Bay Area Wellness Practice Policies

Here is a downloadable PDF Version of the Policies and Fees described below.

BILLING/INSURANCE

1. Dr. Toups is not a contracted provider on any insurance plans. Insurance companies simply do not adequately reimburse for the extensive amount of time it takes to undertake a comprehensive Functional Medicine assessment and treatment.
   
   However, your fees will generally be reimbursed at the Out-of-Network rates on your Health Insurance Plan, based on what the Insurance Company considers usual and customary fees. Since Dr. Toups is a Medical Doctor, most patients are reimbursed for a portion of their visits if they have a PPO plan.
   
   

2. Reimbursement also requires that you have met your deductible for the calendar year.
   
   

3. We will provide you with an itemized SuperBill receipt with traditional ICD-10 diagnosis codes and CPT procedure codes at the completion of each visit that can be submitted to your health insurance plan if they will compensate for an out-of-network provider.
   
   

4. SuperBills (health insurance invoices) are stored in your on-line Patient Portal under the “Invoices and Payment” tab, so you will always have access to them when you are ready to submit claims to your insurance company for reimbursement in the future.
   
   

5. You can usually obtain claim submission forms on the website of your Insurance Company, and then include the SuperBill receipt that we provide with each visit when you submit your claim.
   
   

6. If you would like to check on your insurance reimbursement before your visit, the CPT Billing codes we use for the initial visit are: 99205 + 99354 + 99355.
   
   

7. If you would like us to respond to insurance carrier requests for additional information about your claim, Dr. Toups will bill at a pro-rated amount of her hourly fee to submit this information if the request cannot be completed by the Patient Coordinator.

MEDICARE

1. Dr. Toups is not a Medicare provider, which means that you will be unable to bill Medicare for any portion of her services. Federal regulations require that you sign a Medicare Opt-Out contract to indicate your understanding of this policy. This can be found under the “Forms and Consents” tab on your Portal.
   
   
2. If you have a Supplemental or Secondary coverage plan, you are allowed to submit your claim to this carrier, but some will not reimburse until after Medicare reimburses.
   
   
3. Dr. Toups has been certified as an Ordering and Referring Physician through Medicare, which means that she is able to order lab tests and make referrals that will be covered if they are allowable Medicare charges.
   
   
4. Many of the specialty lab tests that Dr. Toups might order on your behalf are covered 100% by Medicare.

KAISER PATIENTS or PATIENTS WITH NO INSURANCE

1. Dr. Toups has contracted with Cleveland Heart Lab to provide extremely low cost lab testing for patients with Kaiser Insurance or patients without health insurance.
   
   
2. True Health Diagnostics Lab is another good option we use for patients with Kaiser Insurance.

LABORATORY TESTING COSTS

1. Dr. Toups preferentially orders tests from laboratories that will accept and bill through your traditional medical insurance coverage.
   
   
2. There may be additional outside lab testing needed at times, but of course all lab costs will be discussed with you, and every effort is made to code the requisitions properly in order to maximize your insurance reimbursement
   
   
3. Dr. Toups does not mark up the costs of any labs, nor does she charge any additional interpretation fees. She does not believe in ordering unnecessary tests that will not change your treatment plan.

OBTAINING PRIOR AUTHORIZATION FOR MEDICATIONS or CERTIFICATION LETTERS and FORMS

1. Both Prior Authorizations for non-covered medications and forms or letter-writing can take Dr. Toups some time to complete. She is happy to assist, but will bill a pro-rated amount of her hourly fee to cover the time needed to complete these.

CONSULTING WITH YOUR OTHER PHYSICIANS

1. Dr. Toups is certainly willing to discuss your case, labs, or treatment plan with your other treating clinicians. Please be sure that you have signed a Release of Information form on the Portal for them (“Release To” form for us to release info about you), and ask your Physician to call or email. (Unfortunately, many mainstream M.D.s are not interested in a Functional Medicine approach, so we find it is best if they contact us if interested.)
   
