Can I be seen without health insurance? What if you don’t accept my insurance?

If you do not have health insurance coverage, you are still welcome as a patient of ours. You will be considered “Private Pay” with our practice. Effective July 15, 2020, we now kindly require a credit card to be on file with our office so that your payment can be automatically drafted the day of or after your appointment. If you decline to place a credit card on file, you may pre-pay your visit in full prior to the appointment date. Please call our billing office to receive your estimate for services at (512)458-8400, option 6. For more detailed information click here

What is PCI-DSS compliant?

Payment Card Industry (PCI) Security Standards Council offers robust and comprehensive standards to enhance payment card data security and reduce exposure to credit card fraud. PCI Data Security Standard (DSS) provides an actionable framework for developing a robust payment card data security process, including prevention, detection, and appropriate reaction to security incidents. 

When do I give you my credit card?

We prefer that you enter your credit card information while confirming/pre-registering for your appointment through our secure platform, Phreesia. Please pay close attention to your appointment reminders sent via text & email to complete pre-registration. You can also deliver your credit card information over the phone, by mail, or in person, but the most secure way is online during pre-registration. 

Are medical visits required during the weight program?

If a person has diabetes and is on medications, or has high blood pressure on medications, then these medications may need to be reduced as a person loses weight.  We advise a visit with one of our health care providers for people with diabetes and/or high blood pressure prior to starting the program for medication adjustments and then 2-3 visits after starting for monitoring and further adjustments.

How do I know what my co-pay is?

If your copay is not listed on your insurance card, please contact the 1-800 number on the back of your card to check your benefits.

Do I need a referral to visit TD&E?

Some insurance plans do require a referral in order to have your visit covered. Please contact your insurance carrier to confirm if your plan requires you to obtain a referral to see a specialist. To learn more about our referral process, select the following link: Referrals

What is Osteoporosis?

The weakening of the bones caused by a reduction in the calcium normally stored there.

What are the causes of Osteoporosis?

Patients are at risk for osteoporosis if they are:

  • Post-menopausal
  • Female
  • Low body weight
  • Have taken steroids
  • Have digestive problems
  • Had kidney stones
  • Have a family history of bone loss or fractures
  • Above the age of 70

What are the symptoms of Osteoporosis?

Typically, there are no symptoms.  Osteoporosis is detected by a special x-ray called a DEXA.  It is ordered by your doctor and can be used to track the degree of improvement with treatment.  Unfortunately, some people are only diagnosed after a spine or hip fracture.  This condition is painless.

What is Cardiovascular disease?

A term that describes a number of conditions that impact the heart; however the most common type is coronary artery disease (CAD). This is also the leading cause of death in the United States among men and women.

What are Causes of Cardiovascular disease?

CAD occurs when plaque forms in the arteries that supply the heart with blood. Plaque is made up of fat, cholesterol, calcium, and other substances in the bloodstream. The buildup can restrict bloodflow to the heart. Sometimes a plaque can rupture or burst which can cause a blood clot that completely blocks the artery—this can cause a heart attack or a stroke. If the arteries are damaged by smoking, diabetes, high blood pressure, or high cholesterol this process occurs more readily.

What are Symptoms of heart disease?

Symptoms can be typical such as chest pain or shortness of breath, but sometimes a person will not have symptoms until major damage has occurred. Prevention is key!

What are Heart Disease Treatments?

Treatments include controlling all modifiable risk factors such as treating high cholesterol/lipids, taking care of Diabetes, treating high blood pressure, and not smoking. This can include lifestyle therapies such as exercise and healthy diet as well as medications.

What is Atherosclerosis?

Atherosclerosis is a disease of the arteries caused by buildup and deposits of fatty materials into the artery wall.

What is LDL cholesterol?

This is commonly called the “bad” cholesterol because the cholesterol carried around inside the LDL particles can get deposited into the artery walls.

What is HDL cholesterol?

This is commonly called the “good” cholesterol because the cholesterol carried around inside the HDL particles may have been removed from the artery walls.

What is Traditional lipid testing?

This is a basic group of tests measuring the levels of cholesterol and triglycerides in the blood; it is a good starting point but does not always give enough information.

What is Advanced lipid testing?

This is a more advanced type of testing that measures the actual lipoproteins in the blood and looks at some of the genetic risk factors associated with cardiovascular disease. Lipoprotein levels have been shown to be better predictors of risk than traditional cholesterol levels alone, especially in patients with diabetes or metabolic syndrome.

