Policies and Procedures

Just like most doctor’s offices, we have policies and procedures in place to ensure the best experience possible with our office and staff. We are continually making progress and update this section periodically. Please review prior to your appointment and refer back to this information as needed.  Click on each section to view the relevant information. 

New Patient Appointment Expectations

It is our policy that ALL new patients see Jennifer Piker, PA-C for their very first visit.  Jennifer will perform a comprehensive review and exam, set a treatment plan, prescribe medications if needed, order labwork/testing and have you schedule a return visit with Dr. Cobb to review labs/testing and follow-up on treatment plan.  Dr. Cobb and Jennifer work very closely together to offer the best care possible to our patients.

If you are a new patient, expect a comprehensive review of your past medical, surgical, social and family history.  A form is included for you to complete. Please add additional surgeries or history that may not be addressed on the form or anything else you feel is important: work environment, pets, food allergies, stress level, travel history, etc . Receiving this information prior to your visit allows us to input your information into our computer which can facilitate your visit. Our goal is to ultimately provide you with a copy of your medical visit each time and help you develop an up to date personal health record. 

If you were referred to Dr. Cobb by another provider, please request a letter be sent to Dr. Cobb outlining that physician’s concerns and any pertinent medical history. A release of Information form is included for your convenience. Please forward a copy of it to any medical providers whose records you wish to transfer for review or completeness. Please make every effort to bring these with you to your appointment. 

Please bring the following with you to your appointment:

Insurance ID Card  and Photo ID

A list of all medications including dosages and directions (supplements, herbs and OTC medications included)

Any diagnostic testing results (labs, x-rays etc) done within the last year

Medical records from other treating physicians

Your new patient forms including:  (these forms should be submitted to you by email or fax when your appointment is made.  They may also be accessed at www.nourichemedspa.com or picked up at the office.)

Patient Registration, Assignment of Benefits, Living will

Authorization to disclose PHI and medical records release

Patient Portal Agreement and HIPAA Authorization

Health History Profile

NEW PATIENT FORMS ARE REQUIRED TO BE SUBMITTED COMPLETELY FILLED OUT 48 HOURS PRIOR TO YOUR APPOINTMENT.  IF FORMS ARE NOT RECEIVED 48 HOURS PRIOR TO YOUR APPOINTMENT YOUR APPOINTMENT WILL HAVE TO BE RESCHEDULED.  PLEASE CALL TO MAKE SURE YOUR FORMS ARE RECEIVED

Medication Refill Policy

The following information is designed to assist you with medications refills.

To expedite your refill requests we recommend that you either have your pharmacist submit the request electronically or you submit your request through the patient portal.  Using the patient portal has increased efficiency a great deal and we recommend that you utilize it to its fullest

If you do not have refills left, this may be an indication that you need to be seen by your doctor. Please contact us 1 week before you need your medicine. If you are taking medication for diabetes, high blood pressure, cholesterol or a diuretic among other high risk medications, you will need to have blood work done and office visits every 3-4 months. You can make a lab only appointment and a subsequent 2 week follow up with the receptionist.  

Thyroid hormone adjustments require blood levels at 90 days. Hormone levels should be done yearly if you are stable, more often if not.  We require a yearly physical -type of appointment to review all of your history and medications.

Although we recommend that you use the patient portal to communicate with our office, there may be times that you need to phone us for a request, in that case you will need the following information:

Your full name and date of birth  and Your telephone number

Name of medication (you may want to spell it), strength and dose

Name of your pharmacy, location and phone number

If you use a mail order pharmacy, please contact us immediately after receiving your last filled prescription so we can schedule a follow-up appointment. We will need to have all the paperwork, fax numbers, etc so we can assist you. 

Please try to stick with one pharmacy and alert us if you plan to change so we can update your chart.  

Some prescriptions, such as narcotics and amphetamines, cannot be called in unless we have seen you recently or will be seeing you.  These will not be refilled after hours. There are NO replacement scripts for lost prescriptions on controlled substances.

Timeline for receiving refills:

For refills submitted electronically or through the portal, please allow 24 hours to process your request.

