* understands that Direct Functional Medicine focuses on whole body health and wellness through the use of naturally occurring compounds as much as possible, and pharmacologic interventions when necessary and in the best interest of the client.
Functional Medicine is personalized care that blends conventional medicine with evidence-based complementary and integrative therapies. Recommended therapies may include, but are not limited to, nutraceuticals, traditional prescription medication, peptides, mind-body modalities such as meditation, yoga, and guided imagery, biologically based therapies such as vitamins, herbs and other supplements in oral, injectable and intravenous forms, injections of various prescriptive compounds for therapeutic purposes, nutritional recommendations, exercise recommendations, other systems of medicine-based therapies such as naturopathy and homeopathy.
Individualized care plans are evidence-based and custom-designed to meet the patient’s needs and goals. Evidence bases change frequently for Functional Medicine and recommendations are made with the evidence base currently known to the practitioner at the time of your consultation. These recommendations will very likely not be the medical/legal “standard of care”.
Functional medicine care does not include primary care services. Your primary care practitioner is the provider you will see for traditional “standard of care” protocols.
Patients will receive access to the Practice’s patient portal (Passport). This is only for practice to communicate to patients. We will not respond to patient medical concerns through Passport, these require an office visit.
Direct Functional Medicine never recommends stopping conventional medical treatment or care that is in your best interest.
INSURANCE CLAIMS. Patient acknowledges and understands that Practice is not a participating provider in any Medicaid, Medicare or private health care plan. Patient acknowledges and understands that Practice will not bill insurance carriers on Patient’s behalf for Covered Services provided to Patient, and Practice will not bill any health care plan of which the Patient may be a subscriber or beneficiary
Many labs can be obtained through LabCorp which can bill your insurance company.
Patient is responsible for understanding their insurance benefits regarding labs and deductibles. Practice will not communicate with your insurance company or LabCorp regarding your bill. Practice offers discounted rates through LabCorp that are often cheaper than what insurance provides. It is the patient’s responsibility to let Practice know which rates they wish to use. Practice in unable to change these charges once accrued.
TAX-ADVANTAGED MEDICAL SAVINGS ACCOUNTS. Patient will communicate with their HSA (Health Savings Account), MSA (Medical Savings Account), or FSA (Flexible Savings Account) benefit advisor to determine if charges constitute eligible medical expenses that are payable or reimbursable under their plan.
HEALTH PLANS. Because Practice is not a participating provider in Medicaid, Medicare or private health care plan, third party payers may not count expenses here toward any deductible Patient may have under a health plan. Patient acknowledges through this agreement that neither Practice, nor its Providers, participate in any health insurance, Medicaid, HMO plans or panels, and have opted out of Medicare.
Patient acknowledges through this agreement that Patient understands this care is not an insurance plan or a substitute for health insurance. Patient understands that this care does not replace any existing or future health insurance or health plan coverage that the Patient may carry. This care does not include hospital services, or any services not personally provided by Practice or its staff. The Patient acknowledges by signing this agreement that the Patient has been advised to obtain or keep in full force, health insurance that will cover hospitalizations, catastrophic events, and all other healthcare services not personally provided by Practice.
MAINTAINING SEPARATE PRIMARY CARE ACCESS. Practice does not replace care currently provided to the member by other care teams, such as internists, gynecologists, cardiologists, gastroenterologists, pediatricians, and oncologist or any other specialty care provider. Practice does not function as a primary care provider, rather the practice acts as an extension of the patient’s medical team working on root-cause resolution. Patient should not discontinue any prescription medications without first consulting their prescribing provider. Patient must maintain a relationship with an outside primary care provider to provider emergency and urgent care. Any disability or FMLA paperwork must be completed by Patient’s primary care provider. Direct Functional Medicine does not complete disability or FMLA paperwork.
If a member encounters a medical emergency and is not able to receive care from their primary care provider, patient is required to call 911 or report to the nearest emergency department.
NONPARTICIPATION IN LEGAL MATTERS. Patients involved in legal proceedings pertaining to consequences of symptoms regarding diagnoses, health, work capabilities, or disability, this is not a reason to seek care from Practice in anticipation of legal counsel. By signing below, patient affirms they are not currently involved in legal proceedings in regard to health (mental, physical or otherwise), nor do they intend to pursue legal proceedings related to their medical conditions. Should Practice be asked for expert opinion, witness, or paperwork to submit in a court case, patient agrees to pay $700 per hour for provider services in addition to fee to retain an attorney. A retainer to Practice of $20,000 is required. Practice does not complete paperwork for FMLA or disability.
INDEMNIFICATION. Patient agrees to indemnify and to hold Practice and its members, officers, directors, agents, and employees harmless from and against all demands, claims, actions or causes of action, assessments, losses, damages, liabilities, costs and expenses, including interest, penalties, attorney fees, etc. which are imposed upon or incurred by Practice as a result of the Patient’s breach of any of Patient’s obligations under this Agreement.
APPOINTMENTS. Patients cannot self-schedule online. Patients must call the office to schedule. All appointments must be paid for at the time of scheduling. No refunds for cancellations for missed appointments. One reschedule is allowed outside of 48 hours notice.
REFILLS: Medication refills require a follow-up visit. Please schedule this visit two weeks prior to running out of medicine. Refills will not be made without an appointment and cannot be sent to the pharmacy until that appointment occurs.
I understand if I have an unpaid balance to Direct Functional Medicine and do not make satisfactory payment arrangements, my account may be placed with an external collection agency. I will be responsible for reimbursement of the fee of any collection agency, which may be based on a percentage at a maximum of 35% of the debt, and all costs and expenses, including reasonable collection and attorney’s fees incurred during collection efforts.
In order for Direct Functional Medicine or their designated external collection agency to service my account, and where not prohibited by applicable law, I agree that Direct Functional Medicine and the designated external collection agency are authorized to (i) contact me by telephone at the telephone number(s) I am providing, including wireless telephone numbers, which could result in charges to me, (ii) contact me by sending text messages (message and data rates may apply) or emails, using any email address I provide and (iii) methods of contact may include using pre-recorded/artificial voice message and/or use of an automatic dialing device, as applicable. Furthermore, I consent the designated external collection agency to share personal contact and account related information with third party vendors to communicate account related information via telephone, text, e-mail, and mail notification.