#61

@DrFraser Just curious but couldn’t a prospective patient identify himself as living in a different state and what burden of discovery would you have as a practitioner to verify the residency? Or would that pop up during the insurance paperwork process?

Asking for a friend :wink:

Also I owe you an apology for going MIA after volunteering to help you with your proofreading so I’ll make it a public one. You must think me very flaky but I had my baby shortly after we last corresponded and all hell broke loose on my end soon after with health complications (mastitis essentially shut down my capacity to deal with anything above and beyond surviving from one day to the next… perhaps TMI). Anyway I’ve mostly landed on two feet now and hence alive and well again in the forum.

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#62

All good @medaura

I cannot geolocate - but medication Rx’s get linked to home addresses as does insurance. It looks a little suspect when my patient tells me they are in California and my Rx’s go to New York.

I suspect there are cases of doctors getting prosecuted as practicing medicine without a license is a significant offense. I do have some patients who have links to other states and addresses in states I’m licensed in who I see with them indicating they are in a state I’m licensed in.

Just don’t want to push the limits and end up losing my livelihood.

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#63

No plans for MA? I have no idea how cumbersome and/or costly it is to be licensed in another state.

#64

MA isn’t yet formally a interstate compact state - so licensure is a big deal. With states that are part of that, as I’m setup with imlcc.com I can get a license in over 30 states in as little as a day.

There is a moderate cost with each state both initial and ongoing.

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#65

@DrFraser Maine seems to be among the 30 unless I’m very much mistaken. Would you be willing to go through the trouble of getting licensed there?

#66

Maine is $700 plus other fees … They do have a telemedicine only which might be more cost effective.

How many people in Maine want to see me? Give me 3 and I’ll get the license.

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#67

You can definitely have me and most likely my husband (I say likely because I haven’t discussed it with him yet at all) and after a little while of being your patient and in a position to vouch for you, I could plug you with my in laws here and also locals looking for recommendations. I’m relatively well known and trusted in my town and the admin of a 1.7k strong local FB group. I think you’ll likely reap plenty of patients in this state because access to healthcare is ridiculously scarce — if you don’t schedule a physical a full year in advance you can’t see your doctor at all for a well visit that year. Better luck next time! For sick visits, unless you’re at death’s doorstep, it’s nurse practitioners all the way. So if you can make yourself available to patients they’ll love that as they can’t get it elsewhere.

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#68

Okay - I’ll contact the Maine Medical board and get back with you.

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#69

Dr. Green has many patients that read this forum. To the best of my knowledge he saw all of his patients (at least for the first time) in person in before allowing for telemedicine follow-ups.

For existing patients who are doing well with rapamycin. How many refills do you allow between visits (either in person or via telemedicine)?

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#70

Yes I heard he saw all in person, but still on refills or follow-up the law is the practice of medicine is where the patient is physically located.

If someone just sees me for Rapamycin, not of longevity medicine in addition, I’ll do as long as every 6 months. For longevity medicine, every 3 months where we would be optimizing everything.

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#71

Excellent! Then how does it work with going “in network” with the insurance company? I never quite understood that part.

#72

No one who does functional/anti-aging medicine does anything with insurance. It is always cash pay, but there is a focus on cost effectiveness. If someone has a high deductible plan, way cheaper to see me than standard methods - as I also do comprehensive primary care. If on a low deductible plan, yes, cheaper to see regular doctors, but they won’t be able to offer the same types of care. Patients get a superbill and can send this to their insurer for reimbursement or to go against the deductible.

I very much view insurance as useful for catastrophic events … pretty useless for routine high quality care. The great physicians in primary care or functional medicine are all concierge.

Probably worth a new thread than this one however on how to hack the system and be cost effective and get the care you need.

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#73

That would be a great idea! So I understand, does telemedicine work to replace a general practitioner too or is concierge medicine only supplemental to a family doctor? I want to outright replace mine because she’s essentially absent and I can never see her — I can only talk to NPs unless I book her a year in advance. My blood work is actually picture perfect and I’m not sure what would even need to be optimized at my age, 38. It’s my husband who’s got far from optimal markers and is older too, 46, but shows much of the typical Western man’s reluctance to deal with it.

A separate thread for all things cost engineerings would be very helpful.

#74

I’ll message you as I don’t want to hijack a really meaningful commentary on Dr. Green. But yes - replace the Family Physician.

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#75

And to bring it back on topic, if no one steps up to maintain Dr. Green’s website or if his estate can’t be reached at all, I’d be happy to just scrape the entire content and republish it under a different domain, with attribution, so the materials continue to remain accessible.

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#76

I would suggest that you do this proactively just in case.

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#77

I know the person who maintains Dr. Green’s website (He’s a participant here)… let me chat with him…

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#78

I am so sorry for your loss. I did not know him personally, but he imparted a special joyousness and hope along with his inspiring work to help others.

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#80

Dr Green’s website is part of his estate I’m assuming and should be handled accordingly.

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#81

Yes I assume the estate would have to OK any transfer of the web assets. @RapAdmin I can offer hosting in perpetuity through agency hosting tools I have such that even if I were hit by a bus, service wouldn’t be interrupted due to any bills unpaid with the host. (Wouldn’t that be an ironic end to my life extension efforts by the way?) Perhaps the webmaster can intro me to someone at his estate. I think it likely that his family would like to have his public facing work be preserved, especially if it won’t cost them any trouble or money.

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