Our practice focuses solely on endocrine care. Both of our endocrinologists are Board-Certified in Endocrinology. We use state-of-the-art technology, but strive to provide personalized care to every patient. We specialize in individualized diabetes education, and have an extensive insulin pump program that incorporates in office certified insulin pump trainers. Our electronic medical record (EMR) system allows our patients to have access to the Patient Portal, thereby serving as an additional means of communication and physician access. In addition, our physicians routinely perform convenient in-office thyroid ultrasound and biopsy (fine needle aspiration) using Afirma Thyroid FNA Analysis and gene sequencing.

A Physician Assistant (PA) is a health care professional that is licensed to practice medicine as part of a team of physicians. Physician Assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, counsel on preventive health care and may assist in surgery. Learn more about our PAs.

Yes, our providers require a referral from the healthcare professional who is currently treating/managing your endocrine issue. This referral should include your demographic information, your insurance information (a copy of the card), a clear reason for the referral, office notes, and all applicable lab results, as well as any imaging. Referrals are reviewed daily, and patients are contacted in a timely manner.

Yes. Even though your insurance company does not require a referral, a referral from your primary care or other treating physician allows us to involve them in your care, and provides for better communication. We can obtain necessary testing and records from your physician more easily. Our patients ultimately benefit when their physicians all work together as a team. When an insurance company requires a referral, it is actually requiring an authorization to be given to us by the referring physician to evaluate and treat you as a patient.

Please arrive 20 minutes prior to appointment time and bring the following items with you:

• Driver’s License
• Insurance Card
• Co-Pay
• New Patient Paperwork
• Copies of test results or lab work that your physician may not have provided to us. If you have not had lab work done within 8 weeks of your visit, please be prepared to provide a blood sample.
• All of your medications, including supplements and vitamins.
• Blood glucose meter (Please bring all meters, if you have more than one)
• Glucose sensor, if you wear one (i.e, DEXCOM, Medtronic)

Each time you arrive for an appointment you will be required to:

• Present a current copy of your insurance card, as well a Driver’s License, if either have been updated since your last visit
• Verify your current mailing address and phone number
• Pay your Co-Pay
• Pay any outstanding account balance

Your first appointment is scheduled for 40 minutes, but we ask that you allow 1.5 hours. Our providers are very thorough and like to make sure that you leave our office with all of your questions answered. If you are coming in for a follow-up appointment, you are scheduled for 20-30 minutes, but we ask that you allow up to an hour for these appointments.

Be prepared to request all prescription refills during your scheduled office visit. We will prescribe enough medication for you until your next regular visit. We do not allow call-ins for refills. Those must be completed through a request from your pharmacy or through our Patient Portal.

We are in-network with all of the major payers- Aetna, Anthem Blue Cross/Blue Shield, Cigna, and Medical Mutual of Ohio. We do accept Medicare, Ohio Medicaid, Caresource and Molina insurances for our existing patients, however we are currently not accepting new patients with Medicaid. We do not accept most plans offered through the ACA Marketplace Exchange. We are also not contracted with many of the exchange plans, so please contact your insurance provider for a detailed list of in-network providers.

We do not accept the following insurance types*:

It is your responsibility to bring your insurance card to each visit; however, in the event that you forget to bring this with you, please make us aware of any insurance changes as soon as possible. If your visit is denied by the insurance company, it is your responsibility to contact the insurance company to see if there is additional information that they may need from you.

As a courtesy to our patients, we will file claims to your primary and secondary insurance. Please note, your health insurance is a contract between you and your insurance company so it is your responsibility as the patient to make sure our physicians are covered under your plan. All insurance companies do not carry the same benefits so the services rendered to you in this office may or may not be covered. It is the patients’ responsibility to know what is covered and if you need a referral.
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To pay your bill online, please log-in to the Patient Portal. You can also pay your bill by phone, simply contact our office at 614-764-0707 and we'll be happy to assist you.

Payment in full of either your insurance copay or the complete cost of visit, if you are a self pay patient, is expected at time of service. We accept Visa, MasterCard, American Express, Discover, cash or checks. Please contact our office at  614-764-0707 and request to speak with our Billing Assistant if you need to setup a payment plan.

Our Patient Portal is a virtual office which allows patients and doctors to communicate easily, safely, and securely over the Internet. Patients are given secure passwords that allow them to log into their physician’s system to see their own private set of documents including labs, diagnostics and messages. Patients can also view their statements and make payment online through the portal.

For the basic interpretation, you can refer to the Lab Results page on our website. Your provider will interpret your labs and what they mean specifically to you, either at your visit the following week or in a web-message via the patient portal. If you are not signed up for the patient portal, one of the nurses will contact you with your results. If it has been more than one week since you had your labs drawn and do not have a follow up appointment, please contact the office to make sure that the results were received.

