INSURANCE

Starting January 2022, the Center for Complex Neurology, EDS & POTS (The Center) no longer contracts with any insurance provider. We deeply regret the impact this will have on patients, but caring for a complex population using the insurance model as it currently exists is not sustainable.

We do not submit medical claims on your behalf; however, we will provide you with a superbill that you may submit to your insurance company for possible reimbursement. At least partial reimbursement may be possible if you have out-of-network coverage (this will depend on your insurance). We cannot request or accept single case agreements.

Dr. Saperstein no longer participates in Medicare or Medicaid programs. If you are a Medicare, Medicaid or AHCCCS member and wish to become a patient of the Center for Complex Neurology, EDS & POTS, you are required to accept the terms and conditions set forth in a private contract between you and Complex Neurology, LLC. This private contract outlines that no Medicare or Medicaid payment will be made to you or to Complex Neurology, LLC for the services provided by Dr. Saperstein or the Physician Assistants, even if such services are covered by Medicare or Medicaid. Under this private contract, you acknowledge that you accept full responsibility for all charges for services provided by Complex Neurology, LLC and that payment is due in full at the time care is provided.

Laboratory, imaging, other diagnostic tests, as well as medications and infusion therapies ordered by providers at our Center should be covered by most insurance companies and Medicare, but it is your responsibility to verify whether this is the case for your specific plan.

A federal law called the CURES Act prohibits anything ordered by a provider who is not registered with AHCCCS or Medicaid from being covered. So, if you have AHCCCS or Medicaid you will need a primary care or other provider willing to order tests or treatments; we will not be able to do that.

VISIT FEES AND TYPES

Our current fees are based on those of practices across the country that care for similar patient populations. We offer different levels of care based upon your personal medical needs and the amount of provider time we anticipate your will need. If your appointment takes longer than expected, you will be charged at the provider’s hourly rate.

Please note that we require prepayment for the new patient consultation and post-consultation visits one week before your scheduled visit. We have had patients not show up for these appointments after blocking many hours for them and have a waiting list of other patients that could have benefited from those time slots. So as a Center, we feel this is the best solution for all parties.

If you need to be seen for a neuromuscular disorder, such as Charcot-Marie-Tooth Disease, CIDP, GBS, myasthenia gravis, myositis, or neuropathy, please call the office for a separate price list.

NEW PATIENT CONSULTATIONS

EVALUATION OF NEED

Prior to scheduling, you will be screened with your required information and a very detailed survey. The results of these will be reviewed by Dr. Saperstein to determine the type of appointment you will need. If it is unclear, we may need to have a short call with you or request medical records for a better understanding of your needs. We will provide, in writing, a good-faith estimate of the cost for your planned consultation. There are options to see Dr. Saperstein or a Physician’s Assistant, depending upon the complexity of your case.

COMPLEX NEW PATIENT APPOINTMENT WITH DR. SAPERSTEIN

The consultation includes 1.5 hours of face-to-face time with Dr. Saperstein, additional time for him to review outside records, review your history, symptoms (another 1.5 – 2 hours) and perform a detailed or more limited physical examination (depending on your circumstances).

Initial recommendations for additional testing and the development of a care plan will be presented at the end of the appointment and via orders and a detailed consultation report including impression and recommendations (another 1.5 – 2 hours).

This includes one 20-minute portal messaging exchange after the initial visit  Portal messaging can be used only for non-urgent, non-complex, and simple questions.

This does not include the post-consultation visit, which is recommended for most patients (see below).

NEW PATIENT APPOINTMENT WITH PHYSICIAN ASSISTANT

Patients with a more straightforward medical history, such as those looking for a diagnosis of Ehlers-Danlos Syndrome, or postural orthostatic tachycardia syndrome (POTS), not complicated by other issues, may be eligible for a new-patient appointment with one of our highly trained Physicians Assistants. These consultations will be billed at the Physician Assistant’s hourly rate.

POST-CONSULTATION APPOINTMENT

COMPLEX CASES

For those who have had the initial consultation with Dr. Saperstein, this is often the next step recommended once any additional testing or initial treatment is started.

This consists of 2 hours of Dr. Saperstein’s time, which includes up to 60 minutes of face-to-face time with Dr. Saperstein. This includes Dr. Saperstein’s time to review the initial consultation note, review and analyze–in the context of your personal clinical situation–all laboratory results and other studies ordered at the initial consultation, drafting a report for the encounter, and discussing results and next steps with you.

LESS COMPLEX CASES

For those with less complicated histories who see a Physician’s Assistant, this Post-Consultation Appointment will be at the PA’s hourly rate, at least 30 minutes are spent face-to-face with the PA.