   
2. Consultation time will be billed at a pro-rated amount of the hourly rate if this takes more than a brief call.

MD-HQ PATIENT PORTAL

1. MD-HQ is the Patient Portal we use for our Electronic Medical Records, and to share the information in your chart with you. Our patients tell us they love this Patient Portal, and find it very helpful and easy to negotiate.
   
   

2. MD-HQ works best if you use Chrome or Firefox as your browser.
   
   

3. To register, please go to https://toups.MD-HQ.com/set_password
   
   

4. Once registered, you can access the portal in the future at https://toups.MD-HQ.com
   
   

5. If you forget your password, please go to https://toups.MD-HQ.com/reset_password
   
   

6. All Encounter Notes with visit findings and treatment recommendations will be visible in the MD-HQ Patient Portal. As it can take additional thought after your appointment time to complete the treatment recommendations, these are generally available 1 -2 days after your appointment – you will receive an email notification when the Encounter Note is complete.
   
   

7. There are tabs on MD-HQ for Supplements, Medications, Lab Testing, and Handouts.  You can access and print all of your Lab Testing results easily from your portal.
   
   

8. Please keep your Account Information with insurance company, credit card, and pharmacies up-to-date under t he Portal tab My Account Details. Your Health Insurance info is transmitted electronically when we send prescriptions or lab requests, so it is helpful for your coverage to keep this up-to-date. Please designate your preferred phone number.
   
   

9. Make sure you have uploaded a current photo of yourself (use a jpg, gif, or png format) under My Account Details. It can simply be a selfie from your cell phone – we just need a headshot to identify you (and it helps when I am working on people’s charts to connect!).
   
   

10. If you have changes in your credit card, please update it in the portal under the tab that says Invoices and Payments. We are able to store more than one credit card there, so you can also add an HSA card or alternate credit card. All card numbers are stored encrypted for your protection – we are only able to see the last four digits. (Note: At this time, the MD-HQ program does not let you see what credit card you have entered in the past. I am working with them to change this so that you will hopefully be able to see which cards you have entered and update the expiration date and the like as needed without having to re-enter everything about the card.)
    
    

11. Under the Forms and Consents tab, you can access and sign these Bay Area Wellness Policies, as well as Consents for Release of Medical Records for Dr. Toups to give or request information about you from other providers. You are able to add multiple providers on one form that you might want us to share medical records with.
    
    

12. Under Forms and Consents, there is also a consent that patients with Medicare insurance are required to sign, and a Pre-Appointment Questionnaire to be completed prior to each follow-up appointment.  Consents for other items like Bio-Identical Hormones and B12 injections are also found here.
    
    

13. Documents can be signed electronically now by tracing the approximate shape of your name using your computer mouse. (Don’t worry if it does not look like your regular signature!)
    
    

14. You can upload documents directly to your MD – HQ portal, like lab tests from other doctors, or reports or forms, on the Labs and Documents tab. There you will see a button that says Upload New Documents. You can click on this, and then select a document you have stored in your computer. Please convert your document into a PDF format before uploading. We are unable to open Word documents on MD-HQ.
    
    

15. There are many other features that you can access by clicking on the various tabs, like Scheduling Appointments and sending Portal Messages to our office. (more info on these two features is found below)
    

PORTAL MESSAGE FEES

1. There is generally no fee for Portal Messages with a Patient Coordinator. We want to be able to give you support for your general questions, but clinical issues requiring MD time will be subject to billing.
   
   

2. All Portal messages requiring MD input will incur a minimum $25 basic fee, and time consuming messages may incur additional charges based on the time needed to address the message. Thanks for your understanding.
   
   

3. The easiest and quickest way to get a response for questions is to send messages on the patient portal.
   
   

4. The Bay Area Wellness Patient Coordinator will monitor the Portal messages (at least once a day during the work-week). We endeavor to respond to Portal messages within 2 to 3 work days. Our Patient Coordinator is only available part-time. Portal messages are generally not monitored on the weekends. Please do not use the portal for emergencies.
   
