Precision Medicine – New Patient Information

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Dr. Tony Boggess is a Physical Medicine and Rehabilitation (PM&R) physician, speaker, and writer who specializes in Nutritional and Biomedical Rehab for adults and children. He and his wife, Lilian founded Natural Balance Wellness Medical Center, which has developed into a nationally-recognized center known for its individualized and multi modal approach to patients.

Dr. Boggess earned his Doctorate from Midwestern University in Chicago, completed his specialty training at the University of Michigan, and earned additional certification in Medical Acupuncture through Stanford University. He has a long list of academic accolades, including the Army Medal of Achievement and many letters, lists, and honors related to his undergraduate and graduate careers. As a physician, he has received multiple Patient Choice and Compassionate Care nominations and awards since the clinic first opened its doors in 2008.

Known for his pioneering approach to assessing genetic predisposition, Dr. Boggess is the visionary back bone to the center’s “Precision Medicine & Advanced NeuroCare” programs, attracting patients to Ann Arbor from all over the US and abroad. Recognized for its reputation for addressing perplexing illness, the Natural Balance Wellness Medical Center is able to boast successes in helping patients and families with problems considered unsolvable, or otherwise not fully addressed by other doctors and clinics.

As the medical director of Natural Balance, Dr. Boggess is interested in a wide variety of clinical approaches, but he especially enjoys leading patient education sessions for his Precision Medicine clinics. He is passionate about teaching and his enthusiasm rains through in his style of facilitating both small and large group seminars. He also has a special affinity for working with families, especially those with struggling children, and he strives to help them understand their genetics as a unit. His story is a labor of love and the novel programs and medical center he has created were born from overcoming his own personal health challenges and professional frustrations. We invite you to learn more about this by reading his chapter in Jack Canfield’s best selling book The Road to Success.

His professional mission can be summarized as an effort to educate patients and the public about genomics and other novel approaches to health and healing through his medical center and video clinics. He also assists other healthcare professionals, doctors, and clinics to provide patient-centered education services through his thirdparty consulting company.

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Dr. Aarti Soorya is a board certified Physical Medicine and Rehabilitation physician, who alongside the rest of the Natural Balance team, combines conventional medical training with leading-edge concepts in biomedical-functional medicine. Her approaches include holistic prevention and alternatives, detoxification, physical modalities, nutritional therapy, herbs, chelation, and medications (when needed). Dr. Soorya wears many hats in our clinic including co-leading our nationally recognized Precision Medicine & Advanced Neurocare programs and supervising patients undergoing neurofeedback, hyperbaric oxygen, sleep studies, IV therapies and numerous other clinical activities.

Known for being ahead of the curve, her career path in integrative medicine began long before attending medical school as a research intern for the University of Michigan’s Integrative Medicine Program. There she observed firsthand how a comprehensive, whole person approach led to profound and life changing results for the patient’s she worked with. Recognizing the complex needs of her future patients, Dr. Soorya subsequently made mastering the intricacies of functional medicine a priority by enrolling in the Institute of Functional Medicine’s rigorous training program and seeking board certification.

During her hospital years at Washington University, Dr. Soorya received numerous accolades, including her role as chief resident physician and “Resident of the Year” for her work ethic, leadership qualities and excellent bedside manner.

Presently, Dr. Soorya’s passions lean towards supporting our clinic patient’s and using her numerous layers of training to inspire hope, health and happiness in the many patients who come to our clinic from all over the country. Dr. Soorya joins us as an integral member of the Natural Balance Team. In her free time she enjoys spending time with her family and friends, Indian classical dance, travel, and yoga for her own personal development.

Step 1: New Patient Process

Enrolling in our standard new patient process with small group teaching sessions (“New Patient Bundle”) is the most comprehensive and cost effective way to become a patient with our clinic. During the weeks leading up to your appointments you meet with several team members in person, via phone and videoconference, as we gather your medical history, decide on initial labs, explain our clinic process, and prepare you for your small group teaching and subsequent one-on-one visits with our doctors and clinicians.