PREPARE FOR A SUCCESSFUL VISIT

You are encouraged to organize and provide the most pertinent medical records to improve the efficiency and effectiveness of the record review process. We prefer records uploaded to our secure HIPAA compliant KLARA application. This will save on the time spent by staff and providers scanning and uploading your information to the consultation and ensure that pertinent information is reviewed.

Things we do want to see:

  • Laboratory Tests – positive and negative
  • Genetic Testing
  • All Cardiology Records including Echocardiogram, Loop Recorder, Holter/Heart monitor, exercise testing, and tilt table testing
  • All Neurology records – including EEG, EMG, NCV, Evoked Potentials, Cognitive Testing, Autonomic Testing, Epidermal Nerve Fiber Density (Skin Biopsy) test results, other neurological pathology reports (nerve and muscle biopsies)
  • All Rheumatology Records – including laboratory tests, diagnostic tests and clinical evaluations, treatments tried
  • All Allergy/Immunology Records – Including Mast Cell Activation Syndrome (MCAS) testing,
  • Imaging – all imaging of the spine or brain, including the actual images, which can be uploaded here [hyperlink for imaging website].  are essential.

To make the most of your consultation time, we recommend you organize your thoughts ahead of time to allow a focused review of your medical history and concerns.

CARE AGREEMENT

We understand that you may have many symptoms that are severe and disabling, but please understand that chronic, complex illness such as yours requires time, to assess and treat. It is not uncommon for our patients to require several iterations of treatment with us to find what works best for them

Our practice is designed to provide chronic disease management, not acute care. If you have a new symptom(s), you should be evaluated by your primary care provider to be sure that you do not have a new, unrelated problem. If you have worsening and/or acute symptoms you are concerned about, you should call 911 or be evaluated by the nearest urgent care facility or emergency department.

If needed, after evaluating you first, your provider can contact Dr. Saperstein during our regular business hours.  They can leave a message with the staff, and he will call them back.  As always, there is an on-call provider in case of emergency. However, for a consultation, with your physician, there may be times when Dr. Saperstein is unable to be reached. Please ask your provider to leave a message with their direct contact phone number and their call will be returned as soon as possible. Please note, if your provider leaves a general phone number such as the hospital emergency department line or their clinic’s mainline, their call will not be returned. Dr. Saperstein offers this as a free service when he is able, but it is not a guaranteed service.

If you are having an exacerbation of your illness that cannot wait until your next scheduled appointment, please put a note through the KLARA portal. We ask you to be succinct so that we can quickly triage your needs.

Once we review your message, we will schedule you for the next available appointment and/or add you to the cancellation list. Most medication changes and initiation of any new medication will be made during scheduled office visits after an appropriate evaluation. Medication changes will, generally, not be made over the KLARA portal or by having our office staff ask Dr. Saperstein or the PAs if they can prescribe a medication.

PAYMENT

Please note that we require a 25% deposit to schedule any appointment and prepayment for the new patient consultation and post-consultation visits will be collected, in full, one week before your scheduled visit. The deposit is only refundable up to 4 weeks prior to the appointment date. After that date, we do not refund appointment deposits. Unfortunately, we had to put this policy in place because we have had patients not show up for these appointments after blocking out many hours of time for them and we have a waiting list of other patients in need that could benefit from these spots.

For all other visits, the 25% deposit is still required and the balance of the estimated payment is due, in full, 24 hours before the date of service. We do not require a retainer, but scheduling an appointment requires an active credit card be placed on file so that you may be billed for services provided, including portal time and any other applicable fees.

GUARANTEE

We cannot guarantee your health will improve as a result of our care. We do have a very high success rate in making diagnoses and finding treatments that lead to an improvement in quality of life. This is always our goal, but as with everything in medicine (and life), nothing is 100% successful.

We do not provide refunds for our services.

ARIZONA PATIENTS

Due to the disabling nature of the diseases we treat, the Center offers remote telehealth visits for patients in Arizona.

Telemedicine consultations are billed at the same rate as in-person evaluations. We use secure, HIPAA-compliant systems for our telemedicine appointments. You understand and accept that there may be some limitations to care due to the inability to perform a physical examination or complete vital signs. If you do plan to take advantage of our telemedicine services, please ensure you have access to a strong wi-fi signal in a private, quiet location. If you have issues with your technology, our staff can assist.

We try to keep on schedule, but there is always a potential for Dr. Saperstein or the PAs to be running late for remote visits and we ask that you allow a 45-minute window after your scheduled time in case there is a delay.

OUT OF STATE PATIENTS

Our providers can see and evaluate patients from out-of-state and out-of-country in person at our office in Phoenix, Arizona. For patients who maintain a yearly in-person follow-up, we are able to communicate via our secure online portal, by telephone, or video appointments; however, you are required to have a local provider who will order your medications or treatments. Dr. Saperstein or a Physician Assistant will communicate with your local provider by telephone or email at no additional cost to help coordinate your care.  This communication, however, must be initiated by your local provider.

