Policies & Procedures

Policies & Procedures

Policies & Procedures

Is your doctor a “real” pediatrician?

Yes. Our pediatrician is trained and board certified in General Pediatrics and has been in pediatric medicine for ~20 years. He completed his Pediatrics residency in 2003 at UC Irvine and Long Beach Memorial/Miller Children’s Hospital before working in a variety of pediatric settings: outpatient clinics, pediatric urgent care, and even in the main emergency room of a large children’s hospital. He brings this breadth of experience to your child and you can be assured of a more comprehensive view than some of the holistic providers who market themselves as “holistic pediatricians”, yet do not have much (for example, only 20 hours required by some naturopathic schools in pediatrics), if any, specific training in pediatric medicine and may not recognize a more serious illness as a result. Compare this to the thousands of hours of training in pediatric medicine and rotations through inpatient wards, intensive care units, etc. There simply is no comparison. This is why Pediatrics is a specialty of medicine in it’s own right.

Will your doctor work in conjunction with my child’s regular pediatrician or other holistic practitioners?

For those patients that prefer to come to our practice on a functional medicine or biomedical autism consultative basis, we are happy to work with your PCP. In fact, we would encourage an open and honest dialogue between all providers involved in your child’s care. Your PCP may not have had the time or the specific interest to learn about many of the therapies provided and therefore our doctor will be more than happy to coordinate with them to maximize your child’s potential.

We can function on a purely consultative basis, a purely primary care basis, or a mixture of both. (We have different families doing each of these, depending on their needs).

Do you have acute care appointments available?

Yes. You can schedule your child to be seen for sick visits. We can take care of problems such as strep, flu, urinary tract infections, abdominal pain, suture removals, etc .  Of course, we will try to use the best combination of natural remedies and conventional treatments as is appropriate. Since our doctor also spent many years working in pediatric urgent care and the emergency room, he also has the added benefit of being able to recognize when your child is too sick and needs a higher level of care at the emergency department. The key is knowing when to use the natural remedies versus realizing it is time to use the conventional medicines. That is the art of the integrative medical model.

Although we may not always be able to get you in the same day (depending on how heavily we are already scheduled), we will always try as much as possible to get your child in as soon as we can. Usually, this is the same day or the next day when we are in the office. Please see below for additional information.

PLEASE NOTE:

As the practice has grown since its original opening, the general direction of the medicine practiced has become increasingly specialized. With the merger with Rossignol Medical Center in 2018, this has only accelerated. This is not to say we do not love doing primary care, but the needs of the complex, chronically ill kids have slowly become an increasing portion of the practice. This has resulted in much more travel and absences from the office, as Dr. Dane is a frequent lecturer at multiple autism conferences (TACA, NAA and as a faculty member at MAPS conferences). Additionally he has been asked to help in areas with relatively poor access to the biomedical/integrative model of care for kids with these complex chronic diseases. This means that he is spending increasing time in various parts of the country (e.g. Colorado, Maryland, Florida) seeing patients in areas away from Southern California. As a result, there will be frequent times when he will NOT be in the office to take same day/ sick visits. (For example, he is doing 1 week per month on average in the Denver area consulting for another medical practice).

We realize this is going to represent an inconvenience for some families, but the difficult decision was made that these other families of complex chronically ill kids desperately needed the help that they are often unable to access. If this is going to be major problem for your family, if you need us to be here 24/7 in case your child gets sick and you are not willing to go to an urgent care facility for the rapid flu test or an ear check than any urgent care doctor can easily perform for you, then this probably is not going to be the best practice for you. There are many other practices out there with a dozen doctors to take call, share weekend work, cover holidays, etc. There are no shortages of practices that can better meet those needs, and would encourage you to utilize those practices if the more limited availability is going to upset you. There is only 1 doctor to cover our patients and can only do so much. We are looking to find someone who can possibly come to the practice and cover on the days he is gone, but finding someone that has the balance between natural and allopathic knowledge has been difficult and therefore rather than bring just anyone in, it was felt it was better to have no one at all.

 

Does your doctor see newborns in the hospital or admit to area hospitals?

No.

For newborns, although it would be ideal to come to the hospital nursery to see the new addition, it is not possible to do this as we have patients that come to the office from all over Southern California, let alone just Orange County. To try to go to all the various hospitals would not be possible.

Additionally, the trend in all of medicine is to allow doctors who are specialists in hospitalist medicine care for those patients ill enough to be in the hospital. There have been many studies that have shown that outcomes, length of stay, etc are better with hospitalists. We have made an agreement with the Hospitalist Division at CHOC Orange and Mission for any hospital/acute care needs that may be beyond the scope of what can be provided at the office. We will work with them to coordinate any care needs that may arise, answer any questions about “unconventional” treatments that may arise. In truth, if your child is ill enough to require hospitalization, then this is the time to acknowledge and allow the allopathic model to do what it does best– fix us when we are broken! We can, in turn, use the integrative model to help minimize side effects from the conventional treatments.

What about Vaccinations? Do you carry vaccines? What is your philosophy of vaccination?

Does your office do lab work, blood draws, X-rays, etc?

We perform “point of care testing”, including rapid strep tests, rapid flu tests, urine tests, etc, in office.  We do have the ability to get bloods drawn. in the office if desired, for an additional fee with our nurse. This becomes increasingly helpful when performing some functional-medicine based labs that are difficult to get draw at a conventional lab or the hospital, as they are not trained in handling those specimens/ kits.

These labs will be sent to Quest, Labcorp or West Pacific Labs as required by the patient and insurance contracts.  Insurance based labs (typical labs) will be sent to Quest, Labcorp, etc and you will be able to use your insurance for payment the way you would if it were drawn elsewhere. We also do cash-pay labs which we have gotten discounted from Quest labs– the fees will vary based on what is ordered but the staff can provide an estimate of the cost prior to drawing the labs.