The “New Patient Bundle” includes the following:

1. Phone intake with Dr. Basinger (30 min) - Prior to this appointment, you will have completed our online New Patient Questionnaire. The purpose of this intake will be to “hear your story,” collect important health information, get you started on the labs we have ordered (some labs can take up to 8 weeks to get the results), and to organize your chart in preparation for working with the doctors and other clinicians.

2. Dr. Boggess Chart review (15 minutes) - In preparation for the group visit, Dr. Boggess reviews all of Dr. Basinger’s notes and the full chart summaries to tailor the group educational sessions to the needs of those attending. You are not present during this time.

3. Patient Education Session at Natural Balance with Dr. Boggess - Small Group Setting for 8-10 patients and their family members (3.0 – 3.5 hrs) - At Natural Balance, we have a passion for empowering patients with insights and understanding. During the group session, Dr. Boggess will be covering cutting edge theories about genomics, precision medicine, and our clinic’s approach to working with patients. The group session will also create a solid frame of reference to help you understand the labs and genetic tests we have ordered for you. Because Dr. Boggess will have reviewed every chart prior to the group visit, the interaction will be meaningful and productive. There will also be time for open group Q&A. Patients are encouraged to bring their significant other, or in the case of a child, both parents should attend if possible.

4. One on One Office visit with Dr. Boggess (60 minutes): This visit includes collecting labs, a physical exam, and further opportunity for us to collect additional private details not appropriate to the group visit, review labs from previous doctors, and decide if there is a need for any further testing, et cetera.

Please Note: This visit is not intended to be a comprehensive review of the labs we’ve ordered. Lab reviews take place during visits 2 and 3 and occur following a “3.0 hour group lab review session” (Please see Lab Review Sessions below for details).

5. Appointment with our Health Coach, Theresa Edmunds & Registered Dietician, Jenna Wunder (60 minutes with each, for a total of 2 hrs):  At Natural Balance, we offer an interdisciplinary team approach to our patients. After your group session and office visit with Dr. Boggess, he will be referring you to our health coach and register dietitian for pertinent lifestyle and dietary coaching as per your individual genetics, needs, and overall health concerns. These visits can be either in-person or via videoconference as per your preference and location.

Pleases Note: The “New Patient Bundle” includes items 1-5 above, but does not include any testing, visits to review lab results, or follow-up appointments. These are billed at our standard physician hourly rates (see below).

Out-of-state Patients

Many patients come to us from outside of Michigan. In such case, we customize visits based on the complexity of the patient or situation, and whether or not you are traveling from out-of-state or overseas. A paid, 30-minute, phone meeting with the doctor is generally recommended to provide the opportunity to talk with Dr. Boggess to solidify one’s decision to work with our clinic. Once scheduled, many of the initial medical and education visits can be done via Videoconference. Please keep in mind that all patients must be seen at least once in person at our clinic, and we highly recommend this visit be coordinated with a Group Lab Education Session to take full advantage of the educational experience our clinic is known for. Thereafter, all future follow-up visits can be done via phone or videoconference (taking advantage of our screen sharing capabilities). We are set up to work with out-of-state and overseas patients efficiently, and we ship all testing materials and products from our office to your home reliably.

Platinum Executive Program

This program is designed for busy executives, athletes, or out-of-state patients who do not wish to participate in any of the group sessions and/or want the highest level of one-on-one interaction with Dr. Boggess including direct phone, text, and email access. A paid, 60-90 minute, phone meeting with the doctor is required. Please keep in mind that all patients must either be seen at least once in person at our clinic, or alternatively Dr. Boggess may be able to travel to a patient’s private residence under select circumstances. Thereafter, all future follow-up visits can be done via phone or videoconference at a distance.

 

Step 2: Lab Review Sessions

Several weeks after completing our New Patient Process, Dr. Boggess and our clinical team will teach you how to interpret all your genetic and medical tests and show you how we will use this information to make sense of your clinical presentation and develop a comprehensive treatment plan (see sample video below).

