How is Functional Medicine different from conventional medicine?

Dr. Bera-Miller practices Integrative and Functional Medicine. Patients find that her care complements well the care they receive from the insurance-based primary care and specialty doctors they see. Integrative Medicine means that Dr. Bera-Miller integrates in her recommendations all types of evidence-based and personalized healing modalities including diet, nutraceuticals, herbs, mind-body medicine, energetic healing, and other disciplines (e.g. acupuncture, body work, Ayruveda, homeopathy, etc).  She also can and does prescribe medications including hormones from accredited standard as well as accredited compounding pharmacies (thyroid hormone preparations, bioidentical hormones) if/as needed and desired.

Functional Medicine means that Dr. Bera-Miller practices “root cause” medicine, an approach that identifies which of eight core physiologic systems are out of balance: Nervous System, Gut/Assimilation, Immune, Structural, Hormonal, Tranport/Vasculature, Detoxification, Energy/Mitochondrial. This then guides how to help an individual get out of their inflamed state and back into balance. This root cause approach can help most (80% or so) patients, though of course is very individual. Whether and to what extent an individual improves with the Integrative/Functional Medicine approach and can avoid or reduce the need for medications and other interventions depends on many factors, including how ill they are, how long they have been ill, how able they are to implement recommendations for laboratory testing, lifestyle and other changes, as well as specialty referrals if/as needed.

Dr. Bera-Miller explores and addresses the key factors that contribute to your health and well-being, including:

• Nutritional sufficiency and deficiencies

• Gut health

• Hormonal balancing

• Lifestyle factors including current, past, future stressors

• Infections

• Toxins

• Genetics

With the Integrative/Functional Medicine approach, most patients feel better within the first 2-3 months. However sometimes it can take 6 months or so to feel significantly better. This depends on the same factors that determine whether a person will improve with this root cause holistic healing approach. 
 

What is Dr. Bera-Miller’s multi-disciplinary approach?

The Functional Medicine framework describes five major “Pillars of Health” including Sleep and Rest, Nutrition, