How do you treat chronic pain?
We
treat chronic pain here in a non-interventional manner,
i.e., we do not do epi-durals or facet blocks…only
medications and try to schedule PT for rehabilitation
and strengthening exercises.
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Do
I need a referral to become a pain patient?
No,
not unless you have to pay cash to see us here at the
office. Then we need a referral from your primary care
physician or provider, e.g., chiropractor, that you are
suffering with chronic pain and have the diagnosis of
… There really doesn't need to be much more than
that. The referral needs to be on official letterhead
and we will call and verify the authenticity of the letter.
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What
insurances do you accept?
We
accept Medicare and nearly every PPO there is. We do not
accept Medi-Cal or any HMO's/Kaiser at all. These will
need to pay cash for any visits. We will try and work
with your primary providers to allow you to use any phar-macy
benefits, etc., but we cannot guarantee that it would
work.
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What are your fees for cash-paying patients?
The
initial evaluation is $120 and then the standard visit
is $90 for pain and $60 for other types of visits, not
including any injections or other types of ther-apy that
may be done on the premises. We ask that you pay up front
as you are leaving and not have us "bill" you.
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Do you accept checks?
Yes,
we do accept checks, but we charge a $50 returned check
fee to handle any checks that are returned for non-sufficient
funds. If you are a pain patient, you will not be seen
again until your account is cleared of these charges.
We also accept Visa/MC, cash and money orders.
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Do
you accept Workers Compensation cases?
Yes, we do accept all WC cases that are permanent
and stationary. We do not accept unsettled claims
unless Dr. Work is listed as the secondary provider, e.g.,
your chiropractor who is treating you for a WC injury
sends you to Dr. Work for pain management.
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What do I need to bring for my initial WC visit?
First,
you need to make sure that Dr. Work is authorized to see
you for your injury. Calling your attorney ASAP and requesting
that they call AND write to the WC insurance company
requesting this change of primary treating physician to
Dr. Work will allow Dr. Work to get paid for the visit
by the insurance company. If Dr. Work is not authorized
to see you and you see him anyway, you are liable for
the charges, even if he becomes your primary provider
later on. This is actually at the discretion of the insurance
company but do not take that chance. You will also need
to have all of the contact information for the WC insurance
company and claim number. If you do not have this information
or it has not been sent to Dr. Work prior to the appointment,
you will need to pay in cash on the day of the visit at
the usual rates. If Dr. Work is to be your secondary provider,
your primary provider will do all of the work for you.
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If I am a chronic pain patient only, can I get other issues
addressed at my visit, even if I have insurance?
It
depends upon the issue. If the issue is hormones, then
the answer is yes. If the issue though is instead something
that is considered "primary care", e.g., cholesterol,
diabetes, high blood pressure, then you will need to address
it with your own primary care physician. This allows the
appropriate continuity of care that is important in the
patient-physician relationship.
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If
I am a regular patient of Dr. Work's and I am also a chronic
pain patient, can I get multiple issues addressed at once
while getting my pain medications refilled?
Unless
it falls into the category of hormones or anxiety/depression/constipation,
then the answer is that you will need to make another
appointment. Your pain medications and the proper dispensing
of them is too complex to then have to deal with other
medical issues in the amount of time that is allotted
for your visit.
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What if I am a WC case and I have Dr. Work as my primary
physician for regular care? Can he see me at the same appointment
for WC and non-WC related issues?
No,
the issues have to be separate and they have to be seen
on different days. Otherwise, it would have Dr. Work billing
two different insurances for an office visit on the same
day. This is illegal.
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I am a chronic pain patient and I need a new triplicate
medication because I had a reaction to the previous one
or I have lost my triplicate. Can I just ask for a new one?
No,
you must be seen for an appointment. Because these medications
are so tightly monitored, it requires that an office visit
be done to write down exactly why you needed a change
and what happened to the old medication, etc. There can
be no exceptions.
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I am a chronic pain patient here and I need refills. Can
I have my pharmacy call for refills of my pain medications
or my tranquilizers, etc.?
No,
you must make sure that you have all refills of your pain
medications, muscle relaxants, tranquilizers and anti-depressants
while you were at your scheduled office visit. There were
too many times that prescriptions were over-filled or
messed up because of requests "crossing" paths
with two different providers. We therefore decided that
you must have all controlled substances listed above filled
in that manner. Your non-controlled medications, e.g.,
blood pressure, cholesterol, etc., can be refilled from
your pharmacy.
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Why must I make an appointment for my next pain visit before
I leave the office? Can't I just wait until I need more
medications and then call for an appointment?
No,
you cannot, because in all likelihood, you will not be
able to get in before you run out of medications and you
will not have your medications refilled before you are
seen in an appointment…no exceptions. You will therefore
go through the discomfort of withdrawals for no other
reason than you did not make an appointment at the time
of your last visit. This same scenario applies if you
cancel your appointment. You may not get another one within
the appropriate amount of time before you will run out
of medication.
