General Office Policies and Fees

We strive for complete transparency with our Office Policies.  Please read them in their entirety and we highly recommend you reach out to us with any questions.

Information revealed during sessions and office visits is confidential. We are fully compliant with HIPAA (The Health Insurance Portability and Accountability Act). regulations and you can find our policy in your patient portal. Exceptions to this confidentiality include disclosure by you regarding intention to harm yourself or others. Your record and the information contained within it will not be disclosed to others unless you direct us to do so or unless the law authorizes or compels us to do so. You have the option below to grant us permission to use your anonymous medical data for educational purposes.

Physician-Led New Patient Package: This new patient package includes:

• A comprehensive initial intake session with your doctor.  All follow up sessions with your physician will be billed at their respective hourly rates listed below including physician delivery of  lab results and treatment plan.
• 2 hours of FxNutrition: All nutrition coaching sessions are provided by remote teleconference by our functionally-trained Nutrition Team.. Our nutrition team assists with the implementation of the doctors’ dietary and nutritional protocols. They also provide information about how to improve general health through diet and lifestyle modification. After usage of the included 2 hours, all additional follow-up sessions will be billed at the nutritionist’s respective hourly rates listed below.

Nutritionist-Led New Patient Package: This package includes two hours of nutrition consultation with a licensed nutritionist. All consultations  are provided by remote teleconference. This is usually scheduled as a 90 minute initial intake session and a 30 minute follow up session.  All additional follow-up sessions will be billed at the clinicians’ respective hourly rate listed below. For patients engaging in nutritionist-led care, there is the option to have one of our physicians consult on their case if needed, subject to the physician’s hourly rates.

Note: All services within a package must be used within one year of initial visit.

Clinician Rates:

• Kara Fitzgerald, ND –contact frontdesk@drkarafitzgerald.com for waitlist/fees
• Ken Litwin, MD– $2000 new patient package; Follow up visits $650/hr
• Darisa Espinal, ND– $2000 new patient package; Follow up visits $650/hr
• Melissa Parker, MS CNS CDN – $700 Nutrition only package; $350/hr
• Miranda Kusi, MS, CDN -$700 Nutrition only package; $350/hr

In the case of pediatric patients, we require all legal guardians with medical decision-making capability to sign this document and thereby consent to minor’s evaluation by our office.  We also strongly encourage all responsible parties to be present for consultations.

Teaching Clinic: Our clinic provides an important educational environment for resident nutritionists and Functional Medicine practitioners to shadow consultations. We find this collaborative learning environment significantly enhances the care we provide.  You always have the right to decline having a resident shadow your consultation.

Cancellation policy: When you call and schedule an appointment, time is reserved especially for you and no one else. Since the appointments are much longer than standard doctors’ office visits, cancellations are significant interruptions to the Clinic. Thus, a minimum of 7 days’ notice is required for cancellations of new patient visits and 3 days’ notice for existing patients. There is a 50% deposit for new patients, which will be refunded only if the appointment is canceled with more than 7 days’ notice. Additionally, there will be a 100% office visit charge for “no-shows” or late cancellations. We also require that all new patients complete their new patient paperwork no later than 7 days prior to your appointment. If the new patient paperwork is not completed,, we will reschedule the appointment and cancellation fees will be applied.

Telehealth education: In order to establish a doctor/patient relationship with us, you must see us in our office in person at least once per year. If you do not see us in our office in person at least once each year, there will not be a doctor/patient relationship between us and you. Instead, our communications with you will be for educational purposes only. We call these communications “Telehealth/education services”. These services we provide to you will consist of information and suggestions that are intended to assist you and your health care provider in using natural means to support your health. Telehealth/education services are not intended to serve as a medical diagnosis or treatment of any kind. Our fees for telehealth/education services are the same as the fees that we charge for our telephone consultations and office visits. Please note that medical insurance does not cover telehealth/education services. You will be responsible for paying for all telehealth/education services yourself. We do not refund any amounts paid for telehealth/education services.

Supplements: Payment is expected prior to shipment. We will refund 100% of your purchase (minus shipping) within 20 days of purchase should you need to return them. Probiotics and other heat sensitive items are non-refundable.

Specialty Laboratory Testing: Our clinic frequently uses specialty testing. These are usually an out-of-pocket expense. Occasionally, there is some insurance coverage. We will guide you through identifying the costs associated with your testing.

Emergencies, after-hours care, disability requests: Our providers are not primary care providers. Therefore, you must have a primary care doctor with whom you can consult in the event of an emergency or urgent problem. If you have a serious health problem that requires immediate attention, you should call your other doctors(s), call 911, or have someone take you to the nearest hospital emergency room. If you notice an adverse effect from one of the components of your health plan, you should discontinue it immediately and contact your provider or call the Clinic 203-304-9502.

Please note that because we are not primary providers, we do not complete insurance, disability or workers’ compensation forms for patients.

Billing: We accept cash, checks, credit cards, FSA and HSA cards. We do not accept insurance, nor do we bill insurance or prepare HCFA forms for you. However, we will furnish you with an itemized bill for self-submission if you are seen in office.

There is no refund for services provided. However, you may be eligible for out-of-network insurance reimbursement or tax deduction for medical services.

For our Medicare patients: Since we do not accept Medicare in our office, all services, including labs and mail away specialty lab tests, are self-pay. You will not be able to submit any bill to Medicare for reimbursement from them for any services you encounter in our office by any of our providers.

Prior Authorization: There is a standard $50.00 service fee charged for pursuing prior authorizations from insurance companies.

Forms: Providers’ time spent on completing simple letters and forms related to work/school/travel will be billed at their regular hourly rate. Additional fees may be charged for more complex or time-intensive administrative work and physician chart review.