Policies and Procedures
Basis of Clinic Charges
The Cheney Clinic is a low volume, high intensity practice which serves primarily a very ill population of typically disabled patients with a multi-system, chronic illness called chronic fatigue syndrome. There is no simple, easily repeated treatment algorithm that would allow a high volume, low intensity practice of medicine.
There are many issues to explore and the biochemical individuality and complexities inherent in this population requires an extraordinary breath and depth of knowledge almost never seen in typical medical practices, either primary or sub-specialty.
As a result of the immense challenges of effectively treating this diverse, often very ill as well as complicated patient population, we have been forced to change the compensation scheme traditionally used in most medical practices which is procedure based and not time based. Given the expense of long distance travel, we must also extend the time over a day or two for each visit because we cannot physically see the patient in frequent follow-up as is done in psychiatric practices which are also time based. We also have significant technology-based resources that need to be applied that take time and effort and are expensive to maintain.
Cost Analysis
In the 1990’s we did a cost analysis and showed that patients in our clinic spent significantly less money ($5,000 vs. $25-50,000) on physicians and procedures for their CFS symptoms compared to before they were in this practice. In addition, many patients amortize their visit over the year with only one or two visits per year so the annual cost is not high when compared to the quality of the visits and especially so after the more prolonged and costly first visit.
Probably the most frustrating part for the patient is the uncertainty of insurance re-imbursement, if any. The cost of therapies can usually be managed as there are many ways to control therapeutic costs and to prioritize treatment. Unfortunately, there are many CFS patients who cannot afford any professional care or therapies, much less the Cheney Clinic. For these patients, we hope the rise of the internet and web-based information available on it will help them self-manage their illness. There are countless patients that do just this type of self-management. Our web site is designed to help solve this problem of access to quality care as well as cutting edge care.
Medicare and Insurance Reimbursement
As a result of the atypical nature of this practice, we do not accept Medicare or Medicaid which do not allow this type of charge format and limit re-imbursed charges to levels below what is required to effectively deal with CFS. We also do not accept insurance-only re-imbursement for exactly the same reason.
We do, however, offer the usual and customary insurance invoices with ICD-9 codes for patients to use to seek reimbursement on their own from private insurers. Exceptions to this policy apply to Medicare patients who are Medicare primary. Medicare patients must sign a waiver to acknowledge that we are not a Medicare provider and no professional re-imbursement is allowed by Medicare for visits to this practice. Any future, government backed medical care plan will likely be similar to the current Medicare policy and no reimbursement will be possible either for visits to this clinic.
Cancellations
Any cancellation requires another $1,200 for re-booking. However, one and only one forfeited booking payment can be applied to any future office visit charges but only if the visit occurs within one year of the deposited booking fee. Unused booking fees are forfeited after one year.
Wait-listed patients who have been on the waiting list for six months or longer may be removed from the wait list unless they re-book by phone or in writing.
Pre-Payment of Visits
Pre-payment of some or all of the projected cost of a visit is allowed. This is typically done for non-U.S. patients to allow for the most favorable exchange rate.
All such pre-payments are refundable except for the $1,200 booking fee. Pre-payment checks are deposited but are refundable, except for the $1,200 booking fee, on request at any time until one week before the visit. Within one week, 50% is refundable less the booking fee but the forfeited balance can be applied to a rescheduled visit if such a visit occurs within one year of the first booking date. However, another $1,200 booking fee will be required.
Payment will then be applied to the visit or refunded if cancelled or a no-show, less the $1,200 booking fee. Exchange rates can fluctuate 10% or more within six-months, so this policy could be very beneficial to the non-U.S. patient of the Cheney Clinic.
Primary Care Physician
All patients are expected to have a primary care physician. Dr. Cheney specializes in chronic fatigue syndrome and cannot handle emergencies, common non-CFS conditions, or complete annual health screens. We can, however, send clinic notes to you on request to give to your primary care physician or others as you wish.
Pre-Visit Testing and Laboratory Data
We highly recommend that routine testing is done before or within a year of being seen. This accelerates the evaluation process and can often reduce costs if ordered by your primary care physician. Please review typical tests:
Standard Annual Tests
Annual Routine
(Prioritized by number under the headings)
- Chemistry with blood lipids
- CBC with platelets
- TSH
- Free T4
- Sed Rate
- Uric Acid
- 25 hydroxyvitamin D
- C-Reactive Protein – inflammatory marker
- Fibrinogen – Coagulopathy Marker
- TGF Beta-1 (LabCorps) – immune activation marker
- C4a (LabCorps) – Innate immune marker
- VIP (LabCorps) – Parasympathic/Sympathetic NS status
- MSH (LabCorps) – Hypothalamic status marker
Non-Standard Tests
Documented at least once since you became ill
(Prioritized by number under the headings)
- 24 Hour Urinary Hormone Panel (Genova Labs, Asheville, NC)
- 1-25 dihydroxyvitamin D along with 25 Hydroxyvitamin D above
- Epstein Barr Virus Antibody IgG Titers (VCA, EA and EBNA)
- HHV-6 Antibody IgG Titers
- CMV Antibody IgG Titers
- Lyme Western Blot IgG, IgM
Special tests of current interest
(Vitamin Diagnostics Lab, NJ)
- SOD, GPx, CAT – oxygen handling enzymes
- NADPH, NADH – Anabolic and Catabolic energetics
- GSH/GSSG – Glutathione redox status
- MDA – Measure of lipid peroxidation
(VIP Dx Labs, Reno NV
- XMRV/MLV serology and culture (both tests give the highest chance of excluding a false negative result)
- Cytokine Panel – XMRV/MLV related immune marker
- Lymphocyte Enumeration with NK/NK-T ratio – XMRV/MLV related immune marke
LabCorps
1. Chromosome SNP Microarray (CSM) — Labcorps Test # 510002 (Measure 1.8 million genetic defects including SNP’s linked to CFS)
Optional tests of current interest
(VIP Dx Labs, Reno NV)
- NK Function Panel- Innate immune status
- Elastase – innate immune marker linked to both gut status and RNAP status
- Immunobilan – Degree of gut permeability and gut immune status
- RNase-L and RNAP – Anti-viral immune status