Our Approach to Health Care

Comprehensive  Heart   Care

        Policies of Comprehensive Heart Care

                                                                                                     
At Comprehensive Heart Care we address the health care needs of a large number of people.  Some of our patients live in NW Ohio, but most are coming in from out of town, to receive testing, treatment, and medical advice within our Integrative Cardiology framework.  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 dealing with last minute logistic, financial, and scheduling issues - we want to spend office time on your health, so please review and take note of the following:

Office Hours:  The office is open Monday and Wednesday 8 AM - 5 PM EST, Tuesday and Thursday 8-11, and Friday 8-3.  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 AM, when Dr. Roberts and his staff members are not involved with direct patient care.

Phone Call Policy - Basic Points: 

· The office number is 419-531-4235; this is the only number to which we will respond.

· If we area unable to answer, at eight rings you will be transferred to our voice-mail, to which we typically respond within 24 hours.

· In an emergency call 911, then call the office number.

· The best time to call for non-time sensitive issues is T and R, 8:30-10:00.

· Regarding time sensitive issues, our line is also open M & W, 8:30-12 and 1-4 , T & R 8:30-10:00, and F 8:30-3.

· Non-office hours calls will be picked up by our answering service.

· Our fax number is 419-531-6236,

                                                           
Phone Call Policy - Details and Rationale:

1.  The volume of calls that we are receiving, the majority of which are not time-sensitive, can interfere with our ability to respond to urgent concerns, and to provide direct patient care on office days.  Please consider our concerns and time constraints, and work with us accordingly, such that we can meet your needs and concerns, without unnecessarily compromising our own.

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 or Wed. PM phone consults or responding to an urgent page when I am running) I will call you from my cell phone (with caller ID blocked). 

3. On patient care days, if we are not able to answer your call in prompt fashion, your call will be rolled over to our messaging system. Please leave a brief message in the appropriate slot, which will be converted by the system into a typed message.  We check our messages periodically and then will respond to your enquiry.  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 M, W, & F, and we provide IV infusions and VSEL Activation on W. 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. 
T & R are devoted to non-invasive testing and paperwork catch up; on these days staff members have more time to focus on your non-urgent concerns.  Of course, there will be times when you need to call in on M, W, or F (you may be getting back to us with a call we made to you that day, or you are experiencing a health issue) but the more that non-urgent calls are diverted to T and R, the better for all of us.

5. 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).

6. 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 week backlog of phone calls, pre-authorization forms, pre-op clearances, and other paper work on my desk. Calling in day after day to push me will not speed things up.

7. Call coverage backup. As stated, a beeper is glued to my waist. When I am out of beeper range (the answering service knows 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 RN, our IV nurse, who has a background in hospital cardiac care.  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 seek medical attention (Drs. Karamali or Cassavar cover for me at Toledo and Flower Hospital - but you need to ask for them).   

8. 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 will 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.

11. We do offer out-of-office phone consults, typically T AM and W after office hours. You compensate me for these interactions, which allow you to pick my brain (and then receive a detailed write-up).

12. 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.
If you want, you can push me to take actions that most of you will not appreciate, but a better approach will be for you to appreciate the value of our time just as we try to optimize your health status.  Our relationship is purely voluntary, and if you wish more rapid and cost-free answers to your questions, you are free to transfer to another health care provider. Otherwise, your consideration in these matter is appreciated.

                                                                        
If you are interested in seeing me as a new patient, please keep in mind: 
At age 71, in solo practice, I am interested in preventing emergencies as opposed to treating them.  I will take an in depth look as to why you bear cardiovascular disease, and then we will take action to resolve the causes, and then to ameliorate/reverse your impairments.  This is slow and steady but incredibly meaningful work. Conversely, I am not interested nor equipped to provide emergency or repetitive urgency care. Thus if your primary concern is recurrent atrial fib, unstable hypertension, or recurrent admission with heart failure, then we are not a good match for each other (here you will do better seeing a member of a large CV group).

