Primary Care: I am currently accepting very few new Primary Care Patients who live in Rockbridge County only. Please be aware that I am not the best doctor for people who simply want to have med refills and to manage each problem they have separately.  I like working with people to want to be as  healthy as possible with as few medicines as possible.  To be considered, you need to fill out the new patient forms and submit them.   We will let you know if we will be able to take on your care.

Consults in Functional Medicine, Lyme and Mold Illness:  Currently accepting limited number of patients who seek a Functional Medicine approach to a chronic health problem. I will require that you have a different Primary Care Provider. Each new consult patient will be charged a $250 chart review fee. This fee is not covered by insurance.  It must be paid in full before your visit will be scheduled.  If you cancel with 72-hour notice, my office will fully reimburse this fee.  Shorter notice cancellations will result in loss of this fee.

Functional Medicine Primary Care:  I believe that having a Primary Care Provider who understands health and understands illness. You deserve a provider who knows and cares for you takes time to consider your more complicated concerns. This is the starting point for health care. Our system does not provide that. Our system manages each symptom or illness, one at a time in a short visit. Most Functional Medicine doctors have a concierge system with a monthly fee. I am working on developing such a system for patients who see me for a particular problem and want to continue with me once that problem is addressed. We usually have a waitlist for this. Please call our office to discuss this option.

Mold Litigation: It is my privilege to work with some outstanding attorneys to help people who have been harmed by mold in their homes or workplaces. If you are involved in a lawsuit, I need to know that before you schedule your appointment because of the level of detailed documentation required. This documentation takes extra time, and as such there are additional fees. Please contact us for specifics before you schedule your appointment.

TeleMedicine*: I am happy to hold appointments over the phone. Your insurance does not always pay for this. When you schedule your appointment, we will make sure that you understand this and we will schedule the amount of time you wish.  We will charge you $350 per hour for that time. To provide diagnosis or treatment, you must come to my office for an initial and a yearly appointment because that is both better for you and compliant with the law.

*Coronavirus has changed some of the regulations around telemedicine. Please contact your insurance company to learn about their specific coverage and any changed policies.

Preventing and Reversing Cognitive Decline: 

Because I have a family history and a genetic make-up that make me vulnerable to Alzheimer’s Disease, I have found my interests moving toward neuro-protection and  recovery of brain function. In this context, I have followed Dr Dale Bredesen’s work for several years. His work is a wonderful example of using a Functional Medicine approach to address a complex problem.

In addition to being certified in Functional Medicine, I have completed all available training in The Bredesen Protocol,™ a personalized, comprehensive protocol for the reversal of cognitive decline. I will be working with a limited number of clients on this protocol. I find his approach works best in early cognitive decline and have not had much success in people who have severe or long- standing dementia. However, people with cognitive decline from tick borne infections or from mold exposure often recover fully with treatment. Of course, as is often the case, younger and healthier people have the best chance of full recovery.

Yes. Unfortunately, some of the costs of working with me are not covered by insurance, as most plans only pay for short office visits, standard procedures, prescriptions, and testing. Understand that you are responsible for confirming with your insurance company that Dr. Cathryn Harbor is listed as a provider under your specific plan. If Dr. Harbor is not listed, you will be responsible for the bill for your appointment as well as any other charges that are not usually covered by insurance. We accept cash, checks, credit cards, FSA and HSA cards. We will file any applicable charges to your insurance carrier on your behalf if we take your insurance. Please continue reading for specifics.

My office accepts most major health insurances. However, the insurance payment is based on the assumption that I will see you for around 10 to 15 minutes, and treat your problem with a prescription or perform a procedure during that time. A Functional Medicine approach simply cannot be done in the time insurance companies allot, as it requires a deep examination of your health problems and thoughtful assessment of potential underlying causes. Many Functional Medicine practitioners utilize a concierge model that requires a monthly payment. I do not utilize this system, as my goal is to get you well enough to return to your standard Primary Care Provider. Accordingly, I have implemented a one-time fee of $250 for new patients to cover the cost of long appointments, and the time outside of your appointment I spend analyzing your specific health concerns. This fee is not covered by insurance.

