In order to be compliant with a National Quality of Care initiative, we have developed written answers to many of the common issues. These are available here and in the office.

General Office Policies
Telephone Calls - leaving messages, return calls
Email - confidentiality, junk, reply
Prescriptions and Refills
Insurance Problems - prior authorizations
Controlled Substances - pain medications, etc
Risk of Driving
Law Enforcement - DEA, losing medications, etc

 

Office policies

the office hours are by appointment only. Because Dr. Anderson goes out of the area frequently for lectures, the office may be locked at times when no appointments are scheduled.

Q: What are your office hours?
A: Office hours vary depending on Dr. Anderson's lecture schedule. Typically, followup patients are seen on Mondays and Tuesdays and new patients are seen on Wednesdays. Procedures are performed on Thursdays. We are closed on Fridays. Because routine office tasks are performed off-site, the office may be physically closed (even if the business is open) when there are no scheduled patient appointments.

Q: I dropped by and the office was closed. Why?
A: The office is physically open only for scheduled patient appointments. Most routine tasks are done by computer and therefore, the office may be physically closed even though the business is open. Routine office work on non-patient days is done off-site.

Q: How do you provide transparency?
A: Our office policies and procedures are provided on the internet and in the office. We have a written refill policy, telephone policy, etc. Additionally, Dr. Anderson voluntarily provides his financial disclosure and other information to help ascertain the absence of conflict.

 

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Telephone and Email Message Questions

 we strive to return telephone calls in a timely manner.

Q: Is there a backup physician at all times?
A: Yes. Even if the office is closed, there is a physician available for urgent issues 24 hours per day, 7 days per week. The contact information is provided on the outgoing message.

Q: Do I need to leave a voice message?
A: Probably. Being a small business instead of a huge corporation, we have a small staff. We are not always able to answer the phone because we may be busy helping others. To solve this problem, we ask you to leave a detailed but brief message. We check messages several times daily, and we can research your issue so that when we return your call, we will already have the information you need.

Q: Why didn't I get a return call?
A: We strive to return all calls rapidly. Please remember that we are closed on Fridays, so messages left on Thursday afternoon are typically not received until the next Monday. Occasionally, we find we are NOT able to return your telephone call. The most common reasons are listed here:

The #1 reason for no reply call is that patients do NOT leave their full name and phone number in the message. "Hey, it's Bob, give me a call!" We wouldn't know who to call in reply.

Other reasons include failure to leave a telephone number clearly, or waiting until the very end of the message and saying the telephone number too fast to understand,

Poor cellular reception from the caller so that we cannot understand the message,

Speaking so quickly that the message is not understandable,

Giving us the wrong telephone number,

Not having an answering machine/system and not answering the phone when we do call back.

We strongly recommend that you remove any caller ID blocking so that we have your telephone number; this will help us return your call in case the message itself is garbled. You can add our office to your phonebook as *82-415-558-8584 (for most phone companies); that will provide your number on our caller ID device.

Q: When do you return calls?
A: Please remember that we have one person who answers all messages and makes all telephone calls. We strive to return urgent calls as soon as possible. We try to return routine, non-urgent calls within 24 hours. Sometimes it takes a day or two to return non-urgent calls, especially at the beginning of the week because we have messages from the weekend to review.

Because we are closed on Fridays, telephone messages left on Thursday afternoon, Friday, Saturday and Sunday are not reviewed until Monday. That means that on Monday, we have messages from late Thursday, all day Friday, Saturday, Sunday and early Monday to review BEFORE we begin returning telephone calls.

Q: What about caller ID and call blocking?
A: When returning calls from the office, we do provide a caller ID so that you will know the call is from the office.

However, in urgent cases, especially after hours, an urgent message may be returned via cell phone or home phone. In those cases, we cannot give out our private telephone numbers. If you do NOT accept calls with a blocked called ID, then you will not be able to receive our return calls until the next time the office re-opens for regular business.

