Frequently Asked Questions

• What is Functional Medicine?

  FoundationMED implements a functional medicine approach by focusing on assessing and addressing fundamental physiological processes that are impeding health and wellness and causing declining health or disturbing symptoms. We focus on the environmental inputs, genetic predispositions, physiologic disturbances and systems analysis (ie physiologic systems such as methylation, organ systems such as gut, hormone systems, energy dynamics, and so on). Concurrent with this is the necessity of our patients to address the fundamentals of lifestyle intervention through an awareness on how to identify and optimize nutrition, toxin minimization, movement and exercise, sleep and sleep dynamics and stress and stress management. This combination of patient lifestyle management and physician physiology management has proven to be a powerful way to address many causes of poor health and wellness.

• What fees are associated with FoundationMED?

  FoundationMED is a fee for service medical practice. We cannot, and do not accept or directly bill insurance. Our Physicians are out-of-network providers for all private insurance plans, and are not participating providers with Medicare or Medicaid.

  We can provide a bill with ICD-10 codes that can be submitted to your insurance company, and they certainly may reimburse you for all or a portion of your visit depending on your insurance plan. Medicare, however, cannot be submitted for reimbursement since we are non-participating with Medicare.

  What we do provide is a very personalized, unrushed experience that is based on foundational medical principles - something that is not typically available. We partner with our patients to keep them fully informed as to status of their health and the ways to optimize it.

  Our new patient visit includes a 1.5h consultation with our physician and a brief consultation with our Health Coach. In addition, we provide for brief email-type interchanges for questions that may come up between visits for NO additional fee.

  We are excited to offer full Health Coaching services as well. We have found that Health Coaching OFTEN results in improved outcomes due to better implementation of the recommended therapeutic program.

  Our prices are significantly less then similar medical practices in the area. We knowingly do so that more people can access a physician operated functional medical approach to vexing medical problems.

  We do not offer any type of payment plan.

  Please click here for pricing and more information…

• What is the cost for a follow-up visit?

  The minimal followup visit lasts 45min to 60min and the cost is $275. We do offer extended followup visits. 1.5 hours for $375, 2 hours for $475. We highly recommend extended followup visits for patients with 3 or more diagnostic tests ordered in order to allow for time to completely discuss testing.

• How often are followup visits recommended?

  Of course, this will ultimately depend on your particular clinical situation. The first followup visit is usually recommended in 2-4 months. After that they can vary according to need. If the patient is participating in health coaching, very often physician visits are pushed further out to allow the patient to implement the treatment plan with the health coach. This, too, may vary with need. In all cases, followup appointment scheduling is a joint decision between the patient and the physician.

• How soon will I be called for an appointment

  This can be difficult to predict. It could be days to weeks. Sometimes, with last minute cancellations, you can be offered an earlier appointment if you are available to take it. We contact patients who wish to be called upon cancellations from a cancellation list when needed.

• What is your cancellation policy?

  We do NOT double book. Due to the length of each visit, we only can see 4-5 patients in a day. In addition, our physicians spend a considerable amount of time preparing for each patient visit (usually up to 1-2 hours prior to the visit). When someone cancels at the last minute, it is not possible to fill that void and that is a significant amount of loss for our practice. In addition, last minute cancellations deny those on the cancellation list the opportunity to have their appointment.

  IF you need to reschedule or change your appointment, we ask that you give us AT LEAST 7 DAYS notice. Appointments cancelled/rescheduled within 48h or less (excluding holidays, Sat or Sun) of the appointment time will be charged a $250 cancellation fee.

• Why don't you accept insurance?

  FoundationMED provides an un-rushed, highly personalized care model that is absolutely not comparable with the treat-and-street insurance model. In addition, the operational costs associated with medical insurance billing are staggering. Our physicians spend considerable time both before and after patient visits preparing for your visit as well as creating and updating the treatment plan. Insurance does not adequately compensate for this non-procedural medical work. In addition, adding additional staff to manage insurance billing would add to our costs. Because of these various factors, a functional medical practice with a hyper-focus on personalized patient care cannot sustain itself if it were to accept insurance.

• Can Dr. Citron or Dr. Sachar be my primary care physician?

  No. FoundationMED is a CONSULTATIVE practice. We are not a primary care practice nor make claims to provide primary care. We do not provide for on-call medical coverage, and may be unable to address your medical concerns should our practice be closed. In addition, there are certain chronic medications that we are not able to manage (due to our practice being a consultative practice). We always recommend that you have a relationship with a primary physician and in fact have recommendations for such should you request it.