Additionally, while I do work with insurance, I cannot tell you with certainty whether any test or procedure will or will not be covered by insurance. This is because insurance coverage varies tremendously from policy to policy and even from day to day in our healthcare system. Further, each insurance company offers many policies. I only accept some. This office is able to verify that your insurance is active. We are not able to verify whether your specific insurance policy will pay for your visit. 

It is your responsibility to do two things:

1. Confirm whether or not your insurance has Dr. Cathryn Harbor listed as a provider under your specific plan. You will need to confirm with your insurance to determine whether office visits and tests will be covered under your specific plan.
2. Confirm whether or not your provider pays for testing through Quest Diagnostics. This is the lab we refer patients to. If your specific plan does not cover this lab, you will either need to pay for the labs yourself, or arrange labs somewhere that is covered under your plan and ensure that those results are sent to our office.

Yes. 

Costs not covered by insurance are:

1. Intake Fee: $250 per patient. 

This is required of all new consult patients and

a) covers a detailed review of your health history, and

b)gives you access to the patient portal.  

This fee is not the same as an office visit fee, and it must be paid prior to scheduling your first appointment. To determine whether an office visit is covered by your insurance, please contact them about your specific plan. If Dr. Cathryn Harbor is not listed under your specific plan you are responsible for the $250 office visit fee.

Testing: Some tests may not be covered by your insurance. These tests will not typically be done during your initial visit and may be optional in some cases. We will discuss these costs as the need for them arises. Specialty labs such as Great Plains, Genova, IgenX, and urinary mold testing are not covered by insurance.  However, many of the most important and helpful tests are covered by Medicare.  No testing is mandatory, however if we cannot find an answer to your problems and see improvements in your health, more in-depth testing is highly recommended. 

Lyme-Aid is a program that helps with bills for testing and treatment for children and youth up to age 21 who do not have health insurance.  We will happily help you with the submission.

Our healthcare system is focused on profit. Prescription sales and hospital procedures create tremendous revenue for this system. Doctors who focus on prescriptions and procedures as primary methods of treatment make lots of money for the system, and receive lots of income in return. Those of us who take a deep look into the underlying causes of illness and who seek to heal more than one biological system at a time fall outside the current insurance payment structure that many ‘typical’ doctors benefit from. This deeply frustrates me as I believe that each person successfully treated with a comprehensive approach contributes to a better, cheaper, and more responsible health care system for everyone.

Recovering from chronic illness can also require a significant commitment of time and resources on the part of the patient, outside of the office. Please understand that I am as committed to helping you as you are to getting well. I have spent the past 20 years practicing teaching and studying Functional Medicine. I have treated thousands of patients whose complex medical conditions could only be resolved using the sort of comprehensive in-depth approach that we will use together.

I care deeply about providing high quality, compassionate, up-to-date, and clearly explained health care. Most of the new patients I see have searched for years to find answers to distressing health problems. Helping people regain excellent health is my greatest professional joy. A Functional Medicine approach takes far more time and research than typical primary care medicine. The 5-20 minute visit that insurance will pay for is focused on a single problem, rather than the patient as a whole. I focus my visits on you as an individual, in all your complexity. I try to understand your issues in as much detail as I can so that I can help you take the steps necessary to get back to good health, so that you can return to standard Primary Care without any additional healthcare needs. 

I try not to pass too much of the financial burden of our ineffective healthcare system onto my patients. Unfortunately I cannot provide the kind of quality care I believe in and keep the office open unless I charge extra fees. In my case, rather than billing you monthly to maintain a position in my roster of patients, I charge a one-time $250 fee to new patients. If you have worked with other Lyme treating or Functional Medicine practitioners, you will understand that this is a very small fee compared with most.

