New patient appointment

We look forward to seeing you for your first appointment at Cerbo Clinic. Make sure to bring a family member or friend, because it helps to have support.

Like with any other specialist doctor visit, we will review your information, perform a comprehensive physical exam, and take a detailed look at your labs and MRI and CT images. Sometimes additional tests are needed to confirm the diagnosis and we will schedule a follow-up after you have completed those additional tests.

Once the diagnosis has been established, we will create a treatment plan, share treatment options with you, and create a visit report for you and your referring doctor.

First visits typically take about 90 minutes, most of which is face to face doctor time:

• Establish care – data entry, sign government mandated medical disclosures, insurance verification, pay copays etc: 10 minutes
• Neurosurgeon reviews and completes your information and medical history: 10 minutes
• Neurosurgeon performs a comprehensive neurological and physical examination: 10-15 minutes
• Neurosurgeon reviews and shares pertinent test results and imaging with you: 10-15 minutes
• Neurosurgeon establishes diagnosis, creates the initial treatment plan: 10-15 minutes
• Neurosurgeon explains treatment options, potential benefits, morbidity and mortality risks of surgical versus non-surgical treatments: 10-15 minutes
• Neurosurgeon answers your questions and recommends best next steps in your care: 10-15 minutes
• Wrap up the visit, schedule a follow-up, create visit reports and provide you with educational materials: 10 minutes

Established patient appointment – follow-up

Purpose of your follow-up is to check on how you are doing, to make sure the initial treatment recommendations have resulted in improvement in your condition, or to follow-up on additional tests that were needed to confirm the diagnosis.

Follow-up visits typically take about 30-45 minutes, most of which is face to face doctor time:

• Update your profile and medical records, pay copays etc: 5 minutes
• Neurosurgeon reviews your updated information and history: 5 minutes
• Neurosurgeon performs a focused neurological and physical examination: 5 minutes
• Neurosurgeon reviews pertinent medical findings and test results and imaging with you: 5-10 minutes
• Neurosurgeon reviews and adjusts treatment recommendations: 5 minutes
• Neurosurgeon answers your questions and discusses best next steps in treatment with you: 10 minutes
• Schedule follow-up, schedule surgery if needed, create visit reports: 10-30 minutes

Surgery scheduling

If surgery is needed, we will initiate the process of surgery scheduling for you. Surgery scheduling includes:

• Confirm insurance eligibility and assist you with surgery pre-authorization*
• Provide cost estimate for VIP patients, private patients, and uninsured/underinsured patients**
• Medical clearance/ confirm fitness for surgery and anesthesia. Hospital surgery department and anesthesia department require clearance for most patients, prior to releasing any spots on the operating schedule. We will request surgery clearance on your behalf from your primary care doctor or a qualified MD of your choice. A subspecialty clearance from cardiology, pulmonology or nephrology may be required for anyone with pre-existing heart, lung or kidney conditions.
• Checking medications: Need to stop any and all anti-inflammatory drugs, blood thinners, antiplatelet agents and herbal supplements 10 days prior to surgery. If a critical medical condition requires ongoing antiplatelet or anticoagulant treatments, surgery may not be an option. If surgery cannot wait and is necessary to prevent harm or death, special arrangements can be made with hospital specialists to manage the blood thinning requirements before, during and after surgery. This may require hospitalization several days before the surgery date.

*We only perform neurosurgery operations in a hospital setting because it is the safest option for brain and spine operations. Surgery triggers high costs for the hospitals including OR services, anesthesia, lab and imaging services, specialized nursing and rehabilitation care services etc. Therefore, hospitals will not schedule any surgery without pre-authorization from the insurance carrier.

Low-cost or taxpayer funded social care programs such as MediCal may only pay a tiny portion of your hospital bill or nothing at all. Double check your insurance coverage or make financial arrangements prior to surgery scheduling. Insurance authorization may take several weeks or longer.

Should your insurance refuse to grant a preauthorization, you may pursue several options:

• negotiate with your insurance carrier
• reconsider your treatment options
• change your insurance carrier
• seek surgery care outside the United States (medical tourism)
• pay out-of-pocket (private patient option)

Occasionally, insurance company representatives may give verbal assurances to patients that services will be paid, but determine later that no payment will be made, after services have been provided. Therefore, hospital schedulers often insist on a written pre-authorization from your insurance.

Please note that the patient and insured person will be held responsible for payment of any and all medical services irrespective of insurance decisions to provide or refuse such payments. Whereas Cerbo Clinic accepts insurance pre-authorization in good faith, you will ultimately be responsible for your medical bills, should your insurance default on their payment obligations.

**VIP/private patients, as well as underinsured or non-insured patients who decide to pay out-of-pocket, are advised to also check with the hospital billing services for a cost estimate prior to surgery. We will provide private pay (out-of-pocket) patients with a cost estimate for the surgeon fee charged by Cerbo Clinic. Please note our surgeon fee is only a relatively small amount compared with the service fees billed by hospitals and third parties for surgery related services such as OR, anesthesia, ICU, specialty nursing care, rehab and physical therapy, pharmacy etc.

Post-op appointment

During your post-op visit, our neurosurgeon will check the progress of wound healing, your recovery and performance outcomes. Post-op outpatient care is included for 90 calendar days after the surgery date (90 day global) and does not trigger any additional charges or fees.

Post-op visits typically take 30 minutes and include:

• Review and update medical records and hospital records, copay reconciliation: 5-10 minutes
• Focused general physical and neurological examination: 5 minutes
• Wound check including removal of dressings, sutures and surgical staples: 5 minutes
• Cleaning of incision, re-application of sutures, staples or dressing materials: 5-10 minutes
• Prescription of medicines, follow-up appointment scheduling: 5 minutes

We will assist and guide you and your family at all times. Please reach out to us if you need any additional information or assistance.