I am 100% committed to the concept of Integrative Cardiovascular Medicine.  This interest does not resonate with 90% of the health care providers in NW Ohio. On the other hand, I have developed great relationships with other Integrative Practioners in the region and beyond. If you are working with practioners in NW Ohio who we anticipate will be aggressively uncooperative (why only 20% of our patients live in Toledo), then we will politely decline to schedule you. 

I have learned a lot and want my knowledge to be put to good use. Thus we are very interested in working with patients with previously diagnosed CV disease, ideally who are working with other Integrative Providers, as opposed to seeing individuals with symptoms that may or may not be CV related (these work ups are important but we have only so much time available, and other Doctors can provide you with primary evaluations).

Thus when you contact us for a new patient visit, we will request that you send pertinent records (not everything listed below but key CV records), and tell us a little about yourself, what type of Doctors you are working with, and your health care goals.  This will help us determine whether you and our practice will be a good fit.  We will not respond to a EMR request from a Doctor who we do not know, to simply schedule you; we need to hear from you.

We have long-standing relationships with a large number of patients. We will knock ourselves out to help you, but I cannot serve as a primary care physician.  I will do my best to address issues that may come up during a CV visit, but I do not have the capacity, nor knowledge, to deal with many non-CV issues.  Thus it is best if you are also working with an Integrative Medicine primary care practitioner.

If this philosophy works for you and you can provide us the information we need then we will schedule your first visit.

Thus please provide to us: 

· A list of the medications and supplements that you are taking.

· A little about yourself, your goals, and your concerns.

· Pertinent records, such as:      
           a) Invasive treatment records (angiogram and intervention reports, bypass surgery report, etc).
           b) Non-invasive testing (representative EKG, echo, nuclear, stress study, carotid IMT, etc).
           c) Hospital discharge summaries and cardiology consultation notes
           d) Lipid and other risk factor lab data.
           e) Nutritional status testing (NutrEval or Metabolix studies).
           e) Toxicity testing such as metal challenge results.
           f) GI testing such as SIBO and GI-MAP findings
           g) Other test data or records that you feel might be relevant to our interactions (here it is better to send more than less).

With this information I will likely dictate a problem list, and, to save you an unneeded visit, I may recommend:
          a) Additional lab testing (most of you will have lipid data but maybe not other key indicators such as Lipoprotein (s) or Homocysteine).. Why not get these done pre-visit one?
          b) Carotid Artery Intima-Media testing and EndoPAT Endothelial Function testing can be done on a T or R AM (if you live out-of-town I can see you the following day, with the test results).
          c) If we plan ahead, we can get more work done in a single visit (saving your time and my time and your money).

Timely Attendance:  We run a busy ship, but it is a tight ship, and we are usually ready to see you at the scheduled time of your visit.  If you arrive late, you will slow us down for the rest of the day, compromising others.  It is thus critical that you arrive on time, and it is best if you arrive 10-15 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 to prepare for the visit.  If you read the paper you know that reimbursement to physicians is going down (why we dropped out of Medicare and Insurance), 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 lose their $200 deposit.  Established patients who "no show" (not attending a visit without canceling one business day ahead) will be rescheduled, but will also be assessed a $100 "no show" fee.  If this becomes a chronic problem I will ask you to leave the practice.  The $60 fee will also be assessed if you do not come in for a scheduled office study (e.g. cardiac echo or EndoPAT), as staff time that could have been spent helping others will be lost.  If you do not cancel an IV therapy visit the night before (the answering service will forward the cancellation to us when we arrive) and your IV is made up, then the full IV charge will be applied (we have to throw it away).  If  your visit is canceled because planned pre-visit lab work was not carried out (typically because you waited until the last minute or forgot), the $100 no show fee will be applied.  Thus if you wish to skip a visit or not come in for a scheduled study or treatment you are free to do so, and we are free to apply a corresponding charge.  We may call and remind you of a scheduled visit, but we are not obligated to do so.  "You never called me" is not a reasonable excuse.  "You never gave me a lap slip" isn't an excuse (when we show you the photocopy of the lab slip we did give you).  Severe weather is, and our office will be closed in the event of a level III snow emergency, and of course we will make accommodations for your unexpected constraints.  We can, at any time, convert an office visit into a phone visit.  Thus, if the weather is ominous, call ahead and we can make the necessary arrangements. Our staff will bend over backwards to help you, but you must reciprocate by keeping your scheduled visits.  I do not have the right to waste your time and you do not have the right to waste ours.  If these polices are not acceptable to you, then you are free to work with another medical practice.    