In my 20 years of using a Functional Medicine approach, I have never found a quick and clear definition of Functional Medicine. Perhaps that is because Functional Medicine is not a thing but a process, an approach. The idea behind this process is quite basic. Rather than trying to treat symptoms one at a time as though they are separate and unrelated, a Functional Medicine approach seeks to understand relationships between symptoms and discover their common causes.

For example:

• If you have chronic headaches and a persistent rash, both may be related to your diet
• If your blood pressure is regularly too high, a Functional Medicine approach is more likely to examine sources of stress in your life and within your body than to prescribe a medication
• If you are experiencing memory problems or cognitive difficulties, and your digestion is causing you problems, Functional Medicine is likely to explore the patterns these two seemingly distinct problems follow, and attempt to find a problem that explains them both

Generally: rather than seeing symptoms as targets for medicine and procedures that may stack up as the number of symptoms increases, Functional Medicine sees symptoms as information. A constellation of symptoms makes a Functional Medicine doctor want to look upstream, at genetics, diet, and environment, to explain as many symptoms as possible. This takes a longer time, but ultimately leads to improved health with less news for additional prescriptions and doctors visits.

If you want to get a more complex understanding, here’s what the Institute for Functional Medicine says:

The Functional Medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes.

By addressing root cause, rather than symptoms, practitioners become oriented to identifying the complexity of disease. They may find one condition has many different causes and, likewise, one cause may result in many different conditions. As a result, Functional Medicine treatment targets the specific manifestations of disease in each individual. Functional Medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual.

You are welcome to bring a friend, partner, or relative to your visits if such companionship is comfortable for you. Bringing children with you to your visits is also fine, and we keep toys available for children. However, you should be aware that your visit will be more focused and less interrupted if you are able to find someone to take care of small children during your visits, as they will need to stay with you during your time in our office. We do not provide a daycare service, and you are responsible for their safety during your visit.

Pets are not allowed inside the office. If you have a service animal, you must inform us before your appointment. We have patients with strong environmental sensitivities and make every effort to have clean, healthy indoor air. Well-behaved pets may be tied up on the outside, on the porch or in the yard. We will happily furnish them with water. I have a wonderful golden retriever who often comes to work with me. Sad though this makes him, he has never once been allowed inside the office.

If you cancel your first appointment with 72-hour notice, my office will fully reimburse the $250 Chart Review fee. Shorter notice cancellations or no-shows will result in loss of this fee, as they leave me with an hour of time I cannot always fill. If you are ill and must reschedule at the last minute, I understand that. However, I simply cannot afford to give you another full hour appointment once you have recovered, so you will be rescheduled for ½ hour first visit.

During the Coronavirus pandemic, you are welcome to cancel an in-office visit and substitute it with a phone visit for the same time and duration. You must fill out all the necessary forms, and all fees still apply.

We do not handle testing in our office. I prefer you get your labs done in Lexington, immediately after your first visit. I will provide an order for that. 

Why? 

The labs have worked with my office for years and have learned how to efficiently handle some of the less common tests that my patients often need. Some of these tests require special tubes or special treatments such as freezing or extra time spinning.

If you have further questions about the Quest Diagnostics facilities that we recommend, please contact the office.

You can choose to have your labs done at any lab that provides the required test, but you need to know two things if you choose to do this:

• If the sample is rejected or the wrong test is done (this happens often) your insurance may not pay to re-do the test and negotiating with them will be up to you. If the original labwork was not covered by your insurance and there is a mistake at the testing facility, we are not able to reimburse you for that cost.
• Labs not done locally will not automatically enter our system. We will not be able to track those tests for you. It will be your responsibility to make certain the lab results come to our office. This is often a multi-step process that requires communicating with the lab facility and our office.

The next time you will have direct contact with me is at your next appointment. At the end of your visit, we will have established a plan and a timeframe for follow-up. If you do not know what the next steps are, please call right away for clarification. Otherwise, quick questions will be handled through our office administrator. Longer issues require an office visit. Typically, if you have questions and it has been longer than 8 weeks since your last appointment, you will be asked to schedule another appointment.