There are 2 options for undergoing a comprehensive review of your labs:

Option 1 (group process): The most comprehensive and cost-effective way to review all the genetic and medical testing is to participate in a 3-hour,  group Lab Education Session. Thereafter, you will be scheduled for 2 hours of private lab review where Dr. Boggess will explain, summarize, and dictate the finding and his impressions regarding all that needs to be accomplished in the months ahead.

Option 2: If for whatever reason you are unable to attend a Group Lab Teaching Session or prefer to work one-on-one, plan on anywhere from 3 to 4.5 hours, over the course of 2 to 3 visits to review all the labs.

 

Step 3: Comprehensive Treatment Planning

Patients, again have two options for developing a comprehensive treatment plan with our doctors and clinical team:

Option 1 (group process): The most comprehensive and cost-effective way to develop a fully outlined treatment plan, including logical ordering of our protocols, estimated timeframe for each step, and a more full understanding of the rehabilitation process, is to participate in a 2-hour group Education Session. Thereafter, you will be scheduled for a 1 hour planning session with Dr. Boggess where he will explain, summarize, and design a fully outlined treatment plan for the duration of your projected clinical course.

Option 2: If for whatever reason you are unable to attend a Group Planning Session or prefer to work one-on-one with Dr. Boggess, plan on at least 2 hours to fully outline, explain, and develop a comprehensive treatment plan.

Follow-up Visits (usually 6 to 24 months)

After the Lab Review Sessions have been completed, the time-frame and hourly rates switch to our standard follow-up fee schedule (please see below) and are generally 30-45 minutes until progress is underway (usually 1-2 additional visits). Then, 20-30 minutes every 6-12 weeks, depending on the situation. We also have a number of situations where a quick 10, but less than 15 minute, phone consult is all that is needed. This is where all the education we have done upfront pays off!  Many established patients also return once or twice a year for 45-60 minute visits. 

Determining Length of Treatment

Dr. Boggess who works with our most complex patients typically works closely with patients anywhere between 6 months to 2 years, depending on the complexity of the situation. You will receive a written summary of all labs and open items list as well as estimated time-frame to discharge after your 3rd or 4th visit. Remember! Our goal is to rehabilitate your health and return you to “natural balance.” Hence, the nutraceuticals we prescribe are not meant to be taken long term. They are given in a careful and systematic way for a predetermined timeframe before moving to other protocols. In other words, the order in which things are rehabilitated, and the degree to which a reliable foundation is laid, is the key to our success. Dr. Boggess has been doing this long enough to feel very confident in his projected time-frame. And, in fact, considers it fun to call it accurately–which he often chides patients about upon discharge from the precision medicine program.

Honest Assessment of Our Success

Q: “What is your success rate with helping difficult patients?” (Dr. Boggess and our office have been asked too many times to count…)

First, lets define “success”: For our office, we consider success discharging patients from our program after 6 months to 2 years of treatment on off all supplement protocols (other than ones required based on genetics, or other individualized needs) and feeling anywhere from 70-100% better after following our recommended treatment course?

A: Dr. Boggess - ”While it is difficult to tell, my best estimate is for every 10 patients who enroll in our precision medicine program, 7 (on average) will continue past 5-6 visits. Some drop off because they are feeling much better quickly, only to risk ending up back where they were because the process was not completed. For others, life circumstances change. Some found the program to be more cost or effort than what they were ready for. (Though we do try to minimize the number of individuals who fall under this category by giving as much information up front as possible!) But of those 7 patients, 5 will discharge recovered. That said, while the remaining 2 patients will not have achieved 70-100% improvement upon discharge, rarely do they indicate they are disappointed in our clinic’s effort or dissatisfied with feeling 30, 40, 60% better, etc. Our clinic attracts very complicated cases and most patients who go the distance with our program leave very happy and very well educated about their situation.”

 

General Pricing Information

New Patient Bundle:$870 (covers all appointments in the ”New Patient Bundle”  described above)
New Patient  & Lab Review appointments: $370/hr, prorated to length of the visit in 1o minute increments. There will also be a Group lab review, and Group planning session that average about $200/session.
Follow up in-person/phone: $370/hr, prorated to length of the visit in 1o minute increments.

