Precision Medicine and Genetics
Precision Medicine Program in Ann Arbor, MI
As one of our most novel and sought-after services, our Precision Medicine Program attracts patients to Ann Arbor from all over the country. Patients enrolling in this program often present with puzzling and complex health conditions OR they are interested in the most precise genetic-based preventative and anti-aging strategies available.
Patients enrolling in this program MUST be motivated and ready to invest fully in the educational, clinical, and diagnostic efforts required to achieve their health goals.
To determine if our Precision Medicine program is right for you, we kindly ask you to review the following material to answer initial questions regarding structure, cost, etc. Once finished, please call our office OR schedule a phone appointment via our online scheduler and we will will be happy to answer any other questions you have about the program.
Watch Our New Patient Information Video
(PLEASE NOTE: ALL portions of the Orientation are currently one-on-one rather than in Group Format - as referenced in the video below...)
Learn More About Precision Medicine
Video of Dr. Boggess Reviewing Labs with a Patient to Better Understand our Approach
The Precision Medicine - New Patient Bundle with educational sessions represents the most comprehensive care our clinic offers. Once enrolled, you’ll meet with several clinicians and doctors in person, on the phone, and via videoconference, as we gather your medical history, decide on initial labs, explain our clinic process, and prepare you for educational sessions, lab reviews, and treatment planning visits.
This price includes all the initial visits noted below.
1. Meet and Greet / Planning Session with Dr. Boggess (30 min): As a candidate for this program, you start the process by speaking with Dr. Boggess directly prior to fully enrolling. This is a no-obligation meeting billed as a 30 minute interactions. Prior to your meeting you’ll be asked to watch our introductory videos but will not have completed our online New Patient Questionnaire. The purpose of this meeting is to briefly tell us about your health goals and hear initial thoughts about your case. At this point, no doctor-patient relationship is established, but rather the interaction allows you the opportunity to “pick Dr. Boggess’s brain” and consummate your decision to proceed with this program.
2. Phone intake with Dr. Basinger (30 min): At this point you will have completed all our new patient paperwork, consent forms, and online New Patient Questionnaire. The purpose of this intake will be to undergo a complete medical history and to “hear your story" fully, as well as get you started on initial labs (some labs, especially genetic testing, take up to 8 weeks to process, so it's ideal to start the lab submissions as soon as possible).
3. Video conference, Labs and Testing Orientation (30 min) with Leslie Goss MHE, our Masters Health Educator & Care Manager: The purpose of this meeting is to assist with the diagnostic tests, many of which have specific instructions for collection as well as “hoops” for insurance coverage. Therefore, we schedule dedicated time to assist you with collecting specimens and submitting specimens and required paperwork in a timely and efficient manner. We also use the opportunity to set up your computer for video consults and educational sessions noted below.
4. In-Office Physical Exam (30 min): This visit includes doing a complete physical exam and review of all the assessments noted below.
5. Cellular Hydration/Phase Angle Assessment: Total body hydration and electrolyte imbalance is a primary concern with many patients. If the body is not optimally hydrated at the cellular level, it is difficult to efficiently absorb and assimilate nutrients as well as remove toxins. Using a bio-impedance analyzer (BIA), we collect various electrical parameters that reveal the water content inside and outside of the cells versus fat, muscle, bone mineralization, and soft tissue status. This information allows us to further tailor an individualized hydration and nutrient replenishment plan for each individual, which often gets patients feeling better quickly.
6. In-Office Diagnostics: This appointment is scheduled the day of your in-office physical exam and includes additional testing such as: Orthostatic and positional vitals testing, hydration assessments, BMI calculation, Visual Contrast Testing, Heart Rate Variability, and other special assessments ordered by our Precision Medicine doctors based on specific clinical presentation.
7. Brainwave Assessment (HIRREM EEG): Our Brain Health Center is well known for assessing and treating brain- and mood-related conditions from a holistic perspective. We use HIRREM (high-resolution, relational, resonance-based, electroencephalic mirroring) to look at the brain’s electrical activity. This study allows us to evaluate the brain’s ability to relax and balance and helps to determine if you are a candidate for certain protocols we offer.
