1. What is Functional or Integrative Medicine? How is working with Victoria different from working with my regular healthcare provider?
Functional, integrative or holistic medicine is based in HOW and WHY a disease develops and attempts to restore health by addressing the root causes and triggers for each individual. I start by viewing your medical history and symptoms through a slightly different perspective than your conventional clinician. Through careful listening and thoughtful testing, I’m able to identify key areas of dysfunction and imbalance that can be corrected. Conventional medicine aims to categorize and label your symptoms as a diagnosis, in order to match it to a prescription or rehabilitive treatment. Functional medicine goes upstream to look for causes for your problems and diminish inflammation in your body. The goal is simple: to improve quality of live, diminish prescription burden, and learn what you need to do to remain as healthy as possible, for as long as possible, so you can live your best life.
We do not accept any form of health insurance, Medicare or Medicaid. We are considered an out-of-network or “non-participating provider”, which gives us the liberty to practice freely, with no surprise bills or costs, just clean, clear transparency and open communication.
If you have out-of-network benefits, we can provide you with a receipt*, which insurance calls a “superbill,” which you can submit to your insurance company for possible reimbursement. However, please note that it is your responsibility to determine what, if any, out-of-network benefits you have with your insurance plan.
*If you have Medicare or Medicaid, we are not able to provide a superbill receipt for our services.
We are also happy to charge medical visits to an FSA/HSA card and coaching visits to FSA/HSA with a referral or prescription from your PCP or another referring clinician.
While I worked for many years as a primary care provider (PCP), I am not practicing as a primary care provider currently, and all new patients must retain their PCP. I am serving as a specialist or consultant. I require that all patients retain a primary care provider to handle ordering of important screening tests (like mammograms, colonoscopies, etc), and to handle urgent care issues. As a consultant, I do not provide urgent/same-day care that might require immediate assistance or hospitalization. With your permission, I’ll happily communicate our findings to your PCP (as well as your acupuncturist, physical therapist, specialists, nutritionist, shaman or whomever else is part of your care team) to provide a seamless approach to your overall healthcare.
In advance of your intake visit, please make sure that you have:
Completed the health history and intake form that was emailed to you via IntakeQ. This form is lengthy and thorough, and allows Victoria to really focus on getting to know you during your visits, so give yourself ample time to complete it.
Signed our consent, policy, procedure, privacy and credit card forms that were sent to you via IntakeQ. Victoria cannot see you for you appointment if these forms have not been completed.
Emailed or faxed any recent labs or tests you’ve had done that you would like Victoria to review in advance. Having these available at the time of the appointment is very important so that plans for testing can be made at the time of your visit. If you are unable to upload them, please bring copies (do not bring originals) or have them faxed in advance. Email to email@example.com or fax to 917-924-3371
We will not be drawing blood in office, so please do not come to the office fasting – you will be given a lab requisition to take to Labcorp or Quest, or the kits you need to do your testing at home, with easy pre-paid pre-address FedEx return envelopes.
5. Can you prescribe or refill my medication if I need it?
Absolutely! I am a licensed and board certified Family Nurse Practitioner and can prescribe medication. Some of the most-prescribed medications in our clinic are: thyroid replacement therapy, B12 injections (compounded methylcobalmin), low dose naltrexone (LDN), hormones such as progesterone, and antibiotics to treat gut infections, parasites and SIBO.
6. Can you order labs and will my insurance cover them?
Yes, I can order any laboratory work you may need, and it is my practice to be as practical, efficient and thorough as possible when ordering labs.
This means that I will recommend ordering all the labs we need to optimize your health, but don’t recommend lab work unless I feel confident that the information will be helpful. I prioritize using labs that are both the best scientifically-speaking, and that are will covered by insurance.
Lab tests are ordered from eight main laboratories that Victoria works closely with. Those labs are Labcorp, Quest, Professional Laboratory Coop, Genova Diagnostics, GIMaps, Aerodiagnostics, Precision Analytics/DUTCH test, Cyrex, and Igenex Lyme Testing. Information on each of these labs is below.
You will be given the cost of each lab (other than bloodwork) before testing is ordered in your name, so that you may consent to the cost of testing. We don’t like surprise bills either!
Labcorp & Quest
Labcorp and Quest are two of the most commonly used labs used in New York for routine bloodwork. They are frequently partially or fully covered by your standard health insurance plan, but each plan is different so you should always confirm coverage with your insurer prior to having tests done.
Most bloodwork can be done through Labcorp or Quest, and there are certain advanced Functional Medicine tests that are only available through specialty labs. Visit the Labcorp and Quest sites to see what testing options are available, keeping in mind that some tests are available only in certain states. Lab draw appointments can be scheduled directly on the Labcorp and Quest websites.
For uninsured patients or those with a very high deductible, bloodwork can be ordered through a lab called Professional Laboratory Coop, which provides significant discounts and savings on routine bloodwork.
Genova offers specialized Functional Medicine testing that is not available through conventional labs. While some tests are partially covered by insurance, none are covered 100%, and a co-pay is required at the time of testing. We often order stool, Small Intestine Bacterial Overgrowth (SIBO), and organic acids testing (NutrEval or ION).
The stool and SIBO breath tests are done in the privacy of your own home.
