Frequently Asked Questions

What to bring, insurance billing, and procedural questions.

 

SCHEDULING

How do I schedule an appointment?

  • To schedule an appointment at our California or Washington office locations contact us at 425-326-1665


What should I bring to the appointment?

  1.  You should bring all radiographs taken to date, including x-rays, MRIs, and CT Scans.  Bring a copy of the radiology report as well as a CD of the actual images themselves.  If you do not have them, please contact the imaging center and ask for the CDs and reports.  They will make you a copy.

  2.  If you have medical records, please bring copies with you.  Bring more not less!  Dr. Brown can sort out what he wants to review.


  3.  It is VERY helpful to write a brief timeline or history of your condition, as well as a list of whom you have seen and what has been
done for your chronic pain treatment to date.

 

  4.  If you have a complex history, it is also VERY helpful to take the time to organize your history in a time line and a list of your past medical history and any treatment or procedures you have had in the past and the response to those interventions.  If you do not then Dr. Brown will have to take the time to do so.  By helping in this process you will save time and leave more time for questions and discussion.  We have a template of how to do a medical history.  Please download it and hopefully the template will assist you in organizing your current medical and past medical history.

 

  5.  Please also bring a list of the medications you are currently taking.

FINANCIAL POLICY AND BILLING

Does Dr. Brown accept and bill my insurance?

  • No.  Over the past 17 years we have been a fee-for-service practice. This means that you will be expected to pay for services as they are rendered.  We do not do insurance billing.  We established this policy over the years because of the unique nature of the prarctice.   Dr. Brown utilizes many procedures that insurance companies have no established billing codes for or consider many of the treatment methods he uses as "investigational."  We do provide you with a superbill, which you can submit to your insurance for potential reimbursement.  Many parts of your visit with Dr. Brown will be reimbursable, however, some treatment modalities may not be, depending on your coverage.

 

Does Dr. Brown accept Medicare?

  • No:  This has been one of our greatest frustrations in private practice.  Besides the fact that Medicare over the last several years has been reducing its benefits to an all-time low, they are also refusing to cover many services utilized by pain physicians.  Most importantly, Medicare has refused to cover services such as prolotherapy, PRP, stem cell injection therapies, and other methods of treatment that they consider investigational.  Since these methods of treatment are some of the most common services we offer, we have seen minimal to no reimbursement from Medicare.  We have hired insurance and billing professionals to study this further in hopes of optimizing the care provided to our Medicare patients at a reasonable cost.  At present, Medicare's position is that anything that they consider to be investigational (despite its success) will not be covered.  Thus, we have been forced, at this point, to opt-out of Medicare.

 

How do I bill my insurance company?

  • We will provide you with a superbill with all of the diagnostic and procedure codes necessary to bill your own insurance for services that we have provided. The superbill simply needs to be submitted to your insurance company with a copy of your insurance card.  We state across the top of the superbill in large print that the services have been paid in full and reimbursement needs to be submitted directly to the patient.

 

Can I expect to be reimbursed from my insurance company?

  • This varies depending on your particular coverage.  However, most of our patients do find that they get at least partially reimbursed.

 

Why should I have to pay for health care services when I have already paid for insurance?

  • We share your frustration. The insurance reimbursement infrastructure has deteriorated over time.  Physicians have made up for the loss of reimbursement by increasing patient volume in order to make ends meet, resulting in less time with patients.  Dr. Brown feels that this decreases quality of care.  He prefers to take the time to do the detailed detective work, evaluations, and management procedures that he feels is necessary.   To have the time necessary to deal with the complexity of patients’ issues, and to perform the multiple procedures that we do in a single office visit, we must currently stay a fee-for-service practice.  What if you have multiple pain complaints?  Most physicians do not have time to address all these problems in a single office visit. There has simply not been a way for this practice to work in an "insurance model" practice with the time and attention to details that you will experience with Dr. Brown.  Patients who seek our care typically decide to do so because they are tired of dealing with the conventional methods that have failed them.  Thus they seek to purchase their own health care by seeing an out-of-network provider and the specialty care we provide.

 

Does Dr. Brown accept Worker's Compensation cases?

  • Not usually:  However, we currently work with an orthopedic group that does a lot of Workers' Compensation management.  Thus, Dr. Brown does provide care for selected cases that he helps co-manage with his orthopedic surgeon colleagues.  He will also periodically be requested by industrial insurance carriers to provide second opinion consultations for select cases in California.  For these cases he does not become the treating physician on record or take over management.  He typically does not accept Workers' Compensation cases in the state of Washington.