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I had an appointment at 10:00 a.m. and I didn't get seen
until 11:00 a.m. Why did I have to wait so long to be seen?
Dr.
Work and Ae Lee have discussed this and have decided a
long time ago that patient care must come first and foremost
and a time schedule does not have priority over this patient
care. There are times that medical problems take longer
than the standard 15 minutes to address. Now if there
are multiple medical issues, we will split them
up into more manageable "chunks" of time, but
if an emergency or an issue arises that needs to be addressed,
it will be and you will not be rushed out the door. Therefore,
since we are willing to address your needs, then
we must address others' needs as well. This means
that there are times that we are running behind. Please
do not be offended and do not be angry with us, because
we won't apologize for the lateness of the appointment…this
is the way this practice has decided to operate. If you
desire a practice that will see you on time, first, you
won't find one easily, but if you do, then you are welcome
to transfer your care to them and we will assist you in
any way possible to make it as easy of a transfer as possible.
We want our patients to be happy here and if they are
not, then we want them to be happy in another practice
elsewhere. If you are unhappy with us, then the therapeutic
relationship is lost and it is fairly pointless to continue
the relationship. Please bring a book to read or a laptop
to get some work done. There are always magazines and
brochures to read (though they can get boring).
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Can I refer my friends and family to this practice? Is Dr.
Work accepting new patients?
Dr.
Work is always accepting new patients and accepts all
of the insurances that have been listed elsewhere. Please
do not make an appointment for your friend or relative
but do bring a card and encourage them to call for an
appointment with you there at that time of calling. And
we do appreciate the confidence that you have in us that
you would allow us to treat your friends and family.
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I have to have a prior authorization for a medication and
Dr. Work needs to fill out the request. When can I expect
that to be done?
Although
we would like to say that this is done quickly, in reality,
it is very time-consuming to fill out these forms repeatedly.
This is especially true if it is for the same medication
by the same insurance and yet they want to have another
prior authorization. Once this request is submitted, it
is up to the insurance company and you to get it expedited.
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I had applied for a prior authorization or a Medi-Cal TAR
and it was denied…what now?
There
is not much more that we can do for that particular medication
that was denied. We can try and find a suitable alternative,
but this may require another appointment to see you and
examine you for this alternative… depending upon
which drug was denied and what new drugs will be requested.
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I have paperwork that Dr. Work needs to fill out. Why do
I need to pay to have it done? Isn't this what a primary
provider is supposed to do for his patients?
In
a perfect world and with no time or financial constraints
placed upon the physician, then there would be no charges.
Unfortunately, these forms take time to fill out and frequently
require Dr. Work to review the chart notes for pertinent
information. We are sure that you will agree that Dr.
Work's time is worth something, so the charge is placed
against it. This is a common practice in most medical
practices.
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I want to see Dr. Work but instead I only see the nurse
practitioner. Why don't I get to see Dr. Work always?
Dr.
Work hired Ae Lee Hang, FNP (Family Nurse Practitioner)
as a "mid-level provider" who can examine people
and write prescriptions. Many clinics are run solely by
nurse practitioners. In addition, Ae Lee has worked with
Dr. Work for quite some time and has adopted his methods
of treatment so that the two will not conflict in treatment.
She constantly is trying to learn more from Dr. Work and
on her own (she has even taught Dr. Work a few things).
He reviews her work periodically and if she ever has a
question about a suspect finding or therapeutic outcome,
she immediately addresses it with Dr. Work either personally
or by phone to ensure the highest quality of care. He
has never had an incident where he has had to over-ride
any decision that she has made due to errors or incompetence.
He has found Ae Lee to be very intelligent and one of
the best nurse prac-titioners in Fresno (don't tell
her he says that though…her head will get too big).
If he did not have the utmost confidence in Ae Lee, she
would not be working for him…period. So do not be
offended or think that you are getting second-rate care
when Ae Lee sees you. She is "Dr. Work by proxy"
except a whole lot prettier to look at than he is!
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There
are so many diets out there and Dr. Work offers Medifast.
Which diet should I pick?
That
is all dependent upon how much weight you need to lose
and your financial situation. The larger amounts of weight
are best removed with Medifast (see the brochure for more
information). The upside is that it is safe and simple.
The downside is that it costs approximately $270.00 per
month for the supplements/food. The smaller amounts of
weight should be removed with an Atkins diet. Once the
weight has reached maintenance, you are to increase the
number of carbohydrates that you are eating daily up until
you are maintaining your weight AND the carbohydrates
should NOT be refined. Therefore, you should have no flour,
breads, pastas or tortillas. In addition, you should have
no refined sugars in your diet. Just by cutting those
items out of your diet, you will be able to more easily
retain your weight loss and stay healthier.
