Neurosurgery and Pain Specialists of the Carolinas, PC
Information for Patients
How to get referred, what to expect, what to bring, who pays, etc.
A referral will be necessary to receive an appointment with Dr. Curling. Referrals can be made by your physician, your nurse case manager, your insurance adjustor, or your attorney. Be aware that if your situation involves a worker's compensation injury or other personal injury (following a motor vehicle accident, etc.), there are some pretty strict guidelines that must be followed in order to insure that the appointment is approved and successfully scheduled. We would recommend that you discuss possible referral to our office with your nurse, attorney, etc. to determine the proper mechanism for proceeding. If your situation is not related to a medicolegal issue, then the referral will most likely be made by the physician that has recommended that you see us. All non-medicolegal patients being seen Dr. Curling for possible further treatment must have a present primary care physician in order to be seen at Neurosurgery & Pain Specialists; this is to ensure that even if you are being seen by us for treatment of your neurosurgical or pain issue, we can be assured that your general medical needs are also being addressed by a primary care doctor. If you do not have a case manager or attorney assisting you, or simply need additional information regarding the process of setting up an appointment, you may contact our office directly. Our staff will be able to assist you in determining what should to be done in your particular situation to facilitate an appointment.
Initial Appointments with Dr. Curling
Dr. Curling offers a broad array of new patient evaluations, tailored to various needs and situations. If you have not been injured and/or are not involved in a medicolegal claim (worker's comp, MVA, personal injury, etc.), and are simply in need of a good evaluation and treatment of a brain, spine, nerve or other pain condition, Dr. Curling will schedule a standard new patient consultation (which our staff refers to as NP0). If you have been injured and/or are actively involved in a medicolegal claim, four additional levels of service are available. If you are within 4 months of the date of your injury, Dr. Curling will schedule an Early Intervention Evaluation (NP1), which will include a comprehensive evaluation of all appropriate issues and will usually be followed by further evaluation and treatment in our office, if determined to be necessary. If it has been greater than 4 months since your date of injury, you can be scheduled for an Additional Opinion on Rating (NP2) or an Independent Medical Evaluation (NP3). If it's been more than a year since you have seen Dr. Curling and/or if some major changes have occurred since last being seen (e.g., surgery), then you may be scheduled for a Complex Reevaluation (NP4). These latter visits are usually scheduled as an "evaluation only", and further treatment will not usually be offered, unless all parties agree to do so after reviewing Dr. Curling's recommendations provided in a comprehensive report that will be generated after the appointment. Note that appointments with Dr. Curling are likely much lengthier than what you may be accustomed to, with initial appointments often lasting between one and three hours, and sometimes even longer.
What is an IME?
Independent medical evaluations (IMEs) are very common and may be requested for various reasons--often to get another opinion about the need for surgery, to address issues regarding your ability to return to work or your disability rating, or perhaps just to have someone review everything and give some fresh opinions about what might be done to help you recover from your injury. They may be requested by your treating doctor, an attorney, your worker's comp or disability insurance adjustor, or perhaps your nurse case manager. Irrespective of who refers you to Dr. Curling for an evaluation (i.e., your attorney, "their" attorney, the insurance company, etc.), Dr. Curling will very thoroughly and objectively review all of your available records and studies, take a detailed history from you, perform a pertinent examination, and will then provide an objective opinion based on his assessment of your situation. Following your evaluation, a detailed report will be sent to the appropriate parties documenting the results and conclusions drawn from your evaluation. An IME is an "evaluation only" visit, meaning that no treatment will be initiated at the time of the visit, no prescriptions will be provided, etc.
Payment for Services
If you are being seen in our practice for consultations/visits related to an approved medicolegal claim (worker's comp, etc.), the issue of payment for the service will have been addressed prior to the scheduled appointment, such that no payment or insurance information should be required of you at the time of the appointment (except in rare situations, in which case you will be notified of such prior to the appointment). For regular non-medicolegal cases, payment will be dependent on your particular insurance plan. At present, Dr. Curling does not participate with any insurance plans or file any private or government health insurance claims (except active NC worker's comp claims). As such, all patients seeing Dr. Curling (other than for authorized worker's comp visits) are responsible for payment of services at the time they are seen. If you do have health insurance in force that covers "out of network" providers, you may be able to recover some of your payment directly from your insurer by filing a claim yourself with your insurer(at the time of your visit, request that we provide you with a claim form to file with your insurance). Our office will be able to provide you with an estimate of amount to be paid at the time of your appointment.
What happens if I miss or cancel my appointment?
As a large amount of time is blocked out on our schedule for these appointments, it creates a significant gap with wasted time and lost income if you fail to show or cancel your appointment at the last minute. For this reason, there will usually be charges incurred should that occur. If you find that you are going to be unable to attend your scheduled appointment, please notify us as soon as possible. You should also immediately contact the party that scheduled your appointment (attorney, case manager, scheduling company, doctor's office, etc.) if you determine that you will be unable to attend. If appropriate, your appointment will be rescheduled, though this will usually involve first contacting the party that requested the appointment (nurse, insurance adjustor, etc.) so that it can be coordinated with them as well, and will likely also require addressing the issue of additional payment. In the event of two missed or rescheduled appointments, you will usually not be rescheduled further in our office.