Nutritional Supplements:  I will recommend supplements (as well as drugs) to most of you. I know this literature well and have decades of 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 supplements that we will carry in office are those that cannot be ordered on-line, ones that may take weeks to arrive, and the commonly used agents that we can "put in your hand" to help you get started, and which your can then replenish on-line (or ones that may take weeks to arrive).  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 Fullscript, 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 I recommend).

We do not participate in Medicare or Commercial Insurance.  Please click on We are dropping out of Medicare and all Insurance as of 10/1/26.
Thus you are 100% responsible for our charges (please see chart below), which you must cover at the time of service.  If you are a Medicare or Medicare Advantage Beneficiary, as per Medicare Law, you cannot turn in to Medicare any charge originating from our office. If you have Commercial Insurance, you may or may not be able to obtain partial reimbursement (we can provide you with an itemized statement but we can not involve ourselves in this process).  Your HSA funds likely are applicable but check this with your HSA administrator.

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.

Treatment Lists:  It has been my long-standing habit to dictate a list of all of the treatments (drug and nutraceutical) that you are taking.  Please use these lists and mark up any changes that are made.  Periodically I will re-dictate your list with these interval changes.  Take your treatment list with you should you require emergency attention elsewhere.  It helps me and our staff if you utilize these lists.  If you call in for a refill and a treatment is on the list, then the refill is easy.  If not, then our staff must check with me and then I will need to review your chart, and thus action will be greatly delayed.  Please do not use your own hand written lists as opposed to our dictated list.  If you begin a new treatment that I am not aware of, please bring in a copy of the ingredients, and this will be placed in your chart.  Helping me stay organized helps us helps you.

Medication Preauthorization Letters:  Regarding prescription medications, 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.  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, or fill in a three page form, 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.  If I provide you with a prescription for an agent that I know will require a pre-authorization form (e.g.. PCSK9 inhibitor to lower LDL or one of the newer glucose control agents) then I will not charge you for the initial pre-authorization form, or for a corresponding one-year renewal.  If a second form is required for one of these agents (a hurdle placed by some insurers), or for pre-authorization for older agents that a new insurer may submit (e.g. digoxin, rosuvastatin, and IM testosterone that have been off patent for years but some insurers force us to complete lengthy forms), then 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.  I should not lose money working hard to keep you well.

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 40 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, PPC, EDTA, Cyclodextrin, VSEL Activation, and more to follow).  Dr. Roberts has done research for big pharma, new device manufacturers, and for the National Institute of Health.  The guys who criticize Dr. Roberts today for things they do not understand are the same guys who criticized him 40 years ago 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 you are referred, my practice will be to communicate with your referring practioners, in print, with your initial visit and at follow-up visits if a significant change occurs in your program (and I will forward lab/test results).

Lab testing:
Cleveland Heart (a division of Quest) will forward to us a color copy of your lab results.  You and I can also down load or print out the report from their website.  As I prepare for M, T, and W visits the weekend before, it is important that you get your studies done on time.  Many of the specialty tests I order (why you are seeing me) take time to process, so please allow for a two-week turn around time.  If there are no Quest Labs close to you, Lab Corp will run most of the studies checked on your Cleveland Heart.  In NW Ohio, Mercy and the Toledo Clinic labs will fax us your reports.  Promedica will not, but if we ask them, they will (you need to let us know).  We do not want to spend our time scrounging around on different servers, under time pressure, to fetch your results. If you undergo labs ordered by other physicians, and wish me to integrate the findings in to my analysis (which I am happy to you), then I need this data when I am preparing for your visit. Lab presented to me at the last minute will not lead to my best advice.  I reserve the right to not study these labs until your next visit. Most of our lab vendors will allow you to down load the report. Their contact information is depicted below:

 

Lab	Website
Cleveland Heart	https://www.portal.clevelandheartlabs.com/3.view
Quest Diagnostics	https://physician.quanum.questdiagnostic.com/
Labcorp	https://labcorplink.com
Genova Diagnostics	https://www.gdx.net/mygdx
Doctors Data	https://www.doctorsdata.com/sign-in/
Diagnostic Solutions	https://dslportal.wavefrontsoftware.com/
Sanesco/NeurolabDiagnostic Solutions	https://neuro360.app/

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 (local hospitals will make the results available to you, but do a lousy job or forwarding the results to me). Please push them to do so or print out a copy and mail it to us. .

