Frequently Asked Questions
As a Functional Medicine clinic, we design a treatment plan that is unique and to you and your health needs.
What this means for you, our valued patients:
Our practice will not directly bill your medical insurance or Medicare/Medicaid for office visits. You can however, submit the claim to your insurance for reimbursement.
At the end of your visit we will provide you with an itemized bill with ICD-10 and CPT codes, which you can directly submit to your insurance company for reimbursement at your plan’s out-of-network rate.
You can still use your insurance for lab testing and prescribed medications.
Please note: Patients will be responsible to pay the office visit rate at the time of check in.You may use your flexible spending account (FSA) or health savings account (HSA) to pay for your visit.
Our office visit rates are as follows:
New patient visit – $350 (45-60 minute appointment)
Follow up visit – $175 (20-30 minute follow up appointment)
The benefits of Functional Medicine treatment:
You will now have greater flexibility in how you meet with Dr. Lundell. You can schedule an in-office visit, schedule a phone appointment, or schedule a Skype or Face Time appointment to meet with Dr. Lundell from your home, office, or any location.
Labs and prescriptions can still be processed by your insurance. Please check with your carrier to determine which pharmacies and labs are covered by your plan.
A health plan will be established based on your unique healthcare needs and goals, not on what an insurance plan allows. This puts you, the patient, in control of your healthcare outcomes.
With our treatment plan, we feel this will better enable us to provide the customized care our patients have come to appreciate and in ways that are more convenient and accessible for all of our patients.
Dr. Randy Lundell, DO
The fee for the 45-60 minute initial consultation is $300. Follow-up consultations (20-30 minutes) are $150.
How many times should I be seen?
Each patient has a unique situation and a plan will be customized for you. After your initial visit, a follow-up appointment will be scheduled in 4-5 weeks to review lab results and your treatment plan. If you are on hormone therapy, you will be required to have a follow-up visit every six months. Certain controlled prescription medications will require more frequent follow up appointments.
Because of the way that we practice medicine(Functional Medicine), insurance companies are not interested in having us on their insurance panel. Insurance companies don’t like that we run more in depth labs and spend money getting to root of your issues. They would rather we do minimal labs and just prescribe meds that are approved my them. More and more insurance companies are dictating to doctors how they should practice medicine. If you don’t practice the way they want you to, they will not reimburse you for the visit. In other words, are now running the medical industry and not the doctors that provide your care.
We won’t be billing insurance, but will provide a super bill for you to send to your insurance and they can reimburse you directly. The type of medicine that I and other Functional Medicine clinics provide, is not conducive to reimbursement by insurance. So, until insurance catches up with modern medicine, we have to follow suit with other functional medicine providers and go with patient billed insurance (PBI) only.
We do not accept any form of medical insurance or Medicare/Medicaid, we will provide you with an itemized bill with ICD-10 and CPT codes at the end of your visit and you may file that with your insurance company. You may also use your FSA or HSA to pay for your visit.
Your hormone prescriptions, while always bio-identical, often include a mixture of both drug company products and compounded (pharmacy made) products depending on your unique medical needs. While most insurance companies that offer pharmacy benefits cover the cost of drug company products, only some insurance plans will cover compounded medications. If you wish to determine coverage in advance, check with your insurance provider to see if compounded medications containing bioidentical hormones will be covered.
We recommend you check with your insurance plan to find out if there are any restrictions with your labs or prescriptions being ordered by an out-of-network provider. While most plans will cover the cost, there are some that may require orders come from an in-network provider.
Likely so, but every insurance is different. Make sure and check with your insurance company before having lab tests done.
Many employers offer a Flexible Spending Account (FSA) to their employees. These arrangements permit the employee to stow a portion of their pre-tax earnings in a special account for use on health-related expenses NOT covered by primary health insurance. Depending on the type of FSA, these arrangements may cover medications, office visits, program fees, vitamins & supplements. Ask your employer or visit the IRS FSA site.
You could likely use your Health Saving Account (HSA) for the above costs as well.
Hormones are self-administered once or twice per day via transdermal creams or patches (estrogen, progesterone, testosterone), oral capsules (progesterone, DHEA, pregnenolone, melatonin), sub-lingual tablets (melatonin, progesterone) or subcutaneous injections (HGH, HCG). Injections are relatively painless, using ultra-fine needles.
The bioidentical estradiol, progesterone and testosterone hormones we prescribe are derived from the wild Mexican yam or soy. These molecules are then modified to exact replicas of the hormones currently in your body. HCG hormone is human-derived, and HGH is produced using recombinant DNA technology. In every case, they fit the receptors in exactly the same way as the hormones in your body today.