For refills faxed in or phoned in, please allow 48 hours to process your request

For medications requiring a physician signature please call one week in advance to allow for weekends or days when Dr. Cobb may not be available to sign your prescription

Controlled Substances

WE DO NOT PRESCRIBE NARCOTICS ON A LONG TERM BASIS. We will support you while helping you find a pain management physician. We do not refill lost narcotic, amphetamine or benzodiazepine scripts on a long term basis, if you require more than one refill you will be referred to a provider who will take over prescribing; pain management, psych, etc.  Here is a list of some of the medications that will only be prescribed for a short term basis:

  • Xanax
  • Ambien
  • Restoril
  • Lunesta
  • Klonopin
  • Lortab
  • Norco
  • Adderall

Insurance

Bring your current insurance card and a picture ID to every visit. You will be asked to pay your insurance copay or any required coinsurance and deductible amount at the time of your visit. It is advisable to call us or forward your insurance information prior to your visit so we can verify your coverage. 

If you do not have insurance, you will be expected to pay in full at the time of your visit. We accept cash, personal checks, VISA/MasterCard/Discover/ American Express/ Care Credit.  If you have any billing concerns, please ask to speak with Linda at PCRM, our billing company.

Please be aware there are many services available to you at Nouriche that are not covered by insurance. Some of these are adjunctive tests, treatments or diagnostic procedures that are considered nonconventional but others are routine blood tests (ie: preop labs). 

Please review the advanced beneficiary notice and know what your insurance covers. This is used to authorize services/labs that the doctor believes you need but the insurance company may feel otherwise (saliva tests, spectra cell tests, Medicare testing requirements, hsCRP, homocysteine levels, etc).  Most insurance companies will not pay for mental health services at 100%. This includes complaints and diagnoses such as depression, anxiety, attention deficit and insomnia. Some insurance companies may not reimburse for hormone replacement treatment or testing. 

Be aware of what a wellness visit covers. It varies from plan to plan. 

Please be aware that our staff does not know what each insurance company covers. You are responsible for knowing what your insurance plan does and does not cover and understanding your financial obligations. We do not file insurance companies for functional medicine lab tests.

Lab

Clinical Pathology Labs offers phlebotomy services at Nouriche as a courtesy. We prefer you have your labs drawn on site as it is easy for us to track the results using our EMR system. Please note Dr. Cobb and Jennifer Piker PA-C order labs they feel are medically necessary to optimize your health care, we can not guarantee that these labs will be covered by insurance. It is the patients’s responsibility to find out if the labs order are covered or not.  All lab draws are by appointment.  Please help us expedite receipt of your results by informing us if you will be using an outside lab as many places do not automatically fax us the results. 

We are a draw site for Spectracell, ALCAT and Metametrix. We cannot draw any later than 3 pm for these tests as they need to be sent via fed ex. Note it takes 3-4 weeks for these results to come in.

Insurance

Bring your current insurance card and a picture ID to every visit. You will be asked to pay your insurance copay or any required coinsurance and deductible amount at the time of your visit. It is advisable to call us or forward your insurance information prior to your visit so we can verify your coverage. 

If you do not have insurance, you will be expected to pay in full at the time of your visit. We accept cash, personal checks, VISA/MasterCard/Discover/ American Express/ Care Credit.  If you have any billing concerns, please ask to speak with Linda at PCRM, our billing company.

Please be aware there are many services available to you at Nouriche that are not covered by insurance. Some of these are adjunctive tests, treatments or diagnostic procedures that are considered nonconventional but others are routine blood tests (ie: preop labs). 

Please review the advanced beneficiary notice and know what your insurance covers. This is used to authorize services/labs that the doctor believes you need but the insurance company may feel otherwise (saliva tests, spectra cell tests, Medicare testing requirements, hsCRP, homocysteine levels, etc).  Most insurance companies will not pay for mental health services at 100%. This includes complaints and diagnoses such as depression, anxiety, attention deficit and insomnia. Some insurance companies may not reimburse for hormone replacement treatment or testing. 

Be aware of what a wellness visit covers. It varies from plan to plan. 

Please be aware that our staff does not know what each insurance company covers. You are responsible for knowing what your insurance plan does and does not cover and understanding your financial obligations. We do not file insurance companies for functional medicine lab tests.

Emergency

If you have a clinical emergency (chest pain, fracture, fainting, acute SOB, anaphylaxis, etc)during office hours, call 911. Please ask to speak to the doctor or PA if you have an urgent matter. Depending on the nature of the complaint, you may be seen in the office that day or be referred directly to the ER. If you have a non-emergent issue, a doctor or doctor’s representative will respond within 48 hours. If urgent, please state so we may respond that same day. Same day appointments will always be offered to see Dr. Cobb if she is available or with her physician assistant, Jennifer Menard Piker. One of them will be available 24/7 via our answering service. Dr. Cobb or PA Piker may admit you to a hospitalist service at Lafayette General OR Our lady of Lourdes as Dr Cobb does not do hospital work currently. If you are seen in an ER or urgent care center, please bring your results and records with you to your follow up appointment along with any new prescription drugs prescribed. 

