STEP 2 – ACCEPTED INSURANCES, VERIFICATION, DATA ENTRY

Our Team will proceed checking each prospective New Patient for eligibility.

The Center accepts:

• Commercial Insurances with Out Of Network (OON) Benefits
• Medicare
• Cash Paying patients

We do not accept:

• Medicaid
• Medicaid HMO’s
• Insurance without OON Benefits
• Guaranteed Asset Protection (GAP) Insurances
• Single Case Agreements for OON Insurances

Exception:

• Former patient of the Center, without OON Benefits, who will be eligible for a Single Case Agreement (SCA)

After insurance verification, the eligible patients are notified and receive instructions from Mr. Wood about how to proceed with the clinical data entry and their uploading to a HIPAA compliant cloud system.

STEP 3 – SECOND OPINION LETTERS

Once the clinical uploading is completed, Mr. Wood passes the information to Dr. Bolognese for his review.

Following the sendoff from Mr. Wood, Dr. Bolognese analyzes the data and generates a Second Opinion (SO) Letter, within the following EIGHT WEEKS.

The Second Opinion (SO), follows an established model utilized during the last years by a growing number of Academic Institutions, including Stanford, UPenn, Mayo Clinic, Cornell, Mass General, Columbia, Hopkins, etc.

In its general definition, Second Opinion (SO) consists in a chart review of the medical records available, without a direct Doctor/Patient interaction, performed by a recognized expert in the field, resulting in a written report reflecting the analysis, assessment, and therapeutic plan applicable for that Patient.

Our Second Opinion (SO) Letters usually range between 40 and 60 pages.

The cost for a Second Opinion (SO) Letter is $1,000. The amount is paid by Credit Card.

You can submit the Billing Information relative to the Second Opinion (SO) Letter to your insurance later, for a possible refund.

If applicable on the basis of the clinical review, many patients qualify for the following step, the  Invasive Testing, during which they will encounter and interact directly with Dr. Bolognese (see STEP 4).

The Second Opinion (SO) Letters also contains extensive Educational Material, which is located in the Appendix section.

If despite the Educational Material and the detailed explanations contained in the writeup, the patient still wants to further discuss the contents of the SO Letter with Dr. Bolognese, during a phone follow-up, it can be scheduled through Ms. Pendergast ([email protected])

The encounter will generate another written report.

The cost is $300. The amount is paid by Credit Card.

You can submit the Billing Information relative to this follow-up to your insurance later, for a possible refund.

STEP 4 –INVASIVE PROCEDURES

When applicable as per the results of the Second Opinion (SO) Letter, the patient could be a candidate for Invasive Procedures at our Hospital.

With very few exceptions, the Plan formulated in the Second Opinion (SO) stage involves the execution of Invasive Procedures to be conducted at our Hospital at a later date, thus allowing an extensive face-to-face interaction with Dr. Bolognese, before any surgery is performed.

Invasive Procedures are very important in our workup, since they allow us to test our running diagnostic hypotheses at a higher standard, before finalizing our diagnosis, or implementing our therapeutic plan (“measure twice, cut once”).

Invasive Procedures include:

• Invasive Cervical Traction (ICT)
• Intracranial Pressure (ICP) Bolt with Positional Testing
• Therapeutic LP with measurement of the Opening Pressure, and broad CSF testing
• Craniocervical Angiography with Venography and Venous Manometry
• Venography (Venogram) with Balloon-Test or Temporary Stenting
• Multilevel, high-volume, and/or targeted Epidural Blood Patch
• CT Myelography with/without Dynamic Repositioning, to detect dural blebs, micro CSF leaks, and possible CSF to Venous Fistulae
• CT- Angiogram, with arterial and venous phases, extending from the inion to C7 (mandible included), with thin cuts, bone windows, 2D and 3D reconstructions
• Glossopharyngeal Blocks
• Urodynamics

As an example, the ICT test has the following goals:

• Confirming whether (or not) the tentative diagnosis of Craniocervical Instability (CCI) is correct.
• Confirming whether (or not) the patient has Craniocervical Instability (CCI)
• Confirming whether (or not) CCI is the cause of the Chief Complaints.
• Grading the CCI (if present), as mild, moderate, or severe, based on clinical and morphometric scores (with severe being the threshold for elective surgical qualification).
• (For severe CCI cases only) Giving the patients a sense of what they might experience in terms of symptom relief (or lack of thereof) after a Craniocervical Fusion, thus helping in their decision of pursuing elective surgery. In simple terms, using the ICT testing as a dress rehearsal for the Craniocervical Fusion surgery.
• (For severe CCI cases only) Identifying the anatomical configuration linked to the best clinical response, to be reproduced at the time of the Craniocervical Fusion surgery (using morphometric parameters).

The book the Invasive Procedures (as listed and described in her/his SO Letter), each patient will contact our Surgical Coordinator, Ms. Dawn Verity, at [email protected]

The in-hospital component of the Invasive Procedures ranges from 12 to 23 hours and is preceded by:

• A double Psychiatric Clearance
• A Neurological Consultation with one of our Neurologists, for a detailed neurological exam, to be used as a baseline reference thereafter
• Pre-Surgical Testing (PST) routines

After completing the Invasive Diagnostic Testing procedures, the patient is discharged.

During the following days:

• The Clinical Team analyze the results of the testing
• The applicable imaging tests undergo post-processing
• Bolognese prepare a written summary of the Invasive Test Results and analysis (ranging from 20 to 40 pages), one week later
• The content of the written summary is discussed between Dr. Bolognese and the patient during a phone follow-up, two weeks after the date of the hospital discharge
• The combined cost of the analysis, post-processing, written summary, and follow-up discussion is $1,000. The amount is paid by Credit Card. You can submit the Billing Information to your insurance later, for a possible refund.

STEP 5 – SCHEDULING SURGERIES

If the results of the Invasive Procedures suggest a surgical plan, the patient will contact our Surgical Coordinator, Ms. Dawn Verity, at [email protected]

A few Pathologies we treat do not require Invasive Testing prior to decide in favor of a surgical plan.

In these cases, the patient will be scheduled for a phone follow-up, which will take place between the Second Opinion Letter and the scheduling of the surgery.

Foreign Patients will be allowed to combine the Invasive Testing and the Surgical plan during the same trip, if possible, to ease up on their logistical and economical strain.

The same will apply to severely sick patients, under rare circumstances, which are only determined by the Clinical Team (example: severely ill patients who cannot be transported in any other way than with high level Medical Flights).

Established patients will schedule for phone follow-up encounters with Dr. Bolognese through Ms. Pendergast ([email protected])

We strongly encourage contacting Dr. Bolognese first by email ([email protected]), before booking the follow-up.

If you describe the clinical problem in advance, Dr. Bolognese will provide you with instructions for a targeted diagnostic workup which will be uploaded prior the follow-up takes place.

In this way, all the necessary data will be available when the follow-up actually takes place.

The follow-up encounter will generate a written report (ranging from 20 to 40 pages).

The cost is $500. The amount is paid by Credit Card.

You can submit the Billing Information relative to the Second Opinion (SO) Letter to your insurance later, for a possible refund.