 


PROCEDURES AND AFTERCARE


PROLOTHERAPY

Are prolotherapy injections painful?

  • We expect all patients that have undergone prolotherapy injections to have some post-injection soreness that can last up to 72 hours.  The intensity and duration varies from patient to patient.  Most of our patients state that the discomfort is simply an annoyance and they can carry on their usual day-to-day activities without significant difficulty.


 

  • Occasionally, if patients do experience an elevated state of temporary pain, we do prescribe medications to assist them in their recovery.  The majority of our patients utilize over-the-counter medications for the first 1-2 days.  Ice packs are helpful for the first day, applied in 20 minute intervals.  If a patient is experiencing post-injection pain for longer than 5-7 days we ask that they contact us to discuss the problem.


What do you do to reduce procedural discomfort?

We do everything we can to reduce the discomfort of prolotherapy injections. There are a number of tricks that Dr. Brown uses to accomplish this.

  1.  Rather than using standard lidocaine, which is acidic and stings when injected, he mixes it with sodium bicarbonate.  This
buffers the lidocaine and brings it back to a neutral pH.  It has been shown in clinical trials to reduce the discomfort of lidocaine injections by 80%.

  2.  We typically use a small, 1/2 inch, 30-gauge needle (about the size of an acupuncture needle) to inject this local anesthetic under the skin before any injection procedure is performed. This substantially reduces the discomfort of the overall procedure.

  3.  We use the finest and smallest needle possible for the procedure and we change needles with every injection.  We choose to do this because it makes things significantly more comfortable for the patient.

  4.  We have developed a number of techniques that further reduce discomfort, which will be reviewed as needed at the time of your consultation, depending on the prescribed treatment.

  5.  We utilize conscious sedation on certain occasions, depending on the procedure, and carefully weigh the risks and benefits of offering that service.

  6.  Dr. Brown is a skillful injection specialist and is known for his "gentle touch."

Do I need to take time off work after these injections?

  • The majority of our patients continue their normal work and daily activities.  Some patients feel that exercise helps with post-injection soreness.

 

What medications do I have to restrict after prolotherapy injection?

 

  • Since prolotherapy utilizes the body’s natural inflammation process to stimulate healing, taking an anti-inflammatory medication is often counterproductive. Thus, we recommend reducing or eliminating the use of anti-inflammatory medications. The longer you stay off of them the better.  We like to have our patients off of these medications for at least 3 months after the last injection. The use of corticosteroids may also be counterproductive, and should be avoided.  If you are taking injectable or oral corticosteroids please notify Dr. Brown.

 

What pain medications can I take after my procedure instead?

  • Over-the-counter Tylenol works best. Analgesic medications such as Tramadol, Codeine, Vicodin, and Oxycodone are also okay to use for post-procedural pain.


Can I use heat after injections?

 

  • We rarely advise the use of heat after injections.  For the first day you may experience increased swelling, bleeding, bruising, or even increased pain if heat is used.  Ice tends to be the favored treatment after injections.


What activities should I restrict after prolotherapy?

  • We recommend that our patients keep moving after treatment.  Some patients prefer to reduce activity for a day or two.  Most continue their normal activities. While we understand that may be tempting to catch up on the work that has piled up due to your level of pain, it is not advisable that you complete your spring cleaning as you begin to feel better in your recovery period.  At this point you have not developed sufficient stability to tolerate any significant change in your physical activity level.  Use good judgment and keep to the same level of activity that you were typically engaging in prior to the injections.  We will discuss increasing your physical activity when your condition stabilizes.

 

Are there exercises that I can do to help improve my condition while I am healing after prolotherapy?

  • Yes, absolutely.  We have an excellent multidisciplinary staff of physical therapists, chiropractors, and athletic trainers to assist our patients in developing rehabilitation programs.  This rehabilitation process can be performed within our facility or a patient may choose to receive instruction and then do the exercises on their own.  Although we do provide some exercise instruction ourselves, time spent with our rehabilitation team is invaluable.  They can make sure that you are doing the exercises appropriately and that the program is customized to your specific abilities and diagnosis.  As your condition stabilizes, you will be able to progress on your own with your exercise program, based on the therapeutic goals established with our rehabilitation team.

 

Can I see my chiropractor while I am undergoing prolotherapy?

 

  • Dr. Brown is a chiropractor as well as a board certified subspecialty physician. He therefore has a much greater understanding of the potential benefits of chiropractic treatment.  Having said this, the type and frequency of chiropractic manipulation is an important thing to discuss with Dr. Brown after prolotherapy procedures.  Ligamentous stretching can interfere with the strengthening effects of prolotherapy.  Soft tissue techniques, on the other hand, are completely acceptable any time post-therapy.  If a patient is experiencing a post-injection flare, we find that chiropractic care can be valuable in reducing soreness and pain.