   

5. If your question requires more than a brief clarification that Patient Coordinator can ask Dr. Toups about, she will ask that you schedule an appointment or phone consultation so that your questions can be given full attention and integration with your entire clinical picture. These can be more cost-effective than having Dr. Toups respond to lengthy or involved portal messages.
   
   

6. Brief Phone Consultations with Dr. Toups will incur a fee of $100, and calls over 10 minutes will be billed on the basis of time.
   
   

7. We appreciate your understanding of these policies and charges. Dr. Toups has sometimes spent multiple hours each night answering portal messages, and this is unsustainable.

PHONE CALLS and MD-HQ PORTAL MESSAGES

1. Please Note: Dr. Toups cannot practice Medicine by email or the Patient Portal. Quick piecemeal answers to important clinical questions are not an appropriate way to practice thoughtful Medicine, and these do not serve our patients as they do not look at the big picture.
   
   

2. Questions about new issues, treatment decisions, ordering or interpreting lab tests, supplement ordering or changes, prescription refills, completing forms, etc are best addressed during a visit.
   
   

3. Portal messaging is provided as a courtesy, and is not meant to supplant regular office consultation. (Functional Medicine methodology is a process. Regular follow-up visits every 3 - 6 weeks are essential to make progress initially.)
   
   

4. If a matter is better discussed on a brief phone call, a 15-minute or 30-minute phone visit will be requested and scheduled, and billed at a pro-rated hourly rate.
   
   

5. For non-urgent matters that would best be attended to during an appointment, we request that you hold your question until your next appointment.
   
   

6. We prefer MD-HQ Portal messages from our registered patients, rather than phone calls or email. It’s easier for us to track messages on the Portal, and it also assures that we have a record of your questions and our responses. These are also visible for you. (Once a new patient is scheduled for an initial appointment, we will set up your online Patient Portal.)
   
   

7. Both Dr. Toups and her Patient Coordinator (who is trained in HIPPA compliance to protect your confidentiality) are able to see these Portal requests and can respond to them more quickly than phone or email messages.

PORTAL vs EMAIL vs PHONE

1. Please be aware that email messages are not confidential. Our MD-HQ Patient Portal is HIPPA compliant to protect your confidentiality. We prefer receiving messages on the Portal, and they are generally responded to more quickly.
   
   

2. If you do send an email message, please send to info@BayAreaWellness.net. Dr. Toups cannot respond to messages on her personal email.
   
   

3. When leaving a phone message, you can hit Option 2 to leave routine messages. Out Patient Coordinator is generally not able to answer the phone in real time.
   
   

4. If you have an emergency that requires Dr. Toups’ immediate attention, you can hit Option 3 and she will be paged with your message. (Please be respectful and reserve this option for emergencies. You can also use this option if you are running late for an appointment or lost for your first appointment since Option 2 is not answered in real time.)
   
   

5. If you have a serious Medical Emergency, please do not wait for a return call, but call 911 or go directly to the nearest Emergency Room.
   
   

6. NOTE: Dr. Toups may need to send you a message via her personal cell phone, text, or email from time-to-time. Please do not use these to contact her – she will not respond, as she is unable to track messages from so many sources. Please use the methods of communication outlined above – preferably the MD-HQ Patient Portal.

CANCELLATION AND RESCHEDULING OF APPOINTMENTS

1. We require 7 days notice for cancellation of new patient appointments, and 3 business days notice to cancel or reschedule follow-up appointments.
   
   

2. If appropriate notice is not given, we reserve the right to charge your credit card on file for the full cost of the scheduled appointment. Please be aware that holidays and weekends do NOT constitute business days.
   
   

3. Due to the time allotted and cost associated with each new patient appointment, the only exceptions to being charged for a missed new patient appointment are due to emergencies. We define an emergency as a death in the family or a hospitalization.
   
