sick or office urgencies capture our attention). If we do not pick up on the 8th ring, the call will be routed to our answering service (or you can hang up and call again later that day). We do not wish to inconvenience you, but please remember there are 100s of you and only six of us.
6. When you call in with a concern, the more precise your request, the better. Statements like “my BP or HR is going all over the place” doesn’t help me to respond. Please give us numbers and other data (what meds you took and how you feel). Periodically I update your treatment lists and provide you with a copy; please have this available when you call and when we call you back. Make it easy for us to help you. Often it is better to put your concern in print and forward it to us (those of you who want my best decision making already do this).
7. Please give us time to get back to you on non-urgent matters. Urgencies will be brought to my attention or will trigger a page if I am not in the office. Non-urgencies will be dealt with, but not overnight. Typically, I have a 1–2-week backlog of phone calls, pre-authorization forms, pre-op clearances, and other paper work issues on my desk. Calling in day after day to push me will not speed things up.
8. Call coverage backup. As stated, a beeper is glued to my waist. When I am out of beeper range (they know when I am traveling), our answering service will call me on my cell phone. If I do not answer in a reasonable period of time (in the air, on the road or on a beach outside of cell coverage) they will contact Shelley Smelcer, our IV/EECP nurse. She will make a recommendation to you and transmit the interaction to me. If the issue is one that Shelley alone cannot resolve, and if I cannot be reached, then you will be directed to Drs. Karamali or Cassavar (who cover for me at Toledo, Flower, and McClaren-St. Luke’s).
9. Please be considerate regarding the value of our time. As a younger physician, I spent 90% of my time in the hospital, managing crisis and carrying out invasive procedures; a low overhead, well compensated, and favorably regarded approach to health care. No energy was spent on prevention and questions were not generated. My focus has changed (why you are seeing me). Rather than being the guy doing the most invasive procedures, my goal is to move heaven and earth to keep you out of the hospital, out of the operating room, and out of harm’s way (if you need an invasive procedure, then you need an invasive procedure, and in this situation, I will help to coordinate it). My approach is time-consuming and detail oriented, it is not well compensated nor is it supported by the local medical community, but it does generate a lot of phone calls. When you see me in the office, you and/or your insurance compensate me. Phone calls are free (because I am paying for them). A staff member answers the call, pulls your chart, writes down a message, and then places your chart on my desk. When I get a chance, I spend my time (basically nights and weekends) responding with a written answer, that is later transmitted back to you over the phone or in writing.
10. We do offer out-of-office phone consults, typically T AM and F after office hours. These are not insurance covered but allow you to pick my brain for 15-120 minutes (and you receive a detailed write-up). In relation to the Covid pandemic, Medicare is covering telemedicine and (for brief calls) phone visits (many private insurers also cover telemedicine), and these interactions are available to you.
11. It is
expected that patients will have questions/concerns, and it is part of the
doctor-patient relationship that I respond to your concerns, but a minority
of you are taking advantage of me.
Please provide to us (before your visit):
Nutritional Supplements: I will recommend nutritional interventions to most of you; I have a great deal of knowledge and experience in this regard. However, my knowledge can not help you if you take poor quality supplements. Thus I will recommend specific supplements manufactured by nutraceutical firms I trust. Our website contains links to these manufacturers and we will also provide you with the specific supplements code numbers to facilitate on-line ordering. The only supplements that we will carry in office are those that cannot be ordered on-line. You can obtain supplements from any source you like, but then don't be surprised if the results are sub par. I will emphasize supplements manufactured by Metagenics and Designs for Health. Other supplements can be obtained via Wellviate, a re-seller for multiple manufacturers. Many of the supplements provided by specific manufacturers are available in local Health Food stores and Compounding Pharmacies, and this may be more convenient for you (but again obtain the specific supplement recommended).
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. If you chose to undergo testing that is not covered by your insurer (e.g. Carotid IMT or testing for Heavy Metal Overload), 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, anti-coagulant monitoring - basic testing that all cardiologists carry out in the office setting) will be billed to your insurer, and you will be responsible for the co-pay, just as with your office visit. We will tell you, to the best of our knowledge (keeping in mind that insurers may change their policies without telling anybody) just what your anticipated co-pay will be.
Prescription Refills: This is best done in the
context of an office visit. Bringing in a list of what you need will
make it easier for us to refill your meds (staff members can begin to write
out the scripts during you visit with Dr. Roberts). If a refill needs to made
outside of the office visit setting, please ask your pharmacy to fax us a
pre-printed refill request. If this is not possible then it is best to
contact us on a Tuesday or
Thursday (we see patients Monday, Wednesday, and Friday and on those days
wish to devote our energy to direct patient care). Having me paged for an
after hours med refill is not OK.
Preauthorization Letters: If we need to obtain preauthorization for an office procedure, then we will endeavor to do so. Sometimes this involves me writing a letter or speaking with a physician employed by your insurance company. We are not going to charge you for this effort. Regarding prescription medications, however, insurers are inundating us with pre-authorization demands if I prescribe anything other the lowest cost agent for the conditions that we are addressing. The lowest cost agents are typically not the best agents, nor are they the safest agents available. They make ridiculous time demands such as "if you do not reply within 48 hours the prescription will be cancelled". This is asinine; pre-authorizations are not a medical urgency. When I write a pre-authorization letter, I am not working for free. Rather I am working at a loss, as I have to pay my staff to type and process the letter and the associated paperwork. The rationale for these pre-authorization requests is not to optimize your medical care. The rationale is for your insurer or some middle man drug providing agency to save money. It is not reasonable for me to lose money so they can save money by forcing you to take second rate drugs. Now, I will write these letter, and I will fill out these forms, and I will do my best to justify why a specific agent is preferred, but I reserve the right to charge you $25 for each letter that I write and for each form that I fill out. This is only fair.
Medical Politics: Leave this at the door. We are interested in taking care of you. We are not interested in dealing with name calling, nay saying, 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 Dr. Roberts often refers patients to other Cardiologists for angiography, bypass surgery, 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 possess any deep secrets of Cardiology that Dr. Roberts is unaware of. He's been practicing Cardiology for 35 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; Dr. Roberts does research for big pharma, new device manufacturers, and for the National Institute of Health). The guys who criticize Dr. Roberts today for chelation therapy or EECP are the same guys who criticized him 35 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 has carried out thousands of heart catheterizations and other invasive procedures, 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 personally strong people and we do not want to spend time dealing with them. Dr. Roberts receives 0% of his income from hospital panels or drug company grants. Most of his patients are self-referred or referred by out-of town Integrative Practitioners who think like he does. Thus he is beholden 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.
Out-of-office cardiovascular/radiology testing: For certain cardiovascular tests (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, ultrasound, 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.
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.