For functional medicine/ biomedical autism labs, we have separate lab slips and will provide you with the appropriate “kits” to provide to the lab, which are frequently mailed via FedEx overnight to the respective lab directly by you once the specimen has been collected (urine, stool, hair, etc).

For any radiology needs (X-rays, ultrasounds, CT scans, MRIs, etc), we will provide you with a order sheet to bring to an area radiology department to have the test performed and the results will be sent to our office, as in any standard medical office. Again, these will also be billed to your insurance company buy the radiology department, not our office and therefore our “out of network” status does not impact that in any way.

Do you sell supplements or other alternative remedies? Do I have to buy them from you?

We sell a small selection of commonly used supplements that we have taken the time and care to check and assure that they are as pure as possible and actually contain what they say they contain. We generally only sell or stock those that our patients can not obtain elsewhere, such as the local Whole Foods, Mother’s Market, etc, or if we can buy them for a discounted price that we can then pass on to our patients.

 Additionally, for those who are interested,  patients may get an access code to an online “drop ship” company where you may buy directly at a discounted rate from retail via our online dispensary.

If you are not comfortable purchasing supplements from our office, then there is absolutely no problem. We will gladly provide you the name and strength of the supplements and you may purchase them at your local health food store, online shop, etc. We find that many appreciate the convenience (Anyone who has gone down the supplement aisle at a health food store knows that it can get overwhelming very quickly) and having the confidence that what they are buying has been recommended by their physician. Additionally, they find that our prices are comparable or even less than the cost of buying their supplements independently, as partial distributor discounts are being passed on to our patients.

Do you see adult patients?

Not routinely, although depending on the age and nature of the problem, this may not be an issue. For example, we do see many young adults who are in their 20’s for issues related to their autism, PANDAS/PANS, anxiety, OCD, depression, gut issues, etc as these are very similar to the same diagnoses in a teenager, etc.

Please call the office to discuss a visit for anyone over 18 years of age so we may discuss and make the best decision. Although we have knowledge of holistic treatments for adult problems and functional medicine training also involves many adult-medicine diagnoses, we feel that it is generally best to keep our focus doing what we have the most training and experience doing: caring for children.

For example, we would not be the best practice to care for gynecologic issues, fibromyalgia, adult hormone imbalances, hypertension, type 2 diabetes, etc. However, our integrative health coach can help all the family maximize their wellness through lifestyle and nutrition changes.

Do you see “Self-Pay”, Cash patients?

Yes. We are out of network with insurance carriers in order to retain control and delivery the best quality of care possible, rather than care being dictated by a third party payer who does not necessarily know what is best for you and your child.

We currently used a tiered-system of cost, in order to make the office and visits as accessible as possible. The simplest visits– preventive well care, simple sick visits, vaccine consults, etc– is billed the least expensive in order to make integrative primary care available to more people. While these self pay rates may seem higher than would be expensive, please realize that these rates are similar, or often times, less, than what large medical groups get paid for the same service but with less time allotted to you and without the additional integrative medicine expertise than we can deliver.

As we see increasing numbers of medically complex patients– Autism, PANDAS/PANS, Auto-immune encephalitis, multiple complex diagnoses (asthma, eczema, ADHD, Sensory Processing disorders, genetic conditions, cerebral palsy, etc– then these are priced at a higher price point as they require much more work outside of the visit and the additional rate helps to compensate spent outside thew actual visit time reviewing labs, writing additional prescriptions, reviewing notes, etc.

Please also remember that when comparing self pay rates with different providers, make sure you understand what you are getting for the money. How much time is the doctor spending with you? Is it a 10 minute visit or a 45 minute visit? How much experience do they have taking care of pediatric patients? Are they actually qualified to do the visit? Do they have any additional training in the subject they are caring for with your child? Do they have the humility to say “No” to a visit when they do not have the qualifications to do so? Or will they just see you to get the money?

What about using my Health Care Reimbursement Account (HRCA) Cafeteria plan and Health Savings Account (HSA)?

Likely a part of your employee benefit package is a HRCA/ Cafeteria plan where individuals can set aside pre-tax dollars for qualified medical expenses. The services billed at Raising Sages should qualify for use of your HRCA. Please inquire with your employer or health plan for specifics. For self-employed families, a HSA combines a tax favored savings account with a high deductible health insurance policy

The new limits for health savings accounts (HSA) for 2020 are going up $50 for individual coverage and $100 for family coverage, the IRS announced last week, bringing them to $3,550 and $7,100, respectively. The catch-up contribution limit for those over age 55 will remain at $1,000.

HSAs are tied to high-deductible health plans (HDHPs). The annual out-of-pocket expenses for a HDHP in 2020 are also increasing slightly from this year: They cannot exceed $6,900 for self-only coverage, or $13,800 for family coverage.

The contribution limits are tied to inflation, though the growth of medical costs significantly outpaces inflation each year.

HSAs offer three tax benefits:

  1. Contributions are tax deductible: Like with a 401(k), you contribute pre-tax dollars to a HSA, which reduces your taxable income for the year.
  2. Earnings grow tax-free: You can invest your HSA contributions and the interest accrues tax-free.
  3. You can withdraw money tax-free if it’s used for qualified medical expenses. You can find a list of these expenses on the IRS’s website (your HSA provider should also be able to provide you with a list).

Unlike Flexible Spending Accounts (FSAs), the money you contribute to an HSA does not expire. If you don’t use it during the year you contributed, you can keep rolling it over even if you get a new job. This makes HSAs particularly valuable as a secondary retirement savings vehicle.