Type 1 Diabetes

5% of people with Diabetes have Type 1 Diabetes.  This type of Diabetes is usually diagnosed in childhood, yet many times it is diagnosed in adults, even in adults over the age of 50.  People with Type 1 Diabetes take insulin for treatment since their beta cells (the cells that make insulin) no longer produce insulin due to auto-immune destruction.  People with Type 1 Diabetes take insulin by injection or via an insulin pump.  People with Type 1 Diabetes can lead a full, healthy life with proper management.  Successful treatment of Type 1 Diabetes has been shown to prevent or delay complications tied to Diabetes.

Type 2 Diabetes

95% of people with Diabetes have Type 2 Diabetes.  In 2015, it was estimated that 1 in 9 adults had this type of Diabetes.  Type 2 Diabetes in usually diagnosed in the adult years though it can be seen in (usually overweight and sedentary) children.  In Type 2 Diabetes, the cells that make insulin, beta cells, don’t produce sufficient amounts and there is also resistance to the effect of insulin on the body.  Many people with Type 2 Diabetes can improve their blood sugar with weight loss and exercise alone.  Others require treatments, which range from pills to injections of insulin and other injected medications.  Successful treatment of Type 2 Diabetes has been shown to prevent or delay complications of Diabetes.  People with Type 2 Diabetes are also at higher risk for heart diseases and treating their heart disease risk factors is important.


In 2015, it was estimated that 1 out of 3 adults has Pre-diabetes.  Pre-diabetes can be diagnosed by checking a fasting blood sugar or by measuring the hemoglobin A1c (a 3-month average of blood sugar).  People who are overweight or who have a family history of Diabetes are at high risk for Pre-diabetes (and for Diabetes).  Most people with Pre-diabetes don’t know that they have this condition and it can only be diagnosed with a blood test.  50% of people with Pre-diabetes develop overt Diabetes in 10 years unless they are treated.  The primary treatment of Pre-diabetes is exercise and weight loss.  A 7% weight loss and the equivalent of 30 minutes of walking for 5 days of the week haven been shown to reduce progression of Pre-diabetes to Diabetes by nearly 60%.  A medication, Metformin, is also frequently used to treat Pre-diabetes.

Gestational Diabetes

Gestational Diabetes (GDM) is a frequent complication of Diabetes.  Gestational Diabetes is the development of elevated blood sugar in pregnancy.  Certain hormones produced by the placenta can lead to elevated blood sugar later in pregnancy.  This problem can be diagnosed by doing a glucose tolerance test near the end of the second trimester.  If untreated, GDM, can lead to excessive fetal weight gain and prematurity.  GDM can be treated with dietary modifications and many times, insulin.

Insulin treatments (injections, oral meds & pumps)

Thanks to research advances, there are more, and better, options available to treat Diabetes.  Oral medications, which treat the deficiencies in Diabetes have been developed.  The medications are effective and generally safer than older medications such as sulfonylureas.  The newer medications tend to not cause hypoglycemia and they are associated with either weight loss or no weight gain.  Oral medications are currently available, which increase insulin levels and lower glucagon. One oral medication induces the kidneys to lose glucose in the urine, thereby lowering the blood sugar.

One relatively new class of injectible meds is available to be given in daily and weekly injections.  Insulin is also being developed which provides a more predictable background or basal insulin and faster mealtime insulins are being developed.  Inhaled insulin has recently been approved as a rapid-acting mealtime insulin.

One of the most predictable ways to give insulin is with an insulin pump.  Insulin pumps constantly infuse a small amount of insulin to provide a basal insulin.  At mealtimes the user enters data, such as amount of carbohydrate to be eaten and the fingerstick sugar result to help calculate the mealtime insulin dose.  In our practice, it is estimated that over 50-60% of people with Type 1 Diabetes are using insulin pumps.

Why should I consider using an insulin pump?

Insulin pumps are recommended for people with Type 1 Diabetes or Type 2 Diabetes on multiple doses of insulin per day. The insulin pump is used by people trying to improve their Diabetes control and is a must for people with frequent or problematic hypoglycemia.  It offers flexibility in insulin dosing and offers more insulin dose adjustability than injection insulin.  The pump is commonly used in pregnancy.