NO SHOW AND LATE FEES

Due to long appointment times, no-shows and late cancellations are particularly problematic and we ask for your help in avoiding missed appointments.

A lot of work is done to ensure we are ready for your appointment – collection of records and test reviews, organization of your record and ensuring we have the resources available to support you in the office.

For new patient initial consultation and post-consultation visits, the 25% deposit is not refundable after 4 weeks prior to the appointment. Any no-show or cancellation less than 5 business days of the scheduled appointment time will be charged 50% of the visit fee. Same-day cancellations or no-shows are billed at our full appointment rate.

For follow-up visits, the 25% deposit is refundable up to 5 business days in advance of the appointment. Any no-show or cancellation less than 2 business days of the scheduled appointment time will be charged 50% of the visit fee. If the reason for cancellation is your inability to get to the clinic, your visit can be conducted by telephone or using a surrogate if informed consent is provided.

LATE ARRIVAL

If you are late for your scheduled appointment time, you will be seen for the remainder of your scheduled appointment time and billed for the entire appointment.

NO SCENT POLICY

Many of our patients have mast cell activation syndrome (MCAS) and scents are a potent trigger for some MCAS patients. For this reason, we ask all patients and visitors to our center to please avoid wearing scented products.

MESSAGING

Our priority is to provide the best care we can to all our patients. To facilitate this, we offer our Klara Portal. Klara is a secure, 100% HIPAA compliant tool to communicate with our patients.

The Klara portal and other messages are intended for non-urgent, non-complex, and logistical matters.

If you have an urgent or emergent matter, please go to the closest emergency department or urgent care.

If you have a complex situation or question, please schedule a telephone or in-person appointment.

Given the complexity of our patient population, we receive a significant volume of messages that far exceeds that seen in most other practices. Therefore, there is a charge for this service if provider time is required. There will be no charge for simple and brief questions that can be answered by administrative staff.

Questions that need to be addressed by a provider will be billed at the current provider rate, in 10-minute increments. This time will typically include reviewing your chart and documenting the response.

Portal communication has its limitations.

Diagnoses will not be made over the portal and new medications will not be started over the portal. If you have new symptoms, you must be evaluated by your primary care physician or an emergency provider to be sure there is not a new condition unrelated to the condition(s) we are managing at the Center. If you have increasing symptoms, we will make every effort to try to fit you into the schedule, but this is not always possible, and you may need to see your primary care physician who can contact Dr. Saperstein or a PA if needed.

We do attempt to address portal messages as soon as possible, but given our small office staff, there may be times when we cannot get to your message for 24 hours or even longer, especially over weekends or holidays or if there is a staff or provider absence.

Our emails are not automatically encrypted, nor are they HIPAA-compliant. As a result, we prefer that all communication goes through the KLARA portal, which is HIPAA compliant.

Some patients may choose to carry out 5 to 10-minute portal-based “visits” which will cost about the same as a co-pay and allow for discussion of concerns or review of medication trials rather than waiting for an appointment. This kind of visit has several advantages, but also has some limitations and may work great for some patients, but not for others. It can be a great way to follow patients with MCAS undergoing frequent medication trials. However, periodic in-person or telemedicine visits are still recommended. Keep in mind that provider time involved in portal “visits” includes time to review your chart in the context of the questions or concerns raised and not just the time spent typing. If you communicate often, time spent reviewing your chart will be minimal due to regular involvement in your care and familiarity with your case.

PRIOR AUTHORIZATIONS

There are no FDA-approved treatments for dysautonomia, mast cell activation syndrome, or Ehlers-Danlos syndromes. These conditions are poorly understood by insurance companies. As a result, insurance companies often request extensive and time-consuming documentation to consider approval of many of the treatments used for these conditions. The number of these requests for our patient population far exceeds that of most other practices and we must charge for this service.

If your insurance company requires the Center to obtain a “prior-authorization,” provide a “letter of medical necessity,” assist in an “appeal,” or conduct a “peer-to-peer” physician consultation for medications, infusion therapy, imaging, laboratory tests, procedures, or other care, you will be charged a fee for this service. The fee for prior authorizations or other insurance company issues involving only administrative staff will be charged $50 per medication, other treatment, or service. Medical provider time will be billed at the provider’s rate.

An active credit card must be on file prior to the Center acting on the insurance company request(s) and you will be contacted first to be sure you would like us to move forward.

There is no guarantee that your insurance company will decide in our favor as a result of our actions, but we will make every effort to get the care you need approved.

OUTSIDE CONSULTATIONS

Dr. Saperstein and the PAs will discuss your case by telephone, KLARA portal, or email if needed with an outside medical provider free of charge, if this consultation is initiated by the provider, provided it is a to a direct phone number; clinic, urgent care  ED phone number.

