No, this practice does not accept health insurance as payment.

Full payment by credit card or HSA card is required when booking an appointment. A medical visit with a nurse practitioner is a covered expense for HSA accounts per IRS criteria.

Costs for appointments and lab services are transparent to clients and there are no additional later bills for labs or visits.

While health insurance is not accepted for payment, some insured clients will be able to get some or all of the visit reimbursed if they submit the bill to their health insurance carrier. Despite not billing health insurance directly, I will document a medical visit in a standard insurance coding compliant format and generate a “superbill” that is a specific type of invoice listing medical services with insurance codes. Superbills will be available in the Client Portal and clients can submit this to their health insurance company.

For more information on this process, clients need to contact their health insurance carrier through the Member Support phone number on the back of their insurance card. I have no further advice on this but can discuss more during your appointment time if you wish and am always willing to assist clients in navigating the healthcare system efficiently when I know their needs. Typically, in the current American medical system, the only way to know for sure if something will be covered is to submit the superbill or invoice, wait several months and then hear their decision.

I greatly appreciate knowing if clients are being reimbursed and appreciate any client who uploads a copy of their Explanation of Benefits (EOB) to the Client Portal. In some cases, once an initial EOB has been generated that denied the claim for an office visit in this practice, I may choose to appeal it on behalf of the client (if they wish) and will contact the insurance company directly. I have battled insurance companies many times for clients and patients and sometimes I win.

Absolutely. These are visits with a licensed nurse practitioner and meet IRS criteria to use a HSA card.

Absolutely. This practice works extremely well for people with high deductible health plans (HDHP) with connected Health Savings Account (HSA) cards. Medical visits in this practice meet IRS criteria for payment with a HSA card.

In addition, I have personally had high deductible insurance policies for more than twenty years and understand both their advantages and disadvantages. I encourage people to always max out their HSA contribution if at all possible, with its triple tax advantage.

I have a special interest in assisting people make the most economical and reasonable choices about medical care expenses. While I have always been acutely aware of out of pocket costs to “insured patients” in different settings, I also have five years of experience helping uninsured and low income patients navigate the healthcare system. This background assists me with clients of all income levels who are concerned with costs.

I offer the unique service of telling you ahead of time what visits, labs and other orders will cost and can assist in navigating and coordinating other healthcare choices.

I use an independent cloud based electronic medical record that is HIPAA compliant and secure for all information including chart notes, electronic forms submitted, file uploads, faxes, results and telehealth video visits. It is as secure as other EMRs routinely used in mainstream American medical offices.

Your primary care practice or any other medical practice will have no ability to access the electronic medical record or lab results connected with this Integrative Consultation. Labs completed in the office and visit notes do not populate into any other electronic medical record - except for the Labcorp Patient Portal if labs were drawn at Labcorp.

Scheduling a medical visit in this practice includes signing several standard forms that are filled out before any medical visit. The forms required before booking the appointment include:

• Consent for Treatment

• HIPAA Polices

• Office Polices

• Basic Medical Intake (allergies, medications, supplements, past surgeries, medical diagnoses and current concerns)

• An Advanced Beneficiary Notice of Noncoverage (ABN) form for patients with Medicare

When the above electronic forms are complete, the appointment can be paid for and the time is booked.

Additional intake forms will be sent. Keep in mind that completing all the requested forms before your initial visit will provide you with more efficient and cost effective use of your appointment time. Otherwise the appointment will start with asking questions from the forms that were sent prior to the appointment and could have been reviewed by Susan before the appointment.

No, I do not sell herbs or supplements to my established clients or profit from the suggestions I make. If I do suggest specific supplements I will connect my established clients (defined as those who complete a Medical Visit), if they would like, with an online ordering system where they may get a discount off the Manufacturers Suggested Retail Price (because I do not take a percentage) from some companies and/or I will send a botanical formula to an herbal dispensary where I do not profit from the sale, like a regular pharmacy.

In addition to formal herbal and medical anthropological education, I am a professional member of the American Botanical Society and have access to resources including HerbMedPro, Natural Medicines Database, The Complete German Commission E Monographs (on herbal medicine) and UpToDate.