Financial Policy of Comprehensive Heart Care, Inc.

As a result of our sincere desire to base all medical decisions on what is best for the patient, not what is best for the insurance company, we are no longer contracted with any insurance carriers.

1. All charges must be paid at the time of service and our treatment fees are the same for all patients, regardless of insurance coverage or not, as is required by law.

2. The contract with your insurance company to pay for a portion of your medical care is between you and your insurance company. By eliminating costs associated with billing, coding diagnoses and procedures, referrals, authorizations, payment delays, EOB reviews, claim denials, re-submissions, collection risks, and other managed care costs, we can provide patients a fair price for services without the administrative hassles and bureaucracy.

3. For your benefit, we will always provide you with a list of our fees before any services are performed. We recommend you contact your insurance carrier to verify your benefits so you will have a basic understanding of
how your insurance will reimburse you for services provided by our office. Unfortunately, insurance carriers are not always willing to provide their allowable fees or disclose which billing codes they will cover.

4. It is your responsibility to obtain all referrals/authorizations required by your insurance plan and to file your claim with your referral/authorization.

5. You will be given a completed Super Bill for you to file a claim with your insurance carrier. We recommend you contact your insurance carrier and request instructions for filing your claims.

6. Due to rising administrative costs and the numerous requests we receive, our office does not fill out “forms” from insurance companies.

7. Please Note: We do not charge interest, therefore, we are unable to offer in-house financing or payment plans. If you are unable to pay for your services in full with cash, check or money order, you may put the balance
on your credit card and make monthly payments to your credit card company.

 8. Our clinic is state-of-the-art and our entire staff is exceptional. Our service is superb. Nothing about our practice is “usual” or “customary” – terms employed to justify the comparison of our fees, designed to provide for complex medical diagnosis and treatment with superior equipment, to those allowed by outdated insurance fee schedules.

9. Medicare:  Dr. Roberts has chosen to “Opt Out” of Medicare. All patients who are on Medicare, or are eligible for Medicare, must sign the federally mandated “Private Contract” in order to receive services at our clinic. All services must be paid at the time of service and neither Dr. Roberts nor the patient may file a claim to Medicare for reimbursement.

11. Medicaid:  We are not accepting any Medicaid patients. We will only accept “Private Pay” patients. We will not file any claims to Medicaid for reimbursement of your medical services now or at any time in the future.

12. Champus/Tricare: We are not an active Champus/Tricare/Tricare for Life provider. We will NOT accept Champus/Tricare/Tricare for Life insurance, we will NOT file any claims to Champus/Tricare/Tricare for Life and we will NOT accept the Champus/Tricare/Tricare for Life fee schedule for reimbursement of our services.

13. ALL charges for attorney cases, workers compensation cases, accident and/or injury cases must be paid in full, in advance, no exceptions. We will not file any claims for insurance benefits/reimbursement and we will not provide any discounts/write-offs for insurance or workers compensation plans. By signing this document, you are agreeing to pay for our services in full and forego any insurance benefits/discounts.

I have read, understand and agree to the terms and conditions listed above.

Patient Name ________________________________________ Date____________

 Fee Schedule

                                                                                                                                                 (through 12/26)

        Dr. Roberts will review your chart and interval test reports, and update your records, well before your visit.  Post-visit he will dictate the visit and you will be provided with written instructions with respect to treatment changes and follow-up testing. In most cases, the dictation will be forwarded to you and to your other practioners (if you request) along with copies of pertinent testing. Compensation for these services is included in the visit fees. Please note that the estimated in-office times includes time for Dr. Roberts to dictate the visit.

IV Treatment Fees