8. Brainwave Assessment - Review Of Findings with Dr. Boggess (Video or In-Person, 30 min): During this visit, Dr. Boggess will review the findings of the HIRREM Assessment and discuss clinical significance and treatment options.
9. Pre-education Chart/Record Review by Dr. Boggess / Dr. Basinger (20 min): In preparation for your educational sessions, our doctors review your chart summary thoroughly to tailor the discussion/presentation to your specific needs. (Note: Patients are not present during the chart review).
10. Additional Support Visits, divided into 2 or 3 sessions with Leslie (20 min x 2) for further advising, education, and coordinating: These meetings are intended to reiterate information reviewed during your doctor visits and will serve to assist you in getting the most out of your treatment course with our clinic.
11. Teaching Session with Dr. Boggess/Dr. Basinger, Video or In-Person (60 min): At Natural Balance, we have a passion for empowering patients with insights and understanding. During this session our doctors will be covering cutting-edge theories about genomics and precision medicine as they apply to your specific concerns. The session will also create a solid frame of reference to help you understand the labs and genetic tests we have ordered for you. Patients are encouraged to invite significant others, or in the case of a child, both parents are encouraged to participate if possible.
12. Comprehensive Lifestyle Assessment and Recommendation (60 min) with Leslie: We believe in a comprehensive, individualized approach to diet, sleep hygiene, and lifestyle coaching. There are several screening efforts we apply to our Precision Medicine patients to identify areas of concern and address them early on in the treatment process.
13. Post-Lab support visit with Leslie (20 min x 2): for further advising, education & coordinating. These meetings are intended to reiterate information reviewed during your lab review and will serve to assist you in being compliant with our multi-step nutraceutical protocols.
14. Shipping Charges, Software Fees for Genetics, Phlebotomy and Lab Processing Fees included: Our center takes considerable care to get test-kits shipped quickly and cost-efficiently to our patients. All blood draw and in-office lab processing fees are included. There is a per patient user fee of $30 to translate genetics which our clinic pays on your behalf.
15. Small-Group Teaching Sessions at Natural Balance OR via Video Conference (when offered) included: These small-group teaching sessions (for Precision Medicine patients and their family members only) are tailored for 10-12 patients and no two sessions are alike. The intended purpose of the session is to further orient you to the tenants of precision medicine and effectively prepare you to fully enjoy, understand, and participate in your ongoing treatment course with our clinic. The sessions also provide next-level understanding of our multi-step protocols and the scientific rationale for the diagnostic and genetic assessments our clinic utilizes. There is also lively open group Q&A providing opportunity for reassurance and clarity, along with the opportunity to connect with other patients and build your own support network.
-These visits occur over 4-8 weeks in the approximate order as written.
-Testing, appointments to review labs, and any subsequent follow up visits are charged separately (see next section for details).
-The total time with our doctors for the new patient appointments is typically 3 hours total. However, depending on your specific situation the doctor might need to schedule additional time to finalize your New Patient intake. The extra time will be charged at our New patient rate ($450/hr), prorated to the amount of additional time needed.
-The total number of visits with Leslie is typically 5 visits (20-30 minutes per session). However, depending on your specific situation the doctor might need to schedule additional time to finalize your New Patient intake. The extra time will be charged at our coaching/education rate ($65/per visit), prorated to the number of additional visits needed.
-There is a 50% deposit due at the time of scheduling. The other 50% is due at the time of the physical exam.
-You may cancel the program at any time and will only be charged for services provided up to that time. Please note our cancelation policy is 3 business day prior to any appointments to avoid being assessed a late cancellation fee.
-Super-bills are provided for the above visits to submit to your insurance for reimbursement to your directly.
Once you have completed the New Patient Visits and your tests and genetics are completed, our doctors and clinical team will be teaching you how to interpret your labs and genetics and will develop a treatment plan specific to your needs. All results will be fully explained, summarized, and dictated, and you will be given a copy of all reports and dictations. The doctors will then develop, in partnership with you, a comprehensive treatment plan, including logical ordering and timeline for treatment.