While I sometimes suggest supplements or botanical options, I am more likely to question why people are taking a lot of supplements in the first place. I have completed classes in “deprescribing” and always look carefully at medication and supplement lists. The last thing I want to do is replace Big Pharma with Big Supplement. I hate seeing people on multiple poor quality/unnecessary/expired supplements and herbal products with a questionable rationale for use almost as much as I hate seeing patients on multiple prescription medications that might be avoided by a different approach.

While I believe a mostly healthy lifestyle does not need technological or laboratory confirmation and do not suggest apps, devices or labs for everyone, it is clear that the impact of this data for some individuals can be uniquely motivating for changing habits and making different lifestyle choices. You cannot “unsee” data that unequivocally point to a changing health condition.

As part of medical visits, I work with clients who are monitoring their blood pressure or cardiac markers at home and/or using continuous blood glucose monitors (CGMs), as a diabetic, prediabetic or nondiabetic person. I have extensive experience helping people navigate unexpected new diagnoses and coordinating initial care after emergency room visits.

I can assist in interpreting data and discerning actionable information vs. simply interesting personal physiological statistics from devices like the Apple Watch, Fitbit or Oura rings. I work to stay informed of new technologies (usually learning of them through clients) and will sometimes suggest apps or online programs to supplement medical visits as appropriate. For example in the last year, I have recommended Noom many times and can offer a 30% discount and letter of medical necessity as a provider for HSA documentation.

However, even as I offer these services and explore my interests in evolving technologies and specialty labs, I think it is crucial to use them judiciously and sometimes, not at all. For some people all this data is not useful and contributes to anxiety and unhelpful preoccupation. Drawing a reasonable line with technology and endless information is an ongoing discernment process for all of us, with no clear guidelines available.

I believe there are potential immense health benefits in people disconnecting from phones, limiting internet scrolling and avoiding social media that can all simultaneously create an army of the worried well, misinform, divide communities and nations and destroy the possibility for moments of peace.

“Comparison is the thief of joy.” Theodore Roosevelt

“What gets measured gets managed.” V.F. Ridgway

“Not everything that counts can be counted and not everything than can be counted counts.” Albert Einstein

I am a licensed family nurse practitioner who can practice independently in the state of Virginia. Working within my scope of practice, I provide consultations that combine mainstream standard of care recommendations with integrative, botanical, functional and lifestyle medicine approaches to healthcare.

This is not a concierge practice, primary care practice, membership based practice or direct primary care practice. It might be categorized as an independent cash based micropractice.

I try to specify details of my practice approach on this website, but it is an unusual hybrid that is not for everyone.

I support standard of care practices such as United States Preventative Services Taskforce (USPSTF) guidelines on health screenings as appropriate and standard immunization schedules. I have utilized information from the CDC, NIH and WHO throughout my career. I also have concerns about the medicalization of everyday life, overtreatment, polypharmacy and the potential nocebo affect of labels, diagnoses and standard after visit summaries. I am too open minded and alternative for some people and too mainstream for others.

This practice works well for clients who are adaptable to an innovative integrative perspective, comfortable with technology and who understand there is no front desk person to call with questions. Through the initial forms I work hard to identify who would benefit from this practice and who would not, for the protection of people’s time and investment. In the end, this practice is not a good fit for everyone but when it works for someone, it works very well.

The Patient Portal is a password protected area for established patients where secure HIPAA compliant messages can be sent, appointments made and results, forms, recommendations, summaries and invoices viewed.

Patients can interact with the Portal as much or little as they want. Follow up appointments can be made without logging into the Portal.

I recommend always downloading all results into your personal records for future reference.

Please email me with questions and I will answer within 1-2 business days. However, if you have read through the information on this site and still have questions about whether this practice is appropriate for you, it is usually better to request a free fifteen minute online visit or phone call. I work hard to identify a potential client’s expectations and my capacity to meet them prior to a visit. Some people have chosen to book a massage appointment to meet me in person and ask questions about a future consult during that visit.

I do not list a phone number on this website for reasons that include being busy seeing clients and patients throughout the week, a preference to utilize technology as much as possible to limit phone calls, the volume of robocalls in the past and my own efforts to have technology free time off, like I suggest to patients. There is is no front desk person in this practice to answer the phone. If this is unacceptable to you, this is one indication that this may not be the right practice for you and may not meet your expectations.