FAQ - Frequently Asked Questions
Insurance/Financial Questions Medical Questions
Is this a "concierge" type practice with a membership fee?
No. There is no membership fee to join Wise Women, although we do have many features of a concierge-type practice such as physician access, after hours call or texting, secure messaging, and prices that are listed. We will not be expanding or bringing on other providers. When Dr. Carlson's practice is full, upcoming appointments will be limited to her existing clients. We could be considered a "boutique" type of practice.
I've never gone out of network before. How does the insurance reimbursement work?
We are taking some insurances now, but if you are out of network, we will give you a coded and detailed receipt for the amount that you pay for your visit. Many patients use their health savings accounts (HSA) to pay for the visit. You may also submit your receipt to your insurance company for reimbursement, and we will do everything we can to help you with this. We are registered with all major carriers. Most insurance carriers will reimburse at least a portion of your visit if you have out of network benefits. Please check with your insurance company for your out of network benefits. Women using Medicare are usually covered and should see our page Women with Medicare.
Will I have to pay out of pocket if I need surgery or hospitalization?
No more than you would have to pay normally under your policy. If you need surgery or hospitalization, Dr. Carlson works closely with colleagues - whom she trusts and knows you will feel comfortable with - for any non-office care that you may need. These physicians will be able to utilize your insurance coverage. We will work closely with them and you so that your records are available and you do not have to "re-invent the wheel" with a different physician.
Can I use my insurance to pay for other testing that I may need?
Yes. Because we are registered with your insurance company, any samples that we send for lab evaluation, such as pap smears or cultures, will be billed directly to your insurance. Likewise, if you need blood tests (such as cholesterol testing) or imaging (such as a mammogram or bone density test), these will be ordered and your insurance will again be billed directly, just like with any other provider. If, for some reason, your insurance requires a referral for testing, we will work with your primary care provider in ordering the testing.
Will my office visit count toward my deductible?
It should. Because we are registered with your insurance company, your out of pocket payments should count toward your deductible.
I have been told that I no longer need pap smears or annual exams. Why?
Pap smears were developed to identify problems with the cervix before they develop into cancer. Having them done yearly was based more on "tradition" than on a medical need and several years ago, a panel of nationally and internationally known experts convened to determine how often they need to be done to prevent cervical cancer. These recommendations were updated in 2016. It was determined that some women over age 65, without an abnormal pap in the previous 10 years, who do not have compromised immune systems and have no history of cervical cancer or precancerous conditions in the last 20 years, could safely discontinue pap smears.
More recent articles suggest that we may be doing some women a disservice by doing this. Although the rate of cervical cancer is quite low, 19% of new cervical cancer cases are in women over age 65. Based on this, although it is outside of the current guidelines, we recommend erring on the side of caution and doing pap smears every 2-3 years. The American College of Obstetrics and Gynecology supports an annual exam for other screening, such as for other types of cancers, including those of the breast, uterus, vulvar skin, and rectum. Women who may have compromised immune systems, either because of medications that are taken for other conditions or because of chronic illness, should continue with pap smear screening as they may be at greater risk for cervical cancer.
Nothing is working for my vaginal dryness. Do I have to live with this?
No. Many conditions, including some that are serious, can feel like vaginal dryness and can have symptoms such as burning, itching, irritation, and pain during sex. You should be examined to determine if there is yeast or bacteria (which can be without discharge after menopause) and to examine the skin of the vulva to rule out skin conditions such as lichen sclerosus or even a precancerous skin condition. When burning and itching is due to postmenopausal thinning of the tissues, hormone creams such as estrogens will help. If they do not, then this is a sign that something else is going on.
Is it normal to have a little spotting now and then after menopause?
No. Even if you are on hormone therapy, spotting or bleeding after menopause can be an early sign of a serious problem like cancer. Although spotting like this is sometimes caused by benign polyps or irritation in the vagina or cervix, it is extremely important to be evaluated for signs of uterine, cervical, or other types of cancer. Bleeding after menopause is NOT normal.
Do you prescribe bioidentical hormones?
Bioidentical hormones are hormonal preparations that are thought to mimic your natural hormones and are made from a number of different components. Often testing is done to determine your hormone levels and bioidentical hormones are prescribed individually to tailor your treatment to your hormone levels.
Many women go through menopause with very few, if any problems. They may have a few hot flashes but these pass, and they feel fine. If a women like this has her hormones checked, the estradiol level will almost always be less than 10 and their progesterone and testosterone levels may or may not be decreased, as these "androgenic" hormones are also made by the adrenal glands. These levels are normal for after menopause. We wouldn't treat her because she isn't having any problems and her levels are normal for a postmenopausal woman. It would be foolish to expose her to the risks of hormone therapy.
Some women go through menopause and they have dramatic symptoms - they may have severe hot flashes and mood swings, among other symptoms. As she is going through this transition, her hormones may be wildly fluctuating and basing a treatment on one set of hormone levels would be incorrect, as they may be changing dramatically. We would never refuse treatment to someone having so many symptoms because of "normal" hormone levels.
Hormone therapy should be based on symptoms, not hormone levels, with the goal being to relieve symptoms with the smallest dose of hormones possible. Bioidentical hormones will often relieve symptoms, but when you are taking hormones for menopausal symptoms, it is likely to be safer to take an FDA-approved medication, as you can be better assured of its safety and the consistency of the dosage. There are some hormonal treatments which are FDA-approved and contain plant-based hormones which could be considered "bioidentical". Most bioidentical hormones, however, are not regulated or monitored by the FDA. The claims that they are somehow safer than more conservative or conventional medications has not been proven. Because I care deeply about the safety of my patients, I will never subject you to unnecessary tests and unapproved medications.