Patient Portal:  We offer every patient access to Care Plan notes on via Our Electronic Health Record System. This system allows you to set up a secure link to your medical records from our office. That link will allow you to see your lab results and my comments on those results.  I want to make clear that the Patient Portal is not the place to ask urgent questions and is not a place to ask long or detailed questions. Any issue that requires more than a quick 1-2 sentence answer will not be addressed through the patient portal, and you will need to schedule an appointment to discuss it.

Please know:

• If I am concerned by a lab result, our office will contact you through your chart. Please ensure that you choose a method of communication you are attentive to when you set up your Portal.
• I will not go over health issues or labs on the phone, unless it is during a scheduled TeleMedicine appointment.
• If you have a serious health problem that requires immediate attention, you should call your Primary Care Provider, call 911, or have someone take you to the nearest hospital emergency room.

We encourage and expect our patients to take an active role in their health, and to ask clarifying questions regarding their treatment plan during office visits. I strive to give clear verbal and written directions to my patients.  Please read the directions we send home with you and look at the Care Plan in your chart.

If you feel there is a need for discussion regarding new symptoms or new concerns, then we will recommend you see your Primary Care Provider or schedule an additional follow-up appointment. We will schedule as many appointments as we need to address your concerns. I am not able to answer questions about new symptoms by phone. 

For concerns that you feel must be brought to my attention, you may call the office. Please remember that we are not open on Fridays and that it may take 1-2 working days to respond. Again, if you have a serious health problem that requires immediate attention, please call your Primary Care Provider, 911, or have someone take you to your local Emergency Room.

Your first appointment will be 50 minutes and subsequent appointments will be 25 minutes. If you are a new patient, I will already have read the information you provided in the New Patient Form, so we will have time for me to examine you, ask you questions, and answer yours. If you feel like you need extra time you have 2 choices:  make more frequent appointments or ask to schedule a longer appointment and plan to pay out of pocket for the extra time. My rate is $350 per hour.

The best use of our time together is to first let me ask clarifying questions. Many of the people I work with feel traumatized by their illness and by the care they have gotten prior to coming to my office. I completely understand this. I have asked the questions whose answers I most need, and am good at finding patterns. If we focus too closely on the details of your symptoms, it will use time that might be more fruitfully used in a different way.

You are welcome to record our office visits if you wish.

HIPAA: Information you share during office visits and phone visits is confidential. Exceptions to this confidentiality include disclosure by you regarding intention to harm yourself or others. Your record and the information contained within it will not be disclosed to others unless you direct us to do so or unless the law authorizes or compels us to do so. You will be required to read and sign a HIPAA disclosure form before your first visit. This form is available online and we will provide you with a copy of the privacy policy if you request one. 

You should know I am required by law to report some infectious diseases (such as Coronavirus and Lyme Disease) to the health department. The lab performing the test is also required to report some positive results.

Yes, you can. There is no substitute for a face to face visit, but especially during the Coronavirus pandemic, we all have to adjust to changes in our routine. If you strongly prefer to come to the office, we require you to wear a mask at all times during your visit, all possible interactions will take place 6 feet from others. We are cleaning/disinfecting surfaces routinely. As long as insurance continues to allow, we will offer telemedicine for those who use insurance.

Before you leave your first visit, we will set you up with access to your electronic chart.  You will get a text and an email that will guide you in setting up this electronic portal. Once you have done that, you will need to wait for results to come in. The tests we recommend often take 2-4 weeks to come back to us. As I see your test results, you will get an email from the health record telling you how to see your results. I will explain the lab results within that system.

Many people ask for and expect me to call them to go over their tests. I cannot do that.  We will go over your results at your follow up visit.  If your test results suggest to me that we need to change the plan we agreed on, our office will contact you to discuss that change.

We may decide to do specialty testing, and will discuss that during your visit

Examples of specialty labs we use

• Galaxy Diagnostics
• Genova Diagnostics
• Great Plains
• Igenex
• Mycometrics
• Real Time Labs