• Can children be patients at FoundationMED?

  Sure! We do limit the age of children patients to over 5 or 10 years of age. Dr. Citron will consult with children over age 5 while Dr. Sachar prefers children over age 10. Of course, children will be accepted on an case by case basis. If needed, we can also provide excellent referral to functional medicine pediatric physicians

• Are Phone or Internet consultations available?

  Sure! The North Carolina Medical Board requires that remote patients are seen in person once a year at least for patients residing in North Carolina. Other Medical Boards have various requirements (in other states) but we have multiple patients from other states (and countries) that we consult with remotely when appropriate.

• Does the physician treat "x"?

  By its very nature, functional medicine is really not focusing on disease "x" or disease "y", but is focused on the underlying basic physiology, organ systems, lifestyle confounders, and externalities that can inhibit or otherwise disturb a well functioning physiology. Of course, disease states do matter, and may require targeted treatment BUT we never lose our focus on the underlying "root cause" as the ultimate driver of disease, Our physicians do have advanced training in traditional medicine (as physicians) as well as advanced training in functional medicine. In addition, they are adding to this training on a regular basis. They do not have a singular focus, for example, on hormones (ie a "hormone mill") or on "detox" (ie IV treatment clinic), but rather a broad approach trying to work at a systems level (which may very much involve improving detoxification, improving methylation, absolving micronutrient imbalances and so on).

  Thus by addressing physiology and basic systems, they are not really limited to specific diseases since improving these issues will improve health in a deep and sustainable way. With advanced training in methylation, genetic analysis (ie Opus 23), hormonal balancing and proper physiologic BHRT with proper risk assessment and management, thyroid management, adrenal management, nutritional issues, gut issues including leaky gut and SIBO and more, they can help patients improve their situation in fundamental ways. Even though they are not oncologists and make no claims to treat cancer per se, they certainly can help patients improve their underlying function.

  We realize that taking a functional medicine approach to health and wellness is a big commitment on the part of our patients but we have seen just how life changing it can be. It is very exciting to see patients improve as they move on their health journey.

• What are Dr. Citrons' Qualifications?

  Dr Citron graduated from the Univ of Cincinnati College of Medicine

  He completed an Emergency Medicine Residency at St. Vincents Hospital in Toledo, OH

  He has an active Medical License in the state of North Carolina

  He left Rex Emergency Department after being a partner there for 10 years (shift work = poor health)

  He subsequently worked at both Duke and UNC-Rex hospital systems in the Urgent Care

  He finished fellowship training at A4M and is completing fellowship training at IFM

  He completed all SHEICON Methylation Conferences (with Dr. Ben Lynch)

  He completed advanced OPUS 23 training (genetic analytics)

• What are Dr. Sachar's Qualifications?

  Dr. Sachar was trained in family medicine and completed her family practice training at Long Beach Medical Center in New York

  She was a staff physician at the Cleveland Clinic for 5 years and received an award for outstanding patient satisfaction

  She has completed a fellowship in functional medicine with A4M

  As a functional medicine physician, she is passionate about identifying the root cause of disease rather then focusing on symptoms and drugs.

  She has a particular interest in autoimmune thyroid disorders

  She is certified in the Bredesen Protocol that addresses cognitive decline with exciting solutions

  Dr. Sachar is a certified yoga teacher and incorporates integrative principles to restore health and well being

• Are the physicians available between appointments?

  With our generous appointment times, we do ask that you make notes of non-urgent issues or questions and discuss them at the upcoming appointment. If you need more time at the time of the appointment, we can extend your appointment if needed if able (charged in 15min increments). If there is a singular issues between appointments that needs attention prior to the appointment, we do offer a focused visit (30min) that can typically be worked in (cost is $150).

  Dr. Citron creates an extremely detailed Encounter Note summary as well as a MINI Encounter Note Summary for each visit. We do ask that you print out these summaries to consult when questions arise as often the answer lies within.

  For questions that cannot wait until the next appointment but do not need a focused visit, we ask that you contact the appropriate patient coordinator on our staff. She/he will discuss your issue with the physician and respond. We ask that you use this system judiciously as we do not have the manpower to answer large volumes of emails. Please be patient with this process as we strive to respond to emails the same work-day but sometimes it may take longer then 1 day. As always, if you have a medical condition or complaint that you feel needs to be addressed quickly we ask that you either contact your primary physician or go to the emergency department of your nearest hospital.