Dear Friends and Clients,

Over the past ten years, I’ve built this practice on a foundation of compassion, presence, and deep partnership in healing. Those values aren’t changing. But to sustain this level of care — and to keep showing up with the energy and integrity you deserve — the structure behind the scenes needs to evolve.

 

A Hard Truth About Sustainability

Although I see patients face-to-face about 15 hours a week, I consistently work 60–80 hours each week. That includes:

• Messaging
• Charting
• Reviewing labs and records
• Managing refills, appeals, and prior authorizations
• Fixing lab issues
• Researching complex cases

This invisible labor is a major part of high-quality care — but it’s often uncompensated.

To put this in perspective: my average personal annual income/profit has been around $53,000 before taxes over the past 10 years. This is despite cutting overhead as much as possible. That’s simply not sustainable.

I’ve spent years encouraging all of you to prioritize self-care, boundaries, and rest — while often putting client needs ahead of my own. That needs to change as I cannot replenish you and depreciate myself at the same time.

 

What’s Changing — and Why

Effective immediately, I’m updating my billing and practice policies to more accurately reflect the real time and energy your care requires. These changes are essential to ensuring I can continue to provide personalized, responsive, and high-integrity care for years to come.

 

Visit Time Will Reflect the Time Bracket Reached

In the past, I’ve often rounded time down — for example, charging for a 60-minute visit when we went 70–75 minutes, or waiving time spent charting afterward.

Going forward:

• All visit time will continue to be billed in 15-minute increments.
• Time will be billed according to the bracket reached, not rounded down.
• This reflects not just face-to-face time, but also the follow-up charting and ordering that ensures your care is safe and thorough.
• This change aligns with medical billing standards and more fully honors the full scope of work being done on your behalf.

 

Ways to reduce visit time (and cost):

1-2 days before your visit:

• Send a detailed update or symptom summary ahead of your visit.
• Upload any outside records such as results and consults in advance.
• Upload your homework ahead of your visit.
• Complete your self-check-in on the Athena Portal prior to your appointment.
• Please sign the forms in the self check in as these will reflect current policies.

Cancellation & Missed Visit Policy

Effective immediately:

• Less than 72 hours’ notice → Full visit fee:
  • $199 for follow-up visits
  • $398 for initial visits
• Within 7 days → 50% cancellation fee:
  • $99.50 for follow-ups
  • $199 for initial visits
• Emergency exceptions: ER visits, hospitalizations, etc.
• The previous “first missed visit is free” policy has been retired.
• Why this matters: Missed and late-cancelled visits are rarely filled in wellness care and result in significant lost income and time.

 

Refill Requests, Lab/Test Reorders, & Prior Authorizations

Refill Requests

Refill requests made outside of a visit will now be billed $49.50.

This is because nearly every refill requires me to:

• Review your chart, labs, and last visit notes
• Assess clinical appropriateness and safety
• Evaluate your care plan and follow-up needs

This work takes real time and clinical judgment — and must be treated that way.

 

Re-Generating Clinical Orders (Labs, Imaging, Referrals)

• Lab orders are typically valid for 6 months.
• Expired orders requiring reissue: $49.75
• Switching to a different lab after orders are placed may take 30–60 minutes depending on complexity.
  • Fee: $99.50–$199, depending on time involved based upon the number of orders
• To avoid fees or delays, let me know in advance if you prefer a specific lab or provider for referrals.

 

Using Labs Other Than Quest or LabCorp

You have the right to use any lab. However, please note:

• Many hospital labs don’t offer the same level of complex testing or turnaround for functional testing.
• They often misprocess or miss tests due to incompatible coding systems.
• This is true even if they are just drawing blood for you and then sending them out
• I strongly recommend using Labcorp or Quest wherever possible
• Labs processed outside of Quest/LabCorp are not received electronically and must be entered manually.
• Manual processing adds significant prep time and increases the risk of human error

Will be billed at: $99.50 per 10 lab results, prorated accordingly
(Typical new patient panels involve 35–55 labs)

 

Prior Authorizations

• Most take 15–20 minutes: Fee will be $49.75 each
• More complex cases may take hours.
• For those, you’ll receive a time estimate and approval before the work begins.

 

Messaging Fees

Secure messaging is a vital tool to stay on track and get real time support – but many messages require clinical time.

Going forward:

• Medical messages that require review or care decisions will be billed at $199/hour, prorated in 15-minute increments.
• Most messages: $49.75
• More complex issues may require more time + higher fees
• No charge for admin-only questions (e.g., “Where are my orders?”)
• I’ll notify you of the cost before billing for any extra time

 

Research & In-Depth Record Review

Functional medicine often requires:

• Extensive outside record review
• Deep research into complex, layered conditions

 

If more than 30 minutes is needed:

• I’ll notify you in advance
• You’ll receive a clear price quote before proceeding

This ensures transparency and avoids across-the-board rate increases.

 

📝 New Patient Onboarding & Deposit Policy
All new patients must begin with a free 15-minute Discovery Call to ensure that the care provided aligns with the patient’s needs and goals, and to initiate the onboarding process.

• The full initial consult (2 hours) will not be scheduled until all required intake materials have been submitted, including both the legal consent forms and the Google Symptom Forms.

• Once all forms are received, the office will schedule the initial consult and collect a non-refundable $199 deposit, which will be applied toward the total visit cost.

This protocol ensures that each new patient visit is comprehensive, efficient, and well-tailored to the individual’s care journey.

 

Introducing: The Core Healing Program

The Core Healing Program is 6 month program designed for clients who want high-touch, ongoing support with savings built in! Over the six-month period, new clients will save $328 and established patients save $129, PLUS any additional savings from the 15% discount on extra services. And you can renew as often as it works for you!

• $425/month
• One 1-hour visit per month (or your initial 2 hour visit)
• Up to 5 – secure messages (15 min time blocks) or refills per month
• 15% off additional services / overages
• Renewable every 6 months

Note: Unused visits or messages do not roll over. If you’re unsure if this is a good fit, just ask.

 

In Closing

This work is a labor of love — but it is still labor.

I want to continue offering the kind of deep, thoughtful, and personalized care that’s hard to find in today’s healthcare system at a price point that is sustainable for you and for myself.

Thank you for honoring the time, energy, and spirit that go into this work. Your support makes it possible for this practice to continue healing — together.

Warmly,
Deb Reid, FNP-BC, CFM, RMT
Instinctive Wellness