   

4. You may cancel your appointment by using your Patient Portal at MD-HQ, calling the office at (925) 265-2300, or emailing info@BayAreaWellness.net. A Portal message is best.
   
   

5. We generally have a long waiting list and ask that if you know that you need to cancel or reschedule, please let us know as soon as possible so that we may offer your appointment to someone on the waiting list, as we are only able to see a limited number of patients each week.
   
   

6. By signing below, you agree to our cancellation policy and authorize Bay Area Wellness to charge your credit card on file for any missed visits.

MD-HQ PORTAL SCHEDULING for follow-up appointments

1. The Portal is also a good way to request changes in your appointments or schedule follow-up appointments. Please click on the “Appointments Tab” in the Portal to schedule appointments, and send a message on the Portal if you need to cancel an appointment.
   
   
2. Requests for appointments or schedule changes are best done on the portal, as we do not have a full-time receptionist available.
   
   
3. You are able to see all available follow-up appointment times within the next several months.
   
   
4. If you cannot find a convenient appointment time and would like to be added to a Wait List, please send a Portal Message and we will do our best to accommodate you.
   
   
5. Please note that Dr. Toups is often booked out 6 – 8 weeks in advance, so please plan accordingly.
   
   
6. If you need to cancel an appointment, you will need to write us on the Portal.
   
   
7. Please select an appointment for the appropriate amount of time required for your follow-up. Follow up appointments generally require a minimum 45 minute slot in order to address the big picture, especially if it is early in your treatment with us, but you can also book a 25 minute appointment for more limited concerns. You also have the option to book a 60 or 75 minute appointment if you feel you will need extra time. (Note: If you have not been seen for an extended period of time, you might need to reserve a 75 minute appointment.)
   
   
8. Brief (15 minute) appointments are reserved for simple questions, and are billed on the basis of actual time used. If you would like a 15 minute appointment, please write us on the Portal and specify the best days and times for you. Please let us know if you would like the appointment to be by phone or in-person.
   
   
9. All appointments (both phone and office visits) will be charged on the basis of the time that the appointment takes, regardless of the length that was booked. We strive for efficiency in follow-up appointments with the Pre-Appointment Questionnaires and an in-house Patient Coordinator who can assist with scheduling, lab test kits, and other ancillary details when necessary.

LATE ARRIVAL APPOINTMENTS

1. We do our best to be on time with patient appointments in order to prevent you from waiting. If you arrive late for your consult, we will need to end your appointment at the scheduled time, and you will be charged for the length of the originally scheduled visit.
   
   

FOLLOW-UP APPOINTMENT REMINDERS

1. If you are scheduled for a follow up appointment, we assume you will honor this appointment time unless you notify us otherwise at least 3 business days prior to your scheduled appointment. We will send a reminder email from our office about your appointment one week prior, but these reminders are a courtesy only. Please know it is your responsibility to remember your appointment date and time.
   
   
2. When you log onto your patient portal, your upcoming appointments will be noted on the home page. This is a good way to check the date and time if you are unsure.

SMOKING/FRAGRANCES

1. Please do not wear any fragrances to your appointment or smoke before your appointment. Dr. Toups and many of her patients have fragrance and chemical sensitivities. You may be asked to leave if there is a noticeable presence of fragrance or smoke odor. This includes perfumes, colognes, scented body lotion, deodorant, shampoo, soaps and hairsprays.
   
   
2. Please also advise any friends or family members who plan to accompany you to your appointment of this policy. Thank you for your consideration.

PRESCRIPTION REFILL REQUESTS

1. Prescription refills are best handled at the time of an appointment so a thoughtful decision can be made regarding the appropriateness and dosing of the medication for your treatment, as well as the potential need for laboratory monitoring.
   
   

2. If you need a prescription refill between appointments, we ask that you send a request for the refill via the Portal messaging. Please be specific about the medication strength and how you are taking it.
   
   

3. It may take up to 72 business hours to process a prescription refill. Please note that Dr. Toups is generally not in the office every day to authorize refills. Urgent refill requests will be handled, but maybe subject to a $25 fee. Please plan ahead to avoid any interruptions in your medications.
   