Q: Do you respond to emails?
A: Yes and No. Unfortunately, we no longer accept emails for routine issues. Because we provided our email address to the public, either scammers or automated programs took our email addresses and signed us up for hundreds of inappropriate and junk emails. We no longer are able to accept email because we simply are unable to determine which emails are legitimate and which are risky.

We are currently evaluating a secure email service for specific medical issues. You can access that system by clicking here.

 

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Prescriptions and refill issues

 we typically provide enough medication to last until the next scheduled office visit. Therefore, refills are NOT necessary.

As you may know, the Federal Government is taking step to reduce the potential for medical errors. One of the major initiatives is electronic prescribing. This office uses electronic prescribing for ALL medications that do not require a special type of tamper-resistant paper. Therefore, your prescriptions are sent directly to the pharmacy of your choice with the appropriate quantity and number of refills to last until your next appointment.

Q: Do you telephone or fax refills?
A: In most cases, we provide enough refills to last until the next appointment and refills requests typically are not necessary. For those rare occasions when a prescription needs to be issued at a time other than the routine office visit, it is done electronically (and not by telephone or fax) for those medications that can be sent electronically. For those patients who use controlled substances such as morphine for pain, as you may know, the pharmacist will not fill any telephone or fax refills.

Q: The pharmacy says they need your authorization for the next refill.
A: Because we provide enough refills to last until the next scheduled office visit, the pharmacy should not require our authorization. Sometimes, the pharmacy does not include the refills on the prescription. Before leaving the pharmacy, you should verify that the appropriate number of refills is shown on the bottle. In terms of authorization, if we provided the prescription, we obviously have also authorized you to receive it.

Q: What about exceptions?
A: If there is an exception and you require a refill prior to the next scheduled appointment, please let us know directly. Please do not simply rely on the pharmacy to fax us.

Q: The pharmacy says you didn't reply to the fax. Why?
A: Again, we provide refills to last until the next appointment and therefore, the pharmacy does not need our permission to refill your medication. However, some major pharmacies have an automatic fax system that generates a fax request after a prescription is due to run out, whenever a patient calls the pharmacy, etc., EVEN when there are refills remaining. Therefore, we receive dozens of faxed requests daily for our patients and also for other doctors whose names are similar! If you require assistance with your prescription, please let us know directly.

Q: The insurance company says they need your authorization for the prescription.
A: If we provided a prescription, then we obviously authorized the prescription. What this really means is that the insurance company does not pay for the prescription and they will be requesting more information. With the additional information, the insurance company will decide, based on your written contract with them, whether they will pay for the prescription.

Q: Can you make an insurance company cover my meds?
A: No. We can provide the information requested to your insurance company. Hopefully that will work. However, in neurology and especially in pain management, many medications are used off label. Your specific financial contract with your insurance company may have an exclusion for off-label medications. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

 

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Insurance issues

please remember that insurance billing is a courtesy to the patient. We are not a party to the financial contract you have between yourself and your insurance company and, although we will try to help, we cannot guarantee coverage for treatments or medications.

Q: What insurance plans do you accept?
A: We try to accept as many insurance plans as possible. A current list is found at the INSURANCE web page. Please contact the office, however, because insurance contracts can change very quickly.

Q: Why won't my insurance cover the medication?
A: Many of the medications are off-label. That means that they are being used for a purpose other than what they were originally invented for (a good example is using aspirin for heart attack when it was originally invented for fever). Although ethical, legal and the standard of care, most insurance plans do NOT cover such medication use.

Q: The insurance company says you need to authorize the treatment.
A: If we planned the treatment, then we obviously authorized the treatment. What this really means is that the insurance company does not cover the treatment and they will be requesting more information. We are happy to provide the information. Your specific financial contract with your insurance company may have an exclusion for certain treatments. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

Q: The insurance company says you need to authorize the medications.
A: If we provided a prescription, then we obviously authorized the prescription. What this really means is that the insurance company does not cover the prescription and they will be requesting more information. We are happy to provide the information. Your specific financial contract with your insurance company may have an exclusion for certain medications. Because the financial contract is between you and your insurance, we are not able to change the terms of your contract.