The OAT is done at a lab near you, and we can help you find a participating laboratory.
GIMaps – Diagnostic Solutions
Diagnostic Solutions provides advanced stool testing for assessment of the gut micro biome, parasites and bacterial imbalances, similar to Genova. Victoria will make a clinical decision about which test is better for your specific case. This stool test is done in the privacy of your own home, and is often well covered by insurance with a copay.
Aerodiagnostics – SIBO breath testing
Aerodiagnostics performs cutting edge 3-hour SIBO testing using the gold-standard Quintron machine. This breath test is done in the privacy of your own home, and is often well covered by insurance with a copay.
Precision Analytics – DUTCH test
The Dried Urine Test for Complete Hormones (DUTCH) is a urine test for sex hormones, cortisol and metabolized cortisol (adrenal hormones) and organic acids. This test is done in the privacy of your own home. Insurance often covers about $100 of the cost of this test, and you’ll be given receipts to submit to insurance.
Cyrex is a clinical immunology lab that specializes in Functional Immunology and Autoimmunity. Cyrex offers unique early detection testing and monitoring of complex autoimmune conditions and food allergies. Insurance does not cover Cyrex testing. This testing is done at a lab near you, and we can help you find a participating laboratory
When Lyme disease or coinfections are suspected, a blood test for Lyme and coinfections is usually done through Labcorp or Quest, as these options are usually covered well by most insurance. If a positive result is found, testing can stop there. If that test is negative, we can do more advanced bloodwork testing through Igenex. This lab is generally not covered by insurance, which is why it is not our primary first test for most people. This testing is also is done at a lab near you, and we can help you find a participating laboratory.
8. I want to call my insurance to see if they will reimburse me for medical care with you. What should I tell or ask them?
Please know that you are unlikely to get an actual dollar amount of reimbursement answer from insurance, and will likely be given a percentage of reimbursement. It’s unfortunately all too complicated with the different companies and plans available, and getting a direct answer can be hard. We recommend taking a deep breath before you call insurance…
Questions you may want to ask your insurance company include:
What is my Out of Network coverage?
What percent do you reimburse for Out of Network Providers?
Is that the percent of the actual visit cost or the percent of “Usual and Customary Charges”?
What is my deductible and does it need to be met before reimbursement can happen?
A licensed and board-certified Family Nurse Practitioner
Practicing in zip code 10038 (Manhattan)
Code your intake appointment as procedure code 99205 for a 90-minute intake session
We do not have diagnosis codes because we haven’t met yet, but they may ask for them. Just let them know that we haven’t done our intake session yet, but we will soon.
9. Can my Primary Care Provider order these tests for me?
The testing we are ordering for you is specialized and advanced Functional Medicine testing, and is not available through the regular insurance laboratories (LabCorp, Quest). To order these labs, we have established accounts with these specialty labs that your PCP is unlikely to have created, as they are unlikely to have the years of training needed to know how to order and interpret these labs. That said, you are always welcome to ask your PCP if they can order these tests, or you can ask them for a paper prescription for these tests that you can then submit to insurance along with your receipt. No harm in doing so, but we make no guarantees of any sort of insurance coverage. You should assume the tests will cost the prices listed in each FAQ document you receive from us.
1. If you live in NY State or Washington, DC, where Victoria is licensed, she can see you as a formal medical patient, and while we don’t take insurance, we can send you a “superbill” which is a receipt for insurance out-of-network coverage. For these patients, Victoria can order labs directly, and can prescribe pharmaceuticals or supplements as needed.
2. For those living outside DC or NY, Victoria can work with you as a specialist consultant, can provide health information and guidance, and can recommend specialty labs (stool, SIBO, Cyrex, DUTCH, etc) that she can arrange to have ordered for you. Bloodwork would be ordered through your PCP, with Victoria’s guidance as to what to ask to have ordered. You would receive the same guidance, nutritional support and care as those in DC/NY, but your sessions would Not be eligible for insurance receipts and out of network reimbursement.
For those seeking Life Coaching:
You can live anywhere on the planet that has an internet or phone connection! Victoria has coaching clients across the United States, Canada, Europe, Asia and Latin America.
While most insurance does not cover life coaching yet, some do, so ask your HR rep. If you get a prescription for coaching from your PCP, you can often use your FSA/HSA to pay for your sessions, or can get reimbursed by those programs – another question for your HR rep.
11. This is so exciting! How do I become a patient to start optimizing my health and wellness?
I’m so glad you’re excited to start optimizing your health and feeling your best! It is vital to make sure that my skills are a match for your needs, which is why I require a consultation before we establish medical care. Please click hereto book your complimentary 20 minute session.
This will be a time to get to know each other, and legally, I cannot provide medical care or advice on this call, as you are not yet a patient of mine. This is not the time to give me your whole medical history – we will have plenty of time for that soon enough.
We will optimally do this call over the Zoom video platform, which you can do from your phone or computer, and you will need to download the app in advance of our session to your computer or phone.
You’ll get all the details you need in your visit confirmation email, so be sure to read that!
Can’t get on video? Call me at 857-342-3387. When the system asks for your name, just say your first name, and you’ll be connected to my office. Looking forward to working together to get you feeling your very best!