What to Bring to the First Visit
If your insurance requires a referral (many HMOs do), please make sure it is current. For your first visit it is helpful to have previous medical records including lab results, X-rays, and growth charts available for us to review.
What to Expect at the Visit
Please arrive 20 minutes prior to your first appointment. Upon arrival at our office you will be asked for the completed new patient intake form, the patient registration form, a photo id and insurance card. Then your child will be “checked in”, which entails measuring the height, weight, and vital signs.
You will be put in an exam room, where we will see you. We will take a complete medical history, followed by a comprehensive physical examination. In the case of adolescents your child may be given the option of asking you to leave the room to afford him/her some privacy if he/she so desires. This will be your child’s decision.
At the end of your child’s evaluation he/she may need further testing, such as blood tests, urine tests, or X-rays. We will discuss these tests and why they are necessary with you. These tests may sometimes be done at our office by us, but more commonly are done at an outside laboratory.
If tests are ordered, your doctor will inform you of the follow up plan for test results. When all tests are complete you will typically meet with the doctor again at a return visit to discuss results. Simple test results may be communicated to you by phone, email, or text by Dr. Bernard’s nurse. If you do not hear back from us within 2 weeks of completion of testing, please contact us by phone. We make every effort to contact you with abnormal results.
All new visits are typically 30 minutes, except for Type 1 Diabetics which are 60 minutes for the initial visit, Please schedule your follow-up visits in advance, because the schedule fills up fast.
We will do our best to answer all calls during the day. All non-urgent calls should be made during office hours (before 4:00 PM, Monday through Friday).MEDICAL EMERGENCIES: If you have a medical emergency, please dial 911 or go to the nearest emergency room.
If you have an urgent question that is not a medical emergency, you may call the office number and you will receive instructions how to contact the physician on call. We strive to answer calls in a timely manner. Please note that calls are directed to the cell phone of the physician on call. Therefore, if the physician is in an area where there is no cell service, such as inside a hospital, there may be a delay in our receiving your message. Therefore, if your call is not returned in a timely manner, please keep trying to call us again. Please ensure that you do not have “call block” on your phone, as this will prevent us from contacting you. The physicians do have “call block” on their cell phones. Remember that we can only contact you if you give us your correct phone number and your number is accessible to us.
Urgent calls include the following circumstances:
- Your child has diabetes and is ill, and you require assistance managing his/her diabetes
- You have an urgent question regarding the management of your child’s diabetes
- Your child is experiencing a side-effect from a medication that we have prescribed
- Your child is ill or injured and you have a question about what to do with his/her medication
If you have diabetes or another endocrine disorder and you require urgent advice, we will provide it. However, under no circumstances will we provide any advice about any primary care issues. Therefore, by way of example, if you have diabetes or adrenal insufficiency and your child is vomiting, we will offer advice only about the diabetes management or the adrenal medication, but we will not offer advice about the vomiting, the underlying cause for the vomiting, management of the vomiting, etc. All questions about such primary care issues will need to be directed to your primary care provider and will be handled as per their practice policies.
If you have not been seen at our office because you have failed to keep an appointment or if you have failed to show for your last appointment, we reserve the right to refuse to prescribe medication or to issue a time-limited prescription, to allow you to make another appointment. This is in accordance with the principles of good clinical practice.
AFTER-HOURS FINANCIAL POLICY:
All our patients sign a Financial Policy. This policy includes charges for non-urgent after hours calls. To avoid charges for prescription refills, we ask that you DO NOT call us for prescriptions after hours. This should be done during office hours, before 4:00 PM, Monday through Friday. If you require diabetes supplies or medication after hours, the pharmacist will usually assist you until the next office opening, whereupon you can call our office. This may mean that you will have to pay for that medication or for those supplies out-of-pocket. It is your responsibility to obtain prescriptions from your physician or nurse practitioner during office hours to avoid such circumstances.
We accept most major insurance carriers and will assist you in filing claims for health care services. Should you have any questions about any insurance or billing issues, please call our office during normal business hours.
Co-payments, deductibles, and co-insurance amounts are all due before service is rendered. We accept cash, personal checks, Visa, and MasterCard. When your insurance has responded, any remaining amount you owe will be billed to you. If you should need to make special arrangements concerning your bill, please call the office prior to your appointment.