   

4. The CA State Medical Board requires office visits every three months in order for refills of controlled substances like stimulants (Adderall, Vyvanse) or tranquilizers (Ativan, Xanax, Valium) to be issued. This will be strictly enforced.
   
   

5. For refills of regular prescriptions, if you have not been seen for some time, an appointment may be requested prior to refilling your prescription. Once stable, we require visits every six months for prescription refills

PRIMARY CARE PHYSICIAN

1. Dr. Toups is a Functional Medicine Psychiatrist, and not a Primary Care Physician or Gynecologist. This means that Dr. Toups is not able to address Urgent Care or Primary Care issues. She cannot perform PAP smears or routine gynecology care.
   
   

2. We recommend that you have a Primary Care Physician for your routine and emergency medical problems.

SUPPLEMENTS

1. Dr. Toups does not sell supplements, but will give her patients codes that enable them to order through her professional supplement accounts. These professional accounts are generally only open to licensed practitioners, and they carry pharmaceutical grade supplements of the highest quality.
   
   

2. You can find this ordering information on your MD-HQ patient portal under the “Supplements” tab.
   
   

3. Dr. Toups offers a 10% discount off of retail pricing, which will make your supplements less costly than the Health Food Stores.
   
   

4. Shipping on Natural Partners NP Scripts (one of the primary supplement distributors we use) is only $1.99 with the arrangement negotiated for you.
   
   

5. Dr. Toups grants you access to the entire catalog of supplements available through her accounts, so you are able to order products as needed for your other family members as well. (Some practitioners only grant access to a restricted formulary.)
   
   

6. We caution against purchasing supplements from Amazon or other third-party on-line retailers, as there is no quality control regarding the conditions in which the supplements are stored and transported, or their freshness. We have had patients receive rancid products from Amazon.
   
   

7. If you would like to discuss changes in your supplements, or what supplements to order, between visits, please schedule a brief phone or office visit. 
   
   

8. Assessment of which supplements to start or stop requires more than a simple yes/no, and can involve a significant input of time for Dr. Toups to review your chart and your labs to make thoughtful suggestions

LAB TESTING

1. Dr. Toups uses a variety of lab testing options, from conventional labs to state of the art functional medicine testing. The goal of this testing is to understand how your body is working and to discover the root causes of your illness.
   
   
2. As stated above, Dr. Toups preferentially orders tests from laboratories that will accept and bill through your traditional medical insurance coverage. Conventional labs, like those available through Quest, LabCorp, True Health Diagnostic Labs, or Cleveland Heart Lab, are used for tests like Vitamin D levels, Thyroid testing, sex hormone testing, advanced Lipid Particle Profiles and glucose monitoring, inflammatory markers, MTHFR Folate genetics, salivary cortisol testing, and some vitamin, mineral, and anti-oxidant levels.
   
   
3. As mentioned previously, we have contracts with Cleveland Heart Lab and True Health Diagnostics Lab that provide very low-cost lab studies that can be utilized for Kaiser patients or those with no insurance.
   
   
4. In addition to the conventional testing, Dr. Toups sometimes uses a variety of tests from cutting edge Functional Medicine specialty labs, like Doctors Data (stool testing; heavy metals testing), Cyrex Labs (immunology and allergy testing), Genova/Metametrix, Great Plains Labs (Organic Acid and Toxin testing), CommonWealth Labs (SIBO Breath testing), GenoMind (genetic testing), Precision Analytical (Dutch Hormones Testing), IGenix (Lyme and co-infections testing) , Milford Labs (Lyme testing),  Cologuard Colon Cancer Test, Vitamin Diagnostics, Meridien Valley Labs (hormone testing), and ZRT (hormone testing) to name a few.
   
   

5. There may be additional outside lab testing needed at times, but of course all lab costs will be discussed with you, and every effort is made to code the requisitions properly in order to maximize your insurance reimbursement.
   
