Learn more about services offered to out-of-state patients.
1. Q: Is out-of-state treatment similar to a standard doctor-patient relationship?
A: Treatment requires that a formal doctor-patient relationship be established. Until such a relationship is established, medical advice cannot be provided to patients seeking answers to questions about medical care. All of your records are kept confidential as in any other doctor's office although at the Center we will e-mail copies of your records to you for your personal files or to assist you with discussions with other health care providers or for reimbursement purposes. The only major distinction about tele-medical treatment is there is no physical examination. And, there is no direct in-person encounter unless you choose to travel to New Mexico. If a physical examination is indicated, Dr. Krakow will make appropriate suggestions on what type of doctor to schedule an appointment with, and what type of physical examination is needed. In most instances, it will simply be your primary health care provider or an ear, nose, and throat specialist.
On-site at Maimonides Sleep Arts & Sciences in Albuquerque, New Mexico.
3. Q: What treatment is offered for insomnia?
A: Sleep hygiene instruction is a common tool used among sleep specialists for the treatment of insomnia. Sleep hygiene will provide you with a number of behavioral tips that you can employ to regain a normal sleep schedule and to overcome difficulties with falling asleep and staying asleep. However, to successfully teach an insomniac the principles of sleep hygiene, it is critical to connect these behavioral tips to important underlying beliefs which many insomniacs hold about their sleeplessness. For example, if I recommend removing a clock from the bedroom or turn its face to the wall, I can guarantee you that some people will cure their insomnia simply by doing so. But, I can tell you with even greater certainty that this improvement in your insomnia is likely to be lost if you do not understand the principles behind turning the clock to the wall.
Some sleep specialists might approach their patients with a "Just do it!" mentality. Instead, I prefer that you become aware of the simple relationships, which you have developed toward "clocks," and more importantly "time." A rather quick exploration of these topics will usually lead you to appreciate how it is your view of time, which has led you to think that it is valuable to monitor your clock if you have trouble falling asleep or if you awaken in the middle of the night. But once you have learned why you no longer need to monitor time, then you will find it easier and more sustainable to remove the clock from the bedroom entirely or simply turn it to the wall.
I offer this tip as an example, because issues surrounding clocks are one of the most fundamental dilemmas of most insomniacs. And, because these issues are almost always at the core of the insomnia problem, you can gain rapid success by dealing with the clock problem right from the start of your treatment. Many people in fact have cured their insomnia just by turning the clock face to the wall. To reiterate, however, if you do not understand why you have been watching the clock in the first place and why changing your attitude about time is so beneficial, then in my clinical experience, your success with turning the clock will sooner or later be squandered.
4. Q: How much consultation time is needed to treat insomnia?
A: Patients with more complex problems require more time; but overall, most sleep hygiene training only takes a few hours of consultation time. The keystone of sleep hygiene instruction is trying out different behavioral tips on your own after receiving proper instruction. Thus, many insomnia problems require as little as two hours of initial instruction with no follow-up consultations required for several weeks or months.
5. Q: What treatment is offered for other sleep disorders?
A: The two most common disorders to look for are sleep-disordered breathing and sleep-related movement disorders. Evaluation of these problems starts with learning more about potential symptoms and behaviors that may indicate the presence of a physical sleep disorder, such as a breathing problem, for example, snoring, or a movement problem, for example, restless legs or leg jerks. Treatment options for these conditions vary considerably depending upon the type and severity of the problem.
6. Q: How much consultation time is required to treat these other sleep disorders?
A: Treatment for these sleep disorders usually requires evaluation at a sleep center. Testing usually can be conducted in a lab setting. For those who do not reside in New Mexico or who do not wish to travel, we will help to coordinate care with appropriate physicians in your area if sleep testing is needed. Depending upon the severity of the problem, treatment for sleep breathing and sleep movement disorders usually takes one or two nights of lab testing and anywhere from two to six appointments with a sleep specialist.
7. Q: How is payment made for treatment services?
A: All payments are the responsibility of the patient receiving services, and all fees for treatment services must be paid at or before the date of service. If a credit card is used, then payment can be made on the day of the consultation at the completion of the appointment. If a check or money order is the method of payment, it must be received by the Center prior to the date of the consultation.
8. Q: Will my health insurance cover any of these treatments?
A: No direct payments or referrals through health insurance carriers will be accepted by the Center for telemedical services; however, you will be provided with physician notes that contain full documentation of your evaluation and treatment plans. In some instances, you may be able to use these documents to obtain reimbursement from your health insurance plan. You are welcome to pursue coverage for services provided at the Center through traditional means of primary care referrals, preauthorizations and so forth; however, there is no need to inform us of this intention as all medical notes will be provided directly to you in a timely fashion, usually within 2 working days after completion of any appointment. As a reminder, all payment for services must be provided directly from the patient or a responsible party representing the patient at or before the appointment. Last, if you require additional sleep disorders evaluation and treatment, this can usually be handled directly with your local doctors and your local insurance plan so that your out of pocket expenses are kept to a minimum.
9. Q: Are there laws pertaining to the practice of telemedicine and distance medicine which pertain to a patient seeking care?
A: We are located in the state of New Mexico and, therefore, hold that any encounter with patients occurs under the jurisdiction of the state of New Mexico. Your locale may perceive such encounters differently and therefore you are advised to contact your doctor or your local medical board to determine if there are any legal constraints that would prohibit seeking care at the Center.
Given that certain aspects of sleep disorders represent highly specialized care, there is one safeguard against any infringement of local medical board laws that can always be considered. If you discuss your problems with your primary physician or other healthcare provider, you can request a referral to us on the grounds that you have been unable to successfully seek help for these problems in your area. On a humanitarian basis, if you require treatment for something that you have been unable to find treatment for in your area, then it is likely to be perceived as a reasonable course of action to seek care outside of your area.
In pursuing such a course, you may simply need to discuss all of these points with your physician who can then send a referral to us. In such instances, the Center will maintain regular contact with the referring physician to apprise him or her of the specialized treatment being provided to you. In this way, you remain technically under the care of your primary doctor who has sought additional and temporary assistance in the management of your care for these sleep-related problems. If you prefer even greater clarification of telemedicine issues prior to seeking consultation at the Center, you could write your local board requesting advice or a ruling about your situation.