We are currently accepting most insurance plans (shown below). If you have any quesitons concerning coverage, please contact our office or your insurance company.
- Aetna HMO/POS/PPO
- Beech Street PPO
- Blue Cross / Blue Shield of Georgia POS/PPO/HMO
- Cigna HMO/POS/PPO
- Coventry HMO
- Coventry Leased Network
- Coventry National Network
- 1st Medical Network PPO
- Great West HMO/POS/PPO
- Humana HMO/POS/PPO
- Kaiser Permanente
- Life Well PPO/EPO
- Medical Partners of America
- MultiPlan, Inc.
- NovaNet PPO
- Private Healthcare Systems (PHCS)
- Principal Edge Network (PEN)
- United Healthcare
Please remember to bring your insurance card to each visit so we may file your insurance properly. For insurance providers with which we are not contracted, you will be given a copy of services and charges to file with your insurance claim form. Please keep in mind that providers are too numerous and varied for our staff to know all details of all available plans. It is your responsibility to know your terms and coverage for your own insurance contract.
Co-payments, deductibles, and co-insurance amounts are all due before service is rendered. We accept cash, Visa, MasterCard and Discover. When your insurance has responded, any remaining amount you owe will be billed to you at your home address. Payment is due within 30 days. If you should need to make special arrangements concerning your bill, please call the office prior to your appointment.
What is growth hormone testing?
Very little growth hormone is typically made during the daytime. Therefore, we must provoke the body to release growth hormone by giving medications. Levels of growth hormone are periodically measured during the testing to determine the body’s response to these agents, and determine if growth hormone levels are appropriate (or deficient).
Scheduling the test and Insurance Benefits for testing:
- The front office staff will do the following:
- Verify benefits for the testing (including the office visit, collection of blood samples, medications given). There is no one “procedure code” for the test. Therefore, the insurance company will NOT tell us what it will pay until we submit the claim; we will only get an estimate. We do this as a courtesy, and it is ultimately your responsibility to know your benefits.
- You will be responsible for paying a portion or the full amount of the test due to copay, coinsurance, or deductible. That amount will be collected prior to the testing. Once the claim has been submitted any remaining amount will be due.
- The cost of the lab processing is a separate cost that will be billed by the lab (LabCorp or Quest) that runs the assay.
- Once insurance benefits are verified, we will call you to schedule the test. The test will be scheduled when your portion of the cost of the testing has been paid. We will attempt to call you twice to schedule the testing. If we are unable to reach you, we will assume you no longer want the testing or it will be done at another Endocrinology office. If you still want the testing after 2 phone calls, it will be your responsibility to call the office to schedule the appointment.
Preparations for the test:
The following preparations will ensure that the test will be as easy as possible to complete and that the results will be accurate.
- One week prior to test:
- Stay hydrated – drink 6-8 glasses of water/fluids per day and continue this until the night before the test. This will make it much easier to place the IV. During the summer months, please add even more fluid to this amount if your child is active outside and perspiring.
- EAT LOTS OF CARBOHYDRATES – (including cereals, breads, pastas, starchy vegetables, fruits, and fruit juices)
- No caffeine – No caffeine the week before testing.
- The evening prior to test:
Have a large bedtime snack around 10 PM and nothing to eat after midnight.
- The morning of test:
- The patient may brush teeth and drink plain water, but NOTHING TO EAT!! Please bring a lunch/snack for your child to eat after the test. They will be hungry and may need it after several blood draws.
- If the patient takes any medications in the morning, please check with the doctor or nurse prior to the test date. ADD/ADHD medications are okay and encouraged the morning of the test.
- Due to the small testing room, only parents may accompany your child. Siblings cannot be accommodated. Don’t forget to bring a snack!
The Actual Test: Growth Hormone Stimulation Testing and Preparation
- Testing for growth hormone deficiency is done in our office and will last 3-4hrs. An adult must accompany the child. Please bring books, a DVD player, or other sources of entertainment. We provide Wi-Fi access.
