Q. Why was my prescription denied?
A. Most of the time prescriptions are denied because your are due or past due for your yearly exam and you do not have an appointment scheduled in our system. The doctors require an appointment scheduled in our system to approve refill requests. If the case of vitamin D or thyroid medicine, it may be time for your lab testing. Please call the office for an appointment, and have your pharmacy send an electronic refill request and we will get the refills approved until your appointment. The best thing to do is schedule your appointment a year in advance That way you always have an appointment in our system. When you get your reminder call or email, you can always move your appointment in the system, and there will not be any delays in your refills.
Q. Why did I not receive a written prescription?
A. I send all my prescriptions electronically, on the date of your appointment or phone message. This generates a fax to the pharmacy. I can e-prescribe to any retail or mail order pharmacy. It is more efficient and avoids many medication errors if I send your prescription electronically.
Q. I want to change pharmacies, what do I do?
A. Go to the new pharmacy and tell them what prescriptions you want to transfer your prescription and what pharmacy you have been using, and the pharmacy can move your prescription. You do not need a new prescription from me.
Q. I need a mail order prescription, how do I get one?
A. Just leave me a voicemail or prescription refill request from our website on what prescription you need and to which mail order pharmacy, and I'll send it off electronically.
Q. My prescription has not arrived from my mail order pharmacy, can I get a prescription to a local pharmacy?
A. Yes, just leave me a voicemail or a prescription refill request from our website and let me know which medication you need and which local pharmacy and I'll send one off electronically.
Q. How do I schedule an appointment?
A. Call our main number at 827-424-3112 and press option 1. Our check in and check out staff answer those calls, and make all appointments and changes to appointments.
Q. What are your hours?
A. I see patients Monday - Friday 830-1230. I have limited phone time, I use my time before I see patients, in between patients, and after patients to make phone calls. I usually take some time off around the holidays and spring break.
Q. Can I get my labs done prior to my pap appointment or hormone consult appointment?
A. Yes, we are attempting to do lab appointments about one week prior to your appointment. This way your results will be back and ready to discuss at your appointment. This will require you to make two appointments, one for lab, and one for the pap or hormone consult. We can only do this for established patients, not new patients. If you have United Healthcare, you need to come by our office to get a written lab requisition for Labcorp, and visit their draw station downstairs. If you live far away and would like to use a different Labcorp location, leave me a message and I can mail your lab requisition. They cannot be faxed. For all other insurance companies, you can be drawn in our office by Quest. If you would like to use a different Quest location, please leave me a message so I can put your lab orders into Quest's system electronically.
Q. Can I get my saliva tested prior to my appointment?
A. Yes. For established patients that do NOT have United Healthcare and Aetna, your insurance will cover saliva testing if you get a kit from our office. Come by the office and pick up a kit, and follow the directions for obtaining your saliva specimen. If you are still having monthly cycles, you need to test on Day 19, 20, or 21 of your cycle. Day 1 is the first day of normal flow. If you have had a hysterectomy or ablation, and still have ovaries, try to predict when you are in your PMS zone, test on a moody day, or for example the days your face breaks out. If your ovaries are removed, you can test on any day. Remember to follow the test kit instructions for testing at least 12-24 hours after you have applied topical creams, and 24 hours for oral hormones. If you have Aetna or United, I have different lab kits if you want to pay for saliva testing. It is $30 test, and I for sure recommend getting estrogen, progesterone and testosterone, or we could do blood testing of your female hormones.
Q. Do you do hormone testing?
A. Yes, my favorite way to test female hormones is in the saliva. Neither blood nor saliva are perfect for testing female hormones. Hormones are bound to proteins, and not free floating in the blood or saliva. Both saliva and blood are trying to predict how much hormone you have in the tissues, which is where you would notice symptoms of too much or too little hormones. But in my experience these last 5 years, the saliva results seem to match a women's symptoms better than blood results, and give us better guidance about which hormones to replace, and which hormones may be too high.
Q. Do you have email?
A. No, we have one way patient messaging where you can leave a prescription refill request or a virtual office visit for me. The front office staff can receive a message for an appointment request as well. All this is on the office website, www.grapevineob.com. Log in to the online office with your user name and password. One day when we have electronic medical records we will have email.