   

6. Dr. Toups does not mark up the costs of any labs, nor does she charge any additional interpretation fees. She does not believe in ordering unnecessary tests that will not change your treatment plan.
   
   
7. Dr. Toups will review each of the lab tests received and notify you if any result requires immediate attention.
   
   
8. Otherwise, lab results will be placed in your patient portal for you to view, and the results will be discussed with you at your next scheduled appointment. You will be able to print out lab results to share with your other clinicians.
   
   
9. Please be advised that you will need to make a follow-up appointment to review the testing results with Dr. Toups and have her make appropriate treatment recommendations.

COPIES OF MEDICAL RECORDS FROM OUR OFFICE AND TO OTHER DOCTORS/CLINICS/HOSPITALS

1. All treatment recommendations, medications, supplements, and labs will be visible in your MD-HQ Patient Portal.
   
   

2. This access means you can easily print out all of your information to share with your other treating providers.
   
   

3. We respect your privacy. Medical records or information about you can only be released with your written authorization. You can access the Release of Information forms on your MD-HQ Patient Portal by clicking on the “Forms and Consents” tab.
   
   

4. If you need us to send records to another provider, a $35 fee will be charged to cover our staff time for faxing or mailing the records. Simply sign a “Release To” consent form under the Forms and Consents tab in your Portal, and send us a message on the Patient Portal asking us to send the records you require.
   
   

5. Sign a “Release From” form for anyone that we might need to request records from on your behalf. Multiple names can be added on one form.
   
   

6. Please also sign a “Release To” for any Physicians or family members that you might wish Dr. Toups to speak with in the future. Multiple names can be added on one form.
   
   

7. If you are currently in Psychotherapy, you only need to sign the “Therapy Co-Treatment” release form for your Therapist instead of the two other forms.
   
   

8. You can sign these Release forms directly on the computer by using your mouse (or your finger with the newer computers and I-pads) to write your signature. Don’t forget to hit “Submit” after you sign!
   
   

9. We ask that you take the responsibility to obtain previous medical records from other physicians or health care providers that you wish Dr. Toups to review for your initial consultation. If you feel your medical records are pertinent to your appointment, please contact your physician or other health care provider to obtain these records and make sure that we have received them at least 3 days prior to your initial appointment. If you have a copy, you can upload them directly to your Portal.
   
   

10. It is especially helpful if you obtain copies of any lab results you have from the previous year and upload these into your Portal for Dr. Toups to review. (“Labs and Documents” tab – there is a button that says: “Upload New Document”. Make sure the document is in a PDF format please.)
    
    

11. Your medical records can be faxed or mailed to:
    
    (925) 265-2301 Fax
    
    Kat Toups, MD, DFAPA
    Bay Area Wellness
    2900 Camino Diablo Suite 200
    Walnut Creek, CA 94597
    
    

12. Please note that if you have extensive medical records and labs for Dr. Toups to review, this may take extra time that could be subject to additional fees. Dr. Toups is very conscientious about studying all of the details of these records, and this sometimes adds a substantial amount of extra time above the hour that she allots to review your Intake forms.

OUT OF TOWN PATIENTS

1. In order to establish a Doctor-Patient relationship, as well as to comply with California State Medical Board requirements, patients need to be seen in person for the first visit.
   
   

2. After the initial appointment, Dr. Toups is able to conduct follow-up appointments by phone if you live in the state of California.
   
   

3. If you are coming from out-of-town, please let us know and we will be glad to help with hotel recommendations. We are closest to the Oakland International Airport (OAK), but San Francisco (SFO) is also accessible at 50 minutes away. Downtown San Francisco is 25 minutes without commute traffic.

Thanks for your effort and patience in reviewing these extensive Policies. Please let us know if anything is not clear. We are looking forward to working with you!

Wishing you all the best,

Kat Toups, MD, DFAPA

Bay Area Wellness

Bay Area Wellness Fee Schedule