By the time you have finished your Lab Review session(s), you will have a full understanding of your labs, genetic predispositions, current state of health, and the treatment process that lies ahead.
If you haven't already, we recommend watching this abbreviated video of Dr. Boggess with a patient during a one-on-one Lab Review to better understand the process.
Typical Follow-up Schedule: After completing the Lab Review process, the time frame and hourly rates switch to our standard follow-up fee schedule (please see below) and are generally 20-30 minutes every 3-12 weeks, depending on the situation. We follow-up frequently because your condition and the recovery process are dynamic and changing, so our treatment approach has to be equally dynamic and changing. The same approach that is ideal for you in the beginning may be harmful 3-6 months later. Likewise, too much nutritional supplementation for too long can be equally or even more harmful than the original deficiencies being treated. Therefore, we work intensively, follow up closely, and adjust our protocols carefully and frequently in partnership with our patients.
Determining Length of Treatment: Our clinic works closely with most of our Precision Medicine patients for approximately 1.5 to 3 years, depending on the complexity of the situation. You will receive a written summary of all labs and suggested protocols at the completion of all one-on-one Lab Review sessions, as well as estimated time frame to accomplish our treatment goals.
Remember: Our job is to rehabilitate your health and return you to “natural balance.” Hence, the nutraceuticals/supplements we prescribe are not meant to be taken long term. They are given in an aggressive YET careful, systematic way for a predetermined timeframe before moving to other protocols. In other words, the order in which things are rehabilitated, and the degree to which a reliable foundation is laid, is the key to our success.
Q: What is the success rate of our Precision Medicine Program?
A: Dr. Boggess -“Keeping in mind that our Precision Medicine program attracts very complicated, yet ALSO very motivated patients; let's define success as discharging from active care after 1 to 3 years OFF all supplement protocols and feeling 70 to 100% better... My best estimate of how often this occurs is that out of every 10 patients who enroll in the program, 8 to 9 (on average) will continue beyond 6 to 12 months. Of those 8 to 9 patients who continue past 6 to 12 months, 7 to 8 will succeed (as defined above). In any case, some drop off because they are feeling better quickly, only to risk ending up right back where they were because the process was not completed. For others, life circumstances change. Some find the program more effort than what they were ready for, etc. That said, while the remaining 1 to 2 patients who stayed the course may not have achieved 70-100% improvement upon discharge, rarely do they indicate they are disappointed in our clinic’s effort, OR dissatisfied with feeling 40, 50 or 60% better, etc."
Many patients come to us from outside of Michigan. In such cases, we customize the New Patient Bundle based on the complexity of the patient or situation, and whether or not you are traveling from out-of-state or overseas. A paid, $225, 30-minute phone meeting with the doctor is the first step to solidifying your decision to work with our clinic. Many of the initial medical and education visits associated with the New Patient Bundle are done via phone and videoconference. However, please keep in mind that all patients must be seen at least once in person at our clinic, and we highly recommend this visit be coordinated with a Lab Education session to take full advantage of the educational experience our clinic is known for. Thereafter, all future follow-up visits can be done via phone or videoconference. We are set up for video screen sharing and work with our out-of-state and overseas patients efficiently and effectively, and we ship all testing materials and products from our office to your home reliably.
This program is designed for busy executives, athletes, or any patient that wants the highest level of one-on-one interaction, teaching, and coaching with Dr. Boggess. A paid, 60-minute phone meeting with the doctor is the first step to enroll yourself or your child into this program. There is limited availability and all patients must be seen at least once in person by Dr. Boggess, either in our office, or under select circumstances, a patient’s private residence. Thereafter, all future follow-up visits can be done via phone or videoconference at a distance. The hourly rate for this program, where Dr. Boggess functions as a one-on-one physician coach is $675/hr.
