Seeing a primary doctor first leads to better in-depth evaluations from our expert Endocrinologists. Primary doctor visits can uncover a wealth of health data that greatly enhances your appointment at Capital Endocrine & Diabetes. Visiting a primary doctor first also reduces the chance your insurance denies reimbursements. Even if referrals are not required by your plan, certain tests must be completed by a primary doctor. Otherwise, insurance plans may not consider visits to an endocrinologist "medically necessary" and refuse covering medical costs. This means payments are out of your pocket, which we would like to avoid to save you money.

Prescription refill requests may be rejected if you haven’t completed follow-up appointments or lab work recommended by your provider. These are essential for monitoring your condition and ensuring your treatment remains effective and safe. Refills can also be denied if it has been a long time since your last evaluation, as your condition may have changed.

To avoid interruptions, please stay up to date with follow-ups and lab work. If you have questions, feel free to contact our office

When working with the pharmacy, we send refill authorizations to their exact location and avoid delays in filling the prescription. It also ensures the correct medication dose and formulation is refilled for your safety.

Many insurance plans choose not to cover brand medication to control their costs. We can provide some treatment alternatives if applicable. To ensure you get the appropriate treatment, we authorize medication within your plan's coverage. We encourage you to discuss with your insurance what is or is not covered under your plan.

Cancellation fees or no-show fees are charged when cancellation requests are not received before 48 business hours of your appointment. Appointment slots are especially reserved for each patient as we do not double-book this time to make sure you have dedicated access to our providers. The fees prevent misuse of reservations and help reallocate the appointment to patients in need or on our waiting list. They do not apply in emergency situations.

Please feel free to discuss any concerns directly with your provider. Our providers at Capital Endocrine & Diabetes account for the risk of side effects when prescribing medicine. Part of this analysis is to equally understand the risks of not taking a medicine for your health condition. Providers weigh such risks versus benefits when prescribing any medication. For example, some chronic health conditions such as hypertension, diabetes, high cholesterol or osteoporosis may not show symptoms early on but left untreated cause irreversible damage. We pride ourselves at CED to have an open conversation with each our patients to determine a treatment plan that maximizes their health outcomes.

We understand that navigating healthcare and insurance processes can be overwhelming, and we strive to make it as smooth as possible for our patients. Many insurance companies now require prior authorizations for certain medications, tests, or treatments, which involves a detailed approval process. To handle the increased demand for these authorizations, we’ve had to hire additional staff dedicated to managing these requests efficiently and ensuring timely approvals for your care.

This small charge helps cover the administrative costs of this process, allowing us to continue providing you with the highest level of service.

Please note that while we do our best to manage the prior authorization process, we cannot guarantee that your insurance company will approve or deny requests. We appreciate your understanding and partnership as we work to advocate for your health needs.

Your health and safety are our top priorities, and we are committed to providing care that follows best medical practices. Occasionally, a request to add specific tests or labs may be denied because they fall outside the scope of our practice or are not directly related to the condition we are treating. As specialists, our focus is on addressing your specific endocrine-related needs, and certain tests may not align with this specialty.

Additionally, every test or lab order must meet the requirement of medical necessity. Insurance companies often require evidence that a test is essential for diagnosing or managing a condition. Without this medical necessity, there is a high likelihood that your insurance will not cover the cost of the requested test or lab, leaving you responsible for the expense.

If you believe a test is necessary but it falls outside the scope of our care, we recommend consulting your primary care physician. They can evaluate your broader healthcare needs and help determine whether additional testing is appropriate. We value your understanding and partnership in ensuring you receive the most appropriate and effective care.