Our thorough, initial visit (if you are new to Dr. Figaro) lasts up to 60 minutes. It is a chance to tell your story and for me to listen. Our goal will be to create a road map to address your endocrine concerns and to improve your health. Please sign up for our portal before coming in (patientally.com) and fill out the necessary paperwork electronically. This saves valuable time so that we can focus our appointment on a solid plan. Please come 10 minutes early so we can maximize our time together.

Yes. If you want to come in earlier, please ask to be added to our wait list. If there is a cancellation, we will call you to see if you can come earlier.

In person! Labs provide us crucial information about your health. I want my patients informed and to understand what it means and how it contributes to their chief complaint. I use the information to create a treatment plan and want to be able to discuss this in person so your questions are answered. Sometimes this involves new medications or supplements. I don’t want you confused or worried.

This is up to the individual, depending on the complexity of your health concerns, and ultimately your motivation and willingness to get better. When treating chronic health problems, our visits should generally be more frequent so that we can attack the root cause and get you feeling better faster.

The following is a general guide for frequency of visits:

Come in ONCE YEARLY if you are:

• Super stable/have no new health goals
• Have no change in health over the last year

(Prior to that visit, we will need: yearly labs, based on your medical problem)

Come in TWICE YEARLY if you are:

• On medications, still evolving in your endocrine problem, but stable overall

(Goals: Refill prescription(s), assess effectiveness, make sure there are not major changes in your health)

If you are starting a new medication for a new problem, we suggest appointments every 4-6 weeks until stable, then every 3 months, and every 6 months for maintenance.

For women starting hormone therapy, you should notice changes in symptoms within 2-4 weeks. These therapies may require frequent adjustments and monthly follow-ups initially, then 12 weeks, 6, 9 & 12 months, in order to help you get the full benefit of therapy.

For men starting testosterone replacement, the first year of therapy involves the most monitoring for safety and effectiveness. Labs are checked at baseline 12 weeks, 6, 9 & 12 months. Once a therapeutic dose is established, we can lengthen our intervals.

The Heartland Endocrine Group patient portal is an online tool that helps streamline the process and provides a high rate of satisfaction for our patients. The whole idea is to have open access to some of your health data quicker. I review labs, imaging results and other medical reports and post them to your portal. These results are printable and are always available, in case you need to share the info with someone else. If you are not tech savvy, you could have a representative such as an adult child or spouse, manage your account for you.

In general, the portal is used for: scheduling, refill requests, quick yes-or-no questions, and bill view/pay.

All you need to create an account is a simple log-in/password combination.

I am happy to see you—irrespective of your insurance. I do not take any insurance, including Medicaid, TriCare or Medicare. Patients with insurance are billed in full at the time of service and can submit directly to their carrier; I provide a superbill to help you. I do not take workman’s compensation. It is your responsibility to understand your plan and what is allowable, including co-pays and deductibles. Large patient balances will preclude you from making future appointments.

I will not sign a contract with a health insurer that:

Abuses and bullies me by denying all my first claims.

Reimburses me so little that I may go out of business.

Leverages a $50 penalty against me when my patients accidentally go to out-of-network labs.

Charges me hundreds of dollars of “membership fees” before I’m allowed to see their patients.

Offers me a contract that dictates my responsibility for all legal fees if they determine I did something wrong.

All prescriptions need monitoring for therapeutic effectiveness and potential side effects. This is part of your treatment. If you don’t have refills, you most likely need your follow-up appointment. This is purposeful to prompt you to review our treatment goals. Please make an appointment before you run out. Refills require time, evaluation and management, so please plan ahead. I will review my prior notes and may deny script refills because of lack of follow up. I will not refill medications if you have not been seen in the past year. Refills that are not due to my error (not refilling during your visit), will cost $25.

Please provide the office at least ONE WEEK to prescribe a refill of your insulin, especially if your insurer let you know that a change has occurred on their formulary.  Some insurance companies require prior authorization before a medication can be dispensed if it is not on formulary.  In addition, insulin doses must be capped, according to insurer’s rules. If you are using more insulin than planned at the last visit, I need to know this in order to order more units for you, please do not ration your insulin due to your insurer’s administrative requirements, however, please give ample time for refills due to use of more insulin than expected.

A superbill is a form completed by medical practitioners that allows patients to be reimbursed directly from their health insurance companies. A superbill does not guarantee that an insurance provider will pay for the services provided. Each insurance plan is different, and it is your responsibility to contact your insurance provider and find out exactly will be covered. Many professionals do not work directly with insurance companies, choosing to work as out-of-network providers. This ensures that your doctor makes medical decisions that are purely based on professional expertise and not on health insurance policies. You can xall the customer service phone number listed on your insurance card. Ask, “I want to work with an out-of-network doctor, how much will you reimburse me?” Ask, “What is the best way to submit my claim with a superbill?” Be sure that your benefits are clear to you. Release Authorization: Be aware that should you choose to submit a superbill to your insurer, you are releasing medical information that is protected by law. This means you are waiving some of your rights to privacy and confidentiality. It is standard for your insurance company to keep a record of your diagnoses stated on the superbill as part of your permanent medical file. The superbill you receive from your doctor as well as a photocopy of your insurance ID card, front and back should be faxed to your insurer. Please keep a photocopy of all the documents you send in for your records.

Referrals and official forms require that I assess you and document why I think a certain therapy or documentation is necessary for your health condition. Often it requires exams, labs, vitals etc. as well as my time. I need to evaluate you in person in order to send a current and appropriate referral. Referrals often expire, while forms need to be reevaluated for necessity and documented. This is required by insurance. Please make an appointment.

It’s a cumbersome paper trail, along with phone calls and denial letters. It’s a way for your insurer to not pay for expensive things. Sometimes there is some algorithm they want me to use with drug therapy (fail first, try a cheaper drug first) or a specific code to cover it. I fill out forms, send notes and my rationale. I do not have magical powers over your insurance company to convince them to pay for things. I encourage you to speak to them about denials and find out about appeals. You pay for your plan and they listen much more to you than to me, since the reasons for denials are not medical (90%), they are financial.

Yes. Please feel free to call and see if there are any openings in the schedule. Let the scheduler know it’s acute and they can always talk to me about accommodating. I try to leave time at the end of day for this. Sometimes people call and cancel same-day, leaving last-minute openings.

Typical acute cases that I see include: sore neck with thyroid disease, hypoglycemia on current insulin regimen, side effects of hyperthyroidism or allergic reactions to medication for hyperthyroidism, needing a letter due to missed work.

A patient who participates fully in his/her medical care. E-patients see themselves as equal partners with doctors in the healthcare process. And E patient is informed, empowered, and savvy with health. With the change in information access patients have resources readily available. There are over 2000 published researched health articles a day (not including popular media). The medical databases house millions of research articles. We can’t all keep up. The goal is to collaborate as partners in your health journey. I’m open to listen to what you have read and bring in. I’m willing to read. I’m happy to direct you to good sources for information, I’m happy to recommend books. I do the best I can to stay current so we both benefit.