Q. How do I get my lab results?
A. For everyone but United Healthcare, the fastest way to get your lab results is online through Quest Lab's website. When you were in the office I should have given you a letter with a PIN number to connect me and you through Quest Lab. This one time set up enables you to see all your labs, paps, and cultures online whenever you want. If you forget to set up your account, and the labs have already reported, when you do set up the account, you will need to go to the copy tab at the top of the screen and copy all labs to your new account. Sometimes this system can be difficult, but it's worth the effort to get it set up. Having your labs online gives you the ability to see them whenever you want, and print them for other doctors. If you lost that paper, leave me a voicemail and I can send you one via email from Quest. Check your spam folder if you don't receive it quickly, sometimes it ends up there. If you just can't get it to work, leave me a voicemail and I'll mail you a copy. If you have United Healthcare, your labs will go to Labcorp, which takes a bit longer, then will come in the mail to you after I have seen them. If there is something abnormal with your labs I will call you, and feel free to call with me questions. I have some information about where I like your lab values to be and how to get there under the "Lab Results" tab on my website.
Q. Why have you switched me from prescription Vitamin D to over the counter Vitamin D?
A. A few years ago when I began testing for vitamin D, the only way to give someone high dose Vitamin D was to give the weekly D2 50,000 IU supplement. The better way to get Vitamin D is D3, which is now available over the counter. I usually recommend people buy Vitamin D3 at 2,000 IU as a maintenance dose if your Vitamin D level is perfect (50-70). If your value is 30-50 I usually recommend trying Vitamin D3 at 5,000 IU daily and we will recheck in about 6 months. If your value is <30, I usually recommend taking Vitamin D3 8,000 to 10,000 IU for 6 months and retesting. You can get too much Vitamin D, but it would probably take about 10 years of high dose therapy to get toxic.
Q. Do you recommend taking B12 supplements?
A. Yes, this is one vitamin I test for all the time, and rarely find anyone with normal levels. This vitamin has a lot of power to fight fatigue, is necessary for weight loss, for heart health, cholesterol reduction...the list goes on. It takes a certain cell in your gut to pull B12 out of foods, so eating foods high in B12 will work if you have good parietal cells. If you do not, (which most people don't as they get older), you just need to supplement your B12. If you do not eat meat, you must supplement B12. My favorite way to either sublingual, liquid or shots. I normally tell people you can go with the highest dose of B12 you can find. I've seen it in 1000mcg, 2500 mcg, and 5000 mcg. Five hour energy drinks are full of B12. B 12 is water soluble, so anything your body doesn't need just goes out in your urine, so you cannot get toxic off too much B12. We can do a B12 test when we do your lab work to help you know how much B12 to supplement.
Q. I'm having some side effects from my hormones, what do I do?
A. It's probably a good idea for us to talk about side effects that your are experiencing, but the first thing to try with hormone creams is use a little bit more or a little bit less. True side efffects to hormones probably will decrease if you decrease the dose. If you are not feeling a relief of symptoms, then increasing your dose (using more cream) or using your cream twice a day can sometimes help.
Q. I need a mammogram, how do I get one?
A. Mammograms are scheduled directly with a mammogram facility. It usually does not require an order from me. Screening mammograms appointments can be made by you at your mammogram facility. If you have breast implants, most mammogram facilities require an order for a diagnostic mammogram. Diagnostic and screening mammograms are the same mammogram, but diagnostic mammograms are read by a physician before you leave the facility, and If more views are required, then they take them right then. Some insurance companies do not pay for diagnostic mammograms, or do not pay the same benefit for a diagnostic mammogram. Please note that I do not have any information about your health insurance benefits for mammograms. If you complain of breast pain or a breast lump to either me or the facility when making the appointment, the facility will require a diagnostic mammogram.
Q. The mammogram facility called me and wants to take additional views, should I be worried?
A. Up to 50% of mammograms are recalled for additional views. Usually everything is fine. They will release a final report to me after your second appointment. Mammogram facilities should contact you directly about your results.
Q. My insurance company is requiring a prior authorization for a medication, how is that handled?
A. I handle prior authorizations the best that I can, they take a very long time on the phone with your insurance company, which is very difficult for me. Contacting your insurance company yourself is probably a good idea. They are probably trying to get you to switch to a generic, cheaper alternative, and you and the pharmacist may be able to do this without my assistance. Lately I'm seeing a lot of prior authorizations denied, and insurance companies just want you to pay out of pocket for the medication if you do not want to try the cheaper, covered medication. Also, usually prior authorizations want some specific information about alternative medications you may have tried, and you may need to give me this information, as it may not be information that is in our medical record. Sometimes they ask us to fax copies of your medical record for their physicians to revew.