If you have been locked out of the Patient Portal, and know your user name, you can use the “Forgot Password” feature on the log-in screen. Once you enter your user name, you will receive an email, allowing you to update your password. Even if you are locked out, you will be able to reset your password and will be able to log in again. If you have forgotten your user name as well, you will need to call the office to have this information reset for you.

Download the MyPrivia mobile app to your device for access your patient health record anywhere.

Prior Authorization (PA) is a process in which a prescription insurance plan determines if a medication will be covered based on whether the patient meets the plan’s criteria for coverage of that medication. Common PA criteria include diagnosis, lab results, trial of other medications, and various details from a patient’s medical history.  

Not all medications require PAs. Each prescription insurance plan has a formulary (the list of medications they cover) and decides which medications on their formulary will have prior authorization restrictions. Endocrinology medications frequently require PAs, and our staff has dedicated Prior Authorization Specialists to handle these requests.

• The insurance plan defines the PA rules for the medication
• The prescription claim is rejected at the pharmacy without an approved PA
• A PA request is sent to the doctor’s office
• The doctor’s office answers questions and submits clinical information for the PA request
• The records submitted by the doctor’s office are compared to the plan’s PA criteria and a decision is made to approve or deny insurance coverage of the medication

• This depends on multiple factors, including how quickly we get the PA request, the volume of PA requests we receive, and the time that insurance takes to review the request.he insurance plan defines the PA rules for the medication.
• PAs may be started online, by fax, or by phone; by the pharmacy, by the insurance company, or by the doctor’s office. PAs are not always started and PA requests are not always sent or received immediately.
• The number of PA requests we receive each day varies greatly, and we work to process them as quickly as we can. Particularly busy times for PAs are at the beginning of each year and each quarter when major insurance changes happen.
• Some PAs get a response within minutes, most get a response within a few days, and occasionally insurance takes two weeks or longer to review a PA request and send the notice of approval or denial.

The prescription can be filled by the pharmacy and the insurance plan will cover their portion of the cost.

• Approved medications can be filled at any in-network or preferred pharmacy
• The pharmacy might need to run the prescription with an updated fill date to get a paid claim
• Some PAs get a response within minutes, most get a response within a few days, and occasionally insurance takes two weeks or longer to review a PA request and send the notice of approval or denial.

The insurance plan will not cover the medication. We will work with you to determine the next best steps. Options might include:

• Changing to a different medication
• Using a coupon or discount program
• Filing an appeal with the insurance plan

A plan exclusion is a medication that is never covered by the insurance plan. Plan exclusions might be:

• On the formulary of the insurance company but excluded at the specific plan or employer level
• Not on the formulary and not allowed any exception to coverage
• Completely blocked from the PA process

Changes can occur between one refill and the next

• Plans can change their formularies at any time. Common changes include switching preferred brands, adding or removing medications, and adding or removing PA rules.
• Getting a different insurance plan often means changes to the PA rules for your medications. PA rules can vary widely among different plans handled by the same insurance company or pharmacy benefit manager. Your prescription plan could change even if your medical plan stays the same.
• When we are notified of upcoming changes to PA requirements, we will submit the PA request after the date the changes take effect. Requests submitted early will not process correctly before the new rules are updated in the system.
• PA approvals are valid for a set length of time. Once an approval expires, a new PA might or might not be required for continued coverage of the medication, depending on the PA rules at that time. A new PA could be denied if the coverage criteria have changed, even if you have been taking the same medication for a long time.

Medication costs might still be high

• Insurance coverage of a medication does not mean that insurance pays the entire amount
• Formularies are divided into tiers determining what portion insurance will pay, and medications on higher tiers have higher patient costs
• Some insurance plans have prescription deductibles that must be met before insurance pays their portion

Miscommunications are common

• Pharmacies sometimes send PA requests for prescription claims that were rejected for other issues, and clarifications are necessary.
• Pharmacies are not able to see when our office has submitted a PA request that is waiting for the insurance response, and might tell patients they are waiting for our office to respond instead.
• PA rules are determined by the prior authorization department of an insurance company. Member service departments at most insurance companies have limited access to plan details and do not have access to specific PA criteria details. They often give patients general information that does not apply in all situations, and often give advice that worked in previous cases but no longer applies due to rule changes.
• Member service representatives cannot tell you accurately if a medication will be approved. If they say that your medication will be covered with a PA, keep in mind that means “only if your specific circumstances meet the plan’s current rules for coverage.”

• Communicate with our providers as much as you can about your medical history and other treatments you have tried
• Update our office and your pharmacy as soon as you know about any changes to your insurance, and if you have more than one insurance plan or a separate card for prescription benefits
• Let us know if you get information about your medication coverage from your pharmacy or insurance company
• Be patient and allow plenty of time for the pharmacy to fill your prescriptions
• Remember that we want you to have your medication – otherwise we would not have prescribed it!

• www.ama-assn.org/practice-management/prior-authorization/what-doctors-wish-patients-knew-about-prior-authorization
• fixpriorauth.org