 

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Controlled substances

please also check the definitions page regarding controlled substances. You also may wish to refer to the new patient questionnaire, which includes many of the risks of controlled substance use.

Q: Will I become an addict?
A: The disease of addiction has genetic, social and environmental components. A person who does not have the disease of addiction is NOT likely to become addicted to pain medications; however, there is no guarantee. The risk appears low unless there is a family or personal history of addiction to drugs or alcohol. Some signs of addiction include increasing the dose on your own, seeing multiple prescribing physicians, running out of medication early and getting extra medication from friends and family. If you feel that you may have the disease of addiction, you will need treatment for that medical condition; please let your physicians know so that they can help you.

Q: Are there requirements for me to receive controlled substances?
A: Yes, there are several requirements. Each major society involved in pain management has some recommendations that we follow: the medical societies recommend verification that medications are increasing function; the state legal societies recommend verification that medications are being used for legitimate medical purposes; the federal legal societies recommend verification that abuse is not present (urine testing, absence of illicit drugs, only one pharmacy, etc.).

 

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Driving and machinery

one of the most common questions involves the issue of driving a vehicle.

Q: Can I drive (or operate machinery, etc)?
A: We don't know. Many neurological conditions and their treatments affect the ability to drive. Conditions such as Alzheimers, Parkinsons, epilepsy, pain, arthritis or headache can impair the ability to operate a vehicle or operate machinery. Therefore the medical condition alone could prevent a patient from driving safely. Certainly, medications can impair the ability to drive or operate machinery. Many medications cause sedation or decrease reaction time. We see you for a very brief time of your life (just a few minutes per month). In that time, although we assess fatigue and tiredness, we cannot obtain enough information to make conclusions about your function outside the office. You must assume responsibility for your own behavior: patients are instructed not to drive or operate any vehicle or machinery if there is any impairment whatever, whether related to the underlying disorder or to the medication intended to treat the underlying disorder. If in doubt, do NOT drive.

You should NOT DRIVE if you have disorders that cause:

• lack of consciousness (seizure, for example)
• lack of rapid thinking/reaction (Alzheimer's, for example)
• certain visual issues (loss of half of vision, for example)
• any condition or treatment that impairs concentration
• these are just a few of the possible conditions

 

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Law Enforcement and the DEA

many questions arise related to the legal aspects of pain treatment. These questions mostly relate to chronic pain, although sometimes they relate to neurological conditions and headache.

Q: What steps do we have to take to protect ourselves and to protect the ability of patients to obtain pain medications?
A: We follow the medical and legal guidelines. By following the guidelines and documenting that we have done so, we can provide appropriate pain treatment to our patients. By following the guidelines, we are showing that we support pain management in an ethical and legal manner and that our patients deserve and are entitled to adequate pain control. As you know, a small percentage of abusers has given legitimate patients a bad name; by following the guidelines--although complex and cumbersome to some patients--we can help ensure to the best of our ability that the patients we respect and trust truly have chronic pain and are legitimate patients.

Q: Medical marijuana? Isn't it legal in California?
A: This is a hot topic. Let's look at this in two big ways: the State and the Feds.

(1) The State says that medical marijuana is okay and physicians who have a State license may prescribe it. State medical licenses do not allow the prescribing of narcotics/opioids.

(2) The Feds say that medical marijuana is not okay and physicians who rely on a Federal license may NOT prescribe it. The Federal government provides the permit necessary for the prescribing of controlled substances such as opioid/narcotic pain killers.

So, the issue is rather simple. Pain management physicians prescribe narcotic/opioid pain medications with a FEDERAL permit, and not with a State license. Therefore, pain management physicians cannot legally prescribe medical marijuana. This commentary has nothing to do with personal beliefs about marijuana, but simply clarifies the State and Federal views on the subject.

 

 

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FAQs

 

Our office is a small business focused on quality care and patient satisfaction.

There are several common questions. If your question is not answered here, please let us know. As we strive for transparency in our interactions, we provide additional information about common issues.

 

Office policies

Telephone calls

Prescription and refills

Insurance issues

Controlled substances

Driving (can I drive?)

Law enforcement / DEA