 


PRP


Are PRP injections more painful than prolotherapy?

  • PRP preparation and injection is a very different process than prolotherapy.  PRP involves obtaining a sample of your blood, anticoagulating that blood, and preparing it via a platelet extraction process to generate PRP for the injection procedure.  The anticoagulant utilized is acidic and therefore is painful to inject without local anesthetic.  Thus we do use local anesthetic prior to each PRP infiltration.  This brings the discomfort involved to a minimum.


Is a PRP post-injection flare worse than after prolotherapy?

  • We can only speak from our experience and what our patients most commonly report.  Post-injection flare may depend on many variables: location, volume of injection, type and degree of the condition, etc.  For example, if PRP is injected inside a joint, most patients do not experience much of a flare at all.  However, if PRP is injected within a tendon, a post-injection flare may be expected.  Some patients report less pain than with prolotherapy.  

 

  • We utilize the same strategies for post-procedural pain with PRP as we do with prolotherapy.  Tylenol, analgesics, ice packs, and rest for a day or two is typically all that is needed. On rare occasions we have seen patients who have experienced post-injection flare for a period of 1-2 weeks.  This is more common with certain types of shoulder injections.  On those rare occasions we work with the patient to manage their pain during that period of time.  There is great variability in post-injection flares with PRP.

 


STEM CELL THERAPY


Can stem cells cure my arthritic knee or hip?

  • It is a common misconception that you can simply place "magic stem cells" into a severely arthritic hip or knee to regenerate a joint and cure arthritis.  This is, frankly, untrue.

 

  • Remember that the field of regenerative medicine utilizes a host of techniques to attempt to repair some soft tissue injuries or degeneration.  We can use a local stimulus to release local growth factors that can stimulate repair.  We can deposit cells full of growth factors to help stimulate repair.  Or we can use other substances that have high concentrations of immunomodulators, growth factors, etc. that can help stimulate repair.  On occasion we may use stem cells, which can elicit a number or responses in the local tissues.  These cells may emit regulatory proteins that can initiate an anti-inflammatory and immune modulation effect.  They can proliferate and differentiate, creating a greater effect for potential soft tissue repair.  These cells are often injected with growth factors and extracellular matrix proteins and scaffolding that assist the stem cells’ capacity to remain localized and generate a repair response.  Stem cells can create immunomodulation effects as well as improving pain and function in appropriately selected patients.  

 

  • Many patients are lured into paying outrageous fees to stem cell clinics both in the US and abroad with false promises of a “cure.”  A lot of these patients want to be "younger again" and the only thing that is holding them back from enjoying the life they want is an arthritic joint.  

 

  • Stem cell technology is still in its infancy.  New techniques and methods are emerging daily.  We specialize in autologous stem cell therapies, involving the use of stem laboratory techniques that are compliant with minimal manipulation regulations.  We employ extensive image-guided injection procedures, using ultrasound and fluoroscopy to deploy cells and regenerative injection solutions to specific targeted tissues.  We take pride in our attention to detail and begin with a precision diagnosis in order to provide more definitive therapeutic intervention.  Stem cells are not magical, but we will use the most effective techniques at our disposal to improve your condition.

 

  • Dr. Brown advises his patients to become informed consumers, ask questions, and by all means search other institutions’ background, experience, cost, training, and technologies.  If you compare them to what our institute is offering we believe you’ll see the value of our services and technology.

 

 WHAT IS IROM?

  • IROM stands for Interventional Regenerative Orthopedic Medicine Institute.  It was formed by a group of like-minded pioneers in the field of regenerative orthopedic medicine.  When IROM was created the institute sought out physicians who were considered some of the best stem cell and regenerative orthopedic medicine practitioners in the world.  Each of the participating physicians is highly subspecialized, with unique skill sets and expertise. In addition we also have other disciplines associated with IROM which include veterinary orthopedics, PhD engineers and PhD biologist.  They came together to create a research and development institute to advance regenerative medicine science and technology.  They also organized to create consensus guidelines on the use of this technology for specific conditions.  They are constantly refining the protocols utilized at their 7 IROM centers.  These centers are located in Washington, California, Ohio, Pennsylvania, Texas, Washington DC and Florida in the USA.  The plan is to expand this centers throughout the US and then internationally.  For additional information on our affiliate IROM institutions feel free to give our office a call and we would be happy to provide this information.