- An IV will be inserted from which multiple blood samples will be drawn at specified times. These samples (drawn at least 5 times over a 3 hour period) will measure the growth hormone levels in response to two medications. The first agent is an oral medication. The second agent will be administered by injection into the muscle. These agents are generally well tolerated, but can be associated with a brief period of nausea.
- When the test is complete, the snack you bring may be given to your child.
- Once the test is complete, you will make a follow-up appointment in 2-4 weeks with the front desk to review test results. Test results will not be given over the phone.
Follow up visit to review results:
- If test results indicate that your child is growth hormone deficient, we will discuss the risks and benefits of growth hormone supplementation. If you feel it is in your child’s best interest to be treated with growth hormone, we will begin assembling the medical records necessary to request growth hormone approval from your insurance company.
- In addition, if your child is growth hormone deficient we will order an MRI to evaluate the part of the brain that produces growth hormone. The MRI must be performed prior to submitting the complete application for growth hormone to your insurance. The MRI may require precertification by your insurance company.
GROWTH HORMONE APPROVAL
Initial growth hormone prescription:
- If the results of testing indicate that your child is growth hormone deficient, the physician will submit a prescription for growth hormone to a specialty pharmacy that can dispense growth hormone. Medical records will be submitted to your insurance company for medical review in order to obtain approval for growth hormone coverage.
- The medical review process may take up to 90 days for approval, depending on your particular insurance plan. If the growth hormone is denied, the appeal process can take another 6 months. The brand of growth hormone that will be prescribed, the length of time required for the medical review process, and the pharmacy that will dispense the growth hormone are determined by your insurance company and not up to your physician.
After growth hormone approval:
- You may need to fill out paperwork and register with the mail order pharmacy. You must be there to sign for shipment (drug requires refrigeration).
- Growth hormone is administered by injection every night before bed. Teaching on proper administration of growth hormone can be done by your dispensing pharmacy, drug manufacturer, or can be done at our office. If you wish us to teach you how to administer growth hormone, you must schedule an appointment and your child must be present for the teaching.
Remember, this is a lengthy process. Your child will not be started on growth hormone until all of these procedures have been completed. Please be patient!
Determination of Growth Hormone Coverage
Regardless of the results of growth hormone testing, your insurance company may decide not to approve growth hormone for your child. Your physician will do his/her best to explain to your insurance why growth hormone is a medically necessary intervention for your child, but this does not guarantee coverage for growth hormone.
We request that you personally contact your insurance company to determine if growth hormone is a covered benefit. Your insurance may direct you to your PBM – pharmacy benefit manager (the particular pharmacy that will dispense the growth hormone). If they request diagnosis codes (ICD-9 codes), please offer the code below that best applies to your child. Please circle below the preferred brand(s) of growth hormone and circle or note the preferred pharmacy that will dispense the growth hormone. Bring this information to your stimulation testing.
Questions for Insurance:
- Are self-injectable drugs covered?
- If so, is growth hormone covered?
- Circle the formulary preferred brand(s) on right.
- Is it covered by pharmacy benefits or major medical?
- If it is covered under major medical, what are the benefits:
- Out of pocket?:
- Annual cap?:
- If it’s covered under pharmacy benefits, what are the benefits:
- Flat copay or percentage covered?:
- Annual cap?:
- If it is covered under major medical, what are the benefits:
- Where must patient obtain growth hormone? Does growth hormone have to be obtained from a specialty pharmacy (PBM) or can growth hormone be obtained through local pharmacy?
- If specialty pharmacy, please circle or note on right.
- .Who does the authorization (PBM, major medical, other) and what is their contact information?
DIAGNOSIS CODES (ICD-9 CODES)
253.3 (Growth Hormone Deficiency)
758.6 (Turner Syndrome)
GENERIC: SOMATROPIN (J2941)
PBM (SPECIALTY PHARMACY)
Aetna Specialty Pharmacy
Cigna Specialty Pharmacy
Please remember it is a long process, often times frustrating, to get growth hormone approval from your insurance company. If your benefits change at any time during the process, or after growth hormone is approved, this process MUST be started over. We must be a team and work together. Not being supportive or courteous to our support staff is unacceptable. They care deeply about your child and are working hard to obtain growth hormone coverage. Feel free to call and check in every 4 weeks to get an update on the process. You should receive notification by mail from your insurance as we receive it by fax.