What should I bring to the appointment?
Depending on the nature and timing of your appointment, you may receive some forms in the mail prior to your scheduled appointment (if you do not receive them prior, they will be available at the time of your appointment). You should fill out the registration forms completely, paying particular attention to the medical questions (just do the best you can with the medical spelling--we can usually figure out what you meant, which is better than leaving it blank). For an initial appointment with Dr. Curling, is also extremely important that you bring with you to the appointment any records or films (the actual films, not just the reports) that you can obtain regarding your situation. If you have an attorney or case manager assisting you, you should coordinate with them to determine who will be responsible for getting these items together and to Dr. Curling at (or prior to) the time of the appointment. Please don't just assume that someone else (e.g., your nurse or attorney or fairy godmother) will take care of this for you--be responsible and check to ensure that this information will be available at the time of the appointment. If these items are not available for review at the time of the appointment, oftentimes Dr. Curling will be unable to complete his assessment and will therefore not be able to discuss with you his impressions regarding your situation. In these cases, the evaluation and report will be completed at a later date after those items have been received. On some occasions, if the necessary information is not available, your appointment may need to be cancelled. You should also bring some type of photo ID that we can copy and place in your file. We will also take a head and shoulders photo of you at checkin to attach to your file. For appointments with Dr. Curling, it is essential that you either bring all of your current medications or a complete and detailed up to date list containing all of your current medications and dosages. Note that Dr. Curling is not bilingual, and if you are not fluent in English, it will be important that someone attend the appointment with you who can accurately provide translation services (if this is an issue, the insurance company or person scheduling the appointment will often make arrangements for this, but you should confirm with them prior to the appointment that this issue has been addressed).
To summarize, bring:
- Photo ID (driver's license, passport, work ID, school ID, etc.)
- Completed forms (if received from our office prior to appt)
- List or bottles of current medications
- Any records you have relevant to the situation for which you are being seen
- Any X-rays or other studies relevant to the condition for which you are being evaluated (actual films or CDs, not just written reports)
- Translator if not fluent in English
What should I expect on the day of my initial appointment?
You should plan on a minimum of one hour for a non-medicolegal new patient appointment and two hours for a new medicolegal appointment. During the first portion of that time, you will wait comfortably in our reception room while Dr. Curling finishes a review of your records and studies that you bring (or others provide prior) to the appointment. You will then spend extensive time in the exam room discussing your case with Dr. Curling and having a pertinent exam performed. Note that Dr. Curling does not usually utilize nurses or physician assistants to gather this information--all of your evaluation time will be spent directly with Dr. Curling. If able, he will then review any initial conclusions or impressions with you. Note that you may have your spouse, family member, or other "significant other" accompany you during the evaluation, if you wish. However, Dr. Curling does not permit nurse case managers, attorneys, or other such representatives to accompany you during the evaluation. If one of these individuals is present at your evaluation, he will be happy to meet with you and them immediately following the evaluation to briefly review the initial findings. Note that many evaluations by Dr. Curling are "for evaluation only" or initially just for a consult, meaning that no "physician-patient relationship" will be established. That means he is not your doctor and will not be writing prescriptions, ordering tests, filling out disability forms, etc. at the time of the initial appointment. A decision usually will not be made to offer further treatment until after you have been evaluated and Dr. Curling has determined whether he may be able to offer further help with your situation, and after all involved parties have reviewed his report and recommendations and agreed to proceed with further treatment. As such, in the vast majority of cases, no treatment will be initiated at the time of the appointment. Note that this policy also applies to most patients being referred specifically for help with chronic medication management. Dr. Curling will usually not provide prescriptions for scheduled medications at the time of the initial visit; therefore, if you are taking regular narcotic pain medications, you should plan accordingly and not take your last pill the morning of the appointment, expecting to receive a new prescription at your initial appointment with Dr. Curling. Rather, you should plan to continue receiving medications from your previous physician until Dr. Curling has notified you and them that prescribing of pain medications is being transferred to our office.
As a final word, we would encourage you to relax and enjoy your visit with us. Although many patients enter the office nervous, concerned, or in the setting of medicolegal cases sometimes even angry that they are being sent here for an evaluation, the vast majority leave appreciative of the fact that someone knowledgeable and concerned actually took the time to seriously address their problem and spent the time to discuss it with them. As you should gather from the above information, this will not be the typical five minute doctor's visit--rather, it will be a lengthy and comprehensive encounter that will allow Dr. Curling to formulate opinions regarding your condition, while also allowing you the opportunity to become more informed and thereby become better prepared to participate actively in your recovery.
Should you have any questions that are not addressed in this website or in your introductory packet that you may receive in the mail, feel free to contact our office via phone, fax, or email to request additional information.