Side-effects are often minimal and manageable when restoring hormones to youthful levels. Some patients report breast tenderness or swollen joints when first starting bioidentical hormone replacement therapy; these and other adverse reactions can be remedied by reducing the dosage. None of our patients have reported long-term side effects.
We do test cortisol levels when your history, exam and lab testing suggests that you may have an adrenal problem. We often use saliva testing for Cortisol as this allows several samples to be obtained throughout the day.
Whereas saliva testing may be accurate for hormones that circulate in high concentrations, such as progesterone, not all hormones can be accurately assessed using saliva. For instance, estradiol is typically present in picograms (trillionths of a gram!) Since we require extensive blood testing for each consultation, there is no need to collect saliva samples as well. All the hormones we assess can be accurately measured using the blood samples that will be collected already.
Bioidentical hormone replacement is perfectly safe after a hysterectomy. In fact, since the ovaries produce much of the testosterone in the female body, replacing this hormone is even more important.
You should continue treatment as long as you wish to see results or resolution of symptoms. Patients sometimes request to stop the treatment. If they ever consider restarting, we can assess their relative health by taking new measurements to determine if they would benefit from additional treatment.
In general, supplementation by exogenous (external) hormones will result in decreased endogenous (internal) production. However, the body tends to restore hormones to pre-treatment levels after cessation of treatment. If your own hormone production was low before treatment, it will most likely return to the same levels after treatment. As a result, most of the physical changes enabled by the program will gradually revert back to “normal”.
We currently restore testosterone using injections or transdermal testosterone cream, and HCG, human chorionic gonadotropin. Using the cream and injections, the testes will likely slow production of testosterone in response to (perceived) high levels. This condition also may result in minor atrophy or shrinking of the testes. HCG emulates luteinizing hormone, which stimulates the testes to produce their own testosterone, thereby preserving their function and size. This product is injected each 2 to 3 times per week by the patient using an insulin syringe. HCG can be prescribed in addition to the testosterone injections or transdermal testosterone cream.
The answer to the question of whether to cycle or not to cycle when undergoing bioidentical HRT (BHRT) is complex and depends upon many factors specific to each woman. It also entails a long discussion of the evidence for and against it at this time. Briefly, our current interpretation of available data is that while cycling may turn out to have benefits, there is not enough clinical trial data to mandate it for all patients, particularly those with a low risk of breast cancer and who have difficulty tolerating the fluctuation of hormones that cycling entails.
The menopause is defined as beginning on a single day–12 months after your last period. Your physician’s suggestion that you wait until you have passed this milestone reflects an antiquated view of a woman’s transition from the premenopause to menopause. The majority of women experience their most severe symptoms in the months to years leading up to this milestone. To wait for this single day would be to subject women to a year or more of unnecessary hot flashes, night sweats, mental fogginess, and bone loss. Our approach is to start addressing these symptoms as soon as they appear. They often begin several years before the final menstrual period, a time called the perimenopause. By so doing, we can avoid all the havoc that fluctuating hormone levels can wreak on a woman. Our approach is to smooth the transition from normal cycling through the menopause rather than to wait for a somewhat arbitrarily defined date.
Dr. Lundell always prefers to see his patients in person for the first visit, but then follow up appointments can be done by Skype or telephone consultations. Because testosterone can only be obtained by prescription and is a DEA schedule 3 controlled substance, the FDA and DEA frowns upon the practice of prescribing testosterone to patients without a doctor performing a physical examination. On the other hand, with the price of fuel so high, travel costs and the costs of time associated with traveling are becoming exorbitant.
With that in mind, Dr. Lundell has agreed to offer a telephone consultation to men who can provide our office with documentation of a physical examination by a physician, PA or nurse practitioner that includes blood pressure, pulse rate, height and weight, HEENT, neck, heart, lung, abdomen and genitourinary exam and especially digital rectal and prostate examination. The prostate exam must be documented as normal (in a patient with a prostate) and the exam must have occurred within 2 months of the scheduled telephone consultation before Dr. Lundell would be able to prescribe testosterone. In this way, a physical examination from your local health care provider can act as a proxy for the examination he would conduct if you were seen in our office in person.
The other information we would require prior to the consultation would include a blood test panel and the completed health questionnaire. The blood testing can be done at any laboratory near your residence, and the questionnaire will be e-mailed or faxed to you for completion upon sign-up and then needs to be returned to our office prior to the consultation.
Call our office at 801-504-6117 for details.
Or email us at firstname.lastname@example.org.