Billing Codes, Super-bills, & Insurance
Natural Balance Wellness Medical Center is out-of-network for ALL insurances. We are happy to provide you with an itemized superbill for every qualified encounter with the appropriate codes to submit to your insurance for reimbursement to you directly. However, please understand that we have literally given up trying to figure out the whims of insurance and cannot guarantee you will be reimbursed. For your reference, we have included the codes and pricing we use for the New Patient Bundle and follow-up visits, phone consults, etc. to assist you with checking with your insurance company ahead of time if you wish.
A Note Regarding Visits: The times below for follow-up visits include preparation and post-counseling with the nurse or clinical assistant, as well as direct collaboration with our physicians or clinicians.
At Natural Balance, we bill based on decisions, complexity and relative value (RVU) rather than time.
New Patient Precision Medicine Program Billable Codes:
NOTE: Not all services associated with the New Patient Process qualify for reimbursement or have super bill codes associated. These services have not been included below.
|99205 and 99354||New Patient History & Physical Exam (1 hr and 50 min)||$450 and $415|
|99215 or 99443||Follow Up Visit - Teaching Session (60 min)||$450|
|99214||Follow Up Visit (30 min)||$190|
|98960 (x5)||Health Educator (Clinical Support Visits)||$65, $65, $65, $65, $65|
|98960 (x2)||Health Educator (Lifestyle Assessment)||$65, $65|
|36415||Phlebotomy Fees and Diagnostics||$200|
NOTE: The New Patient Visits DO NOT include any testing, visits to review labs, or future follow up appointments.
Visits to Review Labs (example of a 90 minute Lab Review appointment)
|99215||Medical Office Visit||$450.00|
|99354||Medical Office Visit -extra time||$225.00|
Follow up visits (in office appointments)
|99215||Comprehensive Planning or Lab Visit, Level 5||$380|
|99215||Extended Planning or Lab Visit, Level 5||$295|
|99214||Basic Planning or Lab Visit, Level 4||$230|
|99213||Follow Up, Level 3||$160|
|99212||Simple, Level 2||$105|
Follow up visit (video or phone appointment)
|99443||Comprehensive Planning or Lab Visit, Level 5||$380|
|99443||Extended Planning or Lab Visit, Level 5||$295|
|99443||Basic Planning or Lab Visit, Level 4||$230|
|99443||Follow Up, Level 3||$160|
|99443||Simple, Level 2||$105|
Billing Process: As a medical center, it is our sincere intention that your visit be recognized by insurance AND qualify for reimbursement based on your out-of-network benefits. Our clinic’s ability to provide super-bills for your visit and utilize insurance for testing is why we are able to save patients thousands of dollars compared to other practices run by limited license clinicians such as chiropractors, naturopathic doctors, acupuncturists, etc. That said, we are unable to guarantee that your insurance will reimburse your visits, nor can we project how much reimbursement you might receive.
How we determine Visit Type?
|“Simple” Check-up on a particular protocol without further instructions or decisions. Patient or staff requested a simple visit to solve a problem that cannot be solved by a clinical assistant without a doctor. This also included DBS follow up visits.|
|“Follow up”: Review response to existing protocol, troubleshoot if needed, update Review of Systems (ROS), provide and explain next steps, answer questions.|
|“Basic Planning or Lab Visit”: Multilevel decision making required. Creating a new ROS. If re-testing, 1 or 2 simple labs are reviewed, explained and documented. Wrapping up a previous protocol, establishing and explaining a new protocol, etc.|
|“Extended Planning or Lab Visit”: Same as Level 4, but more extended / higher complexity. If re-testing, 1 complex, multi-page lab OR multiple simple labs reviewed, explained and documented.|
|“Extensive Planning or Lab Visit”: Same as Level 5 Extended Planning or Lab Visit, but more extensive / higher complexity / more time spent. Typically used when reviewing and documenting multiple labs OR re-establishing care. This level of visit is rare for an established patient undergoing follow up visits or lab reviews.|
Our clinic policies include important information about working with our clinic, insurance billing, refund policies, payment information, cancellation policies, etc. We request that all new patients review this material prior to enrolling with our clinic.