Insurance & Codes (for billing purposes)

Natural Balance is out of network for all insurance, and we do not bill your insurance. We will provide you with a itemized superbill for every encounter with the appropriate E&M codes to submit to your insurance for reimbursement to you directly. However, please understand that we have literally given up on trying to figure out the whims of insurance and cannot guarantee you will be reimbursed. For your reference, we have included the codes and pricing we use for the New Patient Bundle and follow up visits, phone consults, et cetera to assist you with checking with your insurance company ahead of time if you wish.

Please note: the times below include preparation and post counseling with the nurse or clinical assistant, as well as face-face / direct collaboration with our Physicians or Physician Assistants.

New Patient Bundle (with “Patient Education Session” $870):

Code        Description                                                           Amount
99205     New Patient Visit (90 minutes)                       $525.00
99354     Medical Office Visit -extra time                       $215.00
97802     Nutritional Consult (60 minutes)                   $130.00

These codes are submitted in the same superbill with the Group Teaching Session ( 3.5 hours) and complimentary health coach visit (60 minutes) which have no billable codes associated. 

Medical Office Visit to review labs (example of a 1.5 hours lab review appointment)
Code       Description                                                                        Amount
99215     Medical Office Visit, Level 5 (60 minutes)                  $370.00
99354    Medical Office Visit, extra time, Level 3                       $195.00

Follow-up visits
Code       Description                                                                 Amount
99215    Medical Office Visit, Level 5 (60-80 minutes)      $370.00
99214    Medical Office Visit, Level 4 (40-60 minutes)      $290.00
99213    Medical Office Visit, Level 3 (30-40 minutes)      $195.00
99212    Medical Office Visit, Level 2 (25-30 minutes)       $140.00
99211     Medical Office Visit, Level 1 (15-20 minutes)       $95.00

Follow-up phone visits
Code       Description                                                                          Amount
99443    Medical Phone Consult, Level 3 (30-40 minutes)          $195.00
99442    Medical Phone Consult, Level 2 (25-30 minutes)          $140.00
99441     Medical Phone Consult, Level 1 (15-20 minutes)           $95

Billing Process: As a medical center, it is our sincere intention that your visit be recognized by insurance AND qualify for reimbursement based on your “out-of network” benefits.

Our clinic’s ability to provide superbills for your visit and utilize insurance for testing is why we are able to save patients thousands of dollars compared to other practices run by limited license clinicians such as chiropractors, naturopathic doctors, acupuncturist, etc.

Therefore, in keeping with the changing emphasis of medical billing AND in remaining in-line with our commitment to provide the highest level of care possible, we provide billing statements based on “complexity” rather than just “time” spent with our clinicians.

The “complexity level” varies from patient to patient, as well as what stage of treatment patient are in. For example: A “Level 4″ visit, which is generally used for most single lab reviews, and protocol planning, will be approximately 40-60 min. This time includes preparation and post counseling with the nurse or clinical assistant. The Dr / PA involvement may be up to 40 min, but may also be less without impacting level of visit billed. A “Level 1″ visit will be the shortest and least complex visit type, and it is used when we need to do a quick touch base on a particular protocol, or checking in with patients prior to starting something you already have instructions for. The total time of the appointment, including preparation and post counseling with the nurse or clinical assistant may be 15 to 20 min. The Dr / PA involvement may be up to 10 min, but may also be less without impacting the level of visit billed.

As you can see, this newer standard of billing roughly mirrors “time-based” billing but also takes into account the level of preparation needed, case management, and required post-visit teaching and counseling with nursing or clinical assistants. This system also takes into consideration the expanded use of highly trained nurses and Physician Assistants (PAs) who assist our patients in very specific ways.

On behalf of the Natural Balance Team, we hope you have found this information helpful and we look forward to working with you!

To schedule your New Patient appointment or if you have any questions, please contact our New Patient Specialist, Emily Sell, at 734-929-2696, extension 11.