Phone & Patient Portal

We are so excited to finally be able to offer our patients a whole new level of communication with our office. We are now able to offer you (through a secure website link) a means to request refills, schedule appointments, cancel appointments, send messages directly to individual staff members’ mailboxes, and view your lab results and health record. We can also send you a copy of your health summary electronically after the visit and send you messages as well. 

HOW DO I SIGN UP?

You must first sign the portal agreement which explains privacy, usage, etc.  Once this is signed a secure user name and password will be generated and sent to your e-mail.  Once you have logged on to the portal you will be able to change your password to something you may better remember.

HOW DO I LOG ON?

The easiest way to log on is to go to our website at www.nourichemedspa.com open the “Current Patients” tab and choose “Patient Portal”, click on “login” and enter your ID and password.  If you have any problems navigating the portal please contact Adrienne  at 456-7304 or at amorain@nourichemedspa.com.

THE PATIENT PORTAL CAN BE USED FOR THE FOLLOWING:

  • Request appointments
  • Look up appointment dates and times
  • Request medication refills
  • Update medical history prior to appointments
  • Update medication changes
  • Receive copies of results, visit notes, etc.

Communicate with office staff.  The staff checks their portal messages frequently throughout the day.  Using the portal eliminates phone tag and is the most efficient way to communicate with our team.

Phone Policy

Our clinic staff will call you back just as soon as they can and everyone is called back by the end of the day if the call is received before 3 pm, if received after 3 pm you will be called back the following day. 

If you leave a phone message please give the following information:

  • Full name as it is on your chart, no nicknames.
  • Date of birth
  • Phone number where you can be reached
  • Name of medication, spelled if you are unsure of how to pronounce it
  • Dosage and directions for medication
  • Pharmacy name, phone number and address (at least the street name)

Patient Responsibilities

Never assume any test was normal. We prefer to review lab and imaging results in person, therefore, you will be scheduled for a return appointment 2-3 weeks following your testing.  However, you will receive your results via the patient portal when they come in with a note from either Jennifer, PA-C , Katherine McDonald, PA-C or Dr. Cobb.  PLEASE USE THE PORTAL!!

If there is an emergent or life threatening abnormality, Dr. Cobb or one of her PAs will call you right away.

Know what your insurance covers. Bring your drug company’s formulary so we may choose the most cost effective medications for you. Know which labs and radiology facilities your insurance company covers. We are not responsible for excess fees incurred.

Always ask about side effects and drug interactions.

Please alert Dr. Cobb to any developments in your health: hospitalizations, ER visits, new medications, surgeries, consultations with other doctors including chiropractors, naturopaths.

Ask your doctor when you need to make a f/u appointment.

Keep a copy of all of your medical records

Ask to fill out a living will. Discuss advance directives with your doctor. 

Become familiar with hospital services/education programs/support groups. Use Up to date and WebMD websites.

Most importantly, FOLLOW UP!!! One appointment is not enough time to cover everything or to make a diagnosis. Symptoms change over time and diseases declare themselves in different ways. Tell your doctor if you feel he or she is missing something. Keep a diary if you feel it is hard for you to communicate with your physician face to face or if you have memory problems. Call back if symptoms change or worsen. Doctors encourage 2nd opinions. Ask for one. If you are not satisfied for any reason, tell your doctor. Bring a list of questions/concerns with you.

Use answering service after hours. We do not refill medications after hours. Medications usually expire because labs need to be drawn or the doctor needs to see you prior to a refill. 

If you would like an assistant present in the room at any time as a witness or to assist with an exam, please let us know.

If you miss 2 or more appointments without contacting us, we will assume you wish to transfer your care elsewhere and will discharge you from our clinic. 

If we have not seen you in over a year, we will contact you to determine if you wish to continue your relationship with your clinic. Please notify us if you wish to change providers so we may document properly and send your medical records to appropriate clinic. It is Dr. Cobb’s policy that you be seen yearly for a review of health issues and for a yearly physical. Please check with your insurance on how we should code this and what they consider to be included at this visit. 

We reserve the right to charge $25 if you do not give us a 24 hour notice of cancellation of a scheduled appointment. We have a waiting list and can give this appointment to another patient.

  • Toradol shots are $25 for 30mg, $50 for 60mg
  • B12 shots are $25. LipoB shots are $40
  • Forms to be filled out will be charged $25 -50 depending on length of form
  • Telephone visits are $50 and need to be scheduled