If you do not wish for Dr. Saperstein or the PAs to respond to outside provides emails or telephone calls about you, please let us know in writing and we will make note of this in your electronic chart.

If you request that Dr. Saperstein perform a consultation with an attorney, school staff, or other non-medical personnel, you will be charged the current provider rate. These consultations must be approved and initiated by the attorney with written approval from you or your legal guardian.

TEST RESULTS

We are happy to provide you with medical records and test results in electronic format via our Klara app upon request, as required by the 21st Century CURES Act.

We appreciate that you are anxious to get your test results and to understand their significance. Please keep in mind that results on the tests we order are not always as simple as “normal” or “abnormal” and often require a provider to analyze them in the context of the larger picture. Therefore, explaining the significance of the results often requires a conversation.

We ask your patience in waiting until your next appointment to discuss test results. Be assured that if anything serious is found we will contact you immediately.

Routine monitoring labs (CBC and CMP) for patients on infusion therapy or certain oral medications do not require an appointment if they are normal.  If there are important laboratory abnormalities, however, a follow-up appointment must be scheduled, even a brief telephone appointment, so that these results and their potential implications may be properly communicated with you. Due to the complexity of the syndromes and diseases we manage, analysis of the labs requires an appointment.

SCHEDULING FOLLOW-UPS OR ADDITIONAL VISITS

Our office will send out two reminders via the KLARA app to schedule your appointment. If you do not respond to those, it then is solely your responsibility to schedule an appointment to review test results and how they may impact your treatment plan or diagnostic journey.

URGENT OR SIGNIFICANT RESULTS

Your provider here at the Center will review your labs when they are received. If there are any urgent issues you will be contacted as soon as possible.

If there is a test result that you are worried about and do not want to wait until your scheduled follow-up appointment, you may send a portal message, but you will be charged at the provider rate for the time spent reviewing your concerns. Please be sure to schedule your follow-up appointments at an appropriate time interval that will allow all ordered tests to be resulted prior to your appointment. For some specialty tests, results can take as long as 6-8 weeks to be finalized.

We do not guarantee that recommended laboratory studies or procedures will be reimbursed by your insurance company. It is your responsibility to ensure that laboratory tests, procedures or other tests ordered by the Center are covered by your insurance policy prior to these studies being completed. If your insurance company requires a different diagnosis code, we are happy to change the submitted codes if appropriate, to improve the insurance company reimbursement. If you request more extensive staff involvement to facilitate getting tests covered after the fact, you will be billed $50.00. If provider time is required for this reason, it will be billed at the provider rate.

PRESCRIPTION REFILLS

Prescriptions are best ordered during your scheduled office visit. We will order enough refills to last until your next recommended follow-up visit. The frequency of recommended follow-up visits depends on the stability of your condition and the medication(s) prescribed. No medications will be prescribed longer than 6 months out.

Certain controlled medications may need to be ordered on a monthly basis due to controlled substance regulations. The Center n does not automatically provide refills. You must reach out via our Klara Portal at least 3 business days in advance of running out. We recommend that you request them 7 days in advance, as these prescriptions require a provider to review and approve your prescription. Controlled substances require visits at least every 3 months to be renewed.

Prescriptions initiated by another provider should be refilled by that provider unless Dr. Saperstein agrees to take over the prescription. It is your responsibility to be sure you do not run out of your medication by scheduling office visits at appropriate intervals.

A new prescription or one recommended by another physician requires an office visit or telemedicine visit.

Controlled Substances:

We do not prescribe narcotics.

Prescriptions for other controlled substances (tranquilizers, non-opioid analgesics, and stimulants) require visits at least every 3 months along with an annual Controlled Substance Agreement.

MEDICAL RECORDS RELEASE

You are responsible for obtaining your medical records from other health care providers/facilities. Medical records from another physician or office can only be released to us with your authorization by completing a Request for Medical Records form. Please contact your other health care provider to obtain the records that we have identified as pertinent to your Complex Neurology, LLC evaluation.

Your Complex Neurology, LLC records are available upon request through our KLARA portal. We will be happy to send electronic records to you at no cost and to the providers of your choice. The report is provided to you via Klara, a secure, HIPAA-compliant online communication portal.

Laboratory and other study results can be obtained directly from the testing facility.

If you prefer paper medical records, there is also an option for those.

We follow the guidelines for the State of AZ for fees charged should you request to have us print out your medical records. These guidelines from AZ State Statute 12-2295:

Per page:

Pages 1-50 $1.25 per page

Pages 51 -100 $0.96 per page

Pages 101+ $0.62 per page

Mailing and shipping are determined by the actual cost.

The medical provider may charge the actual postage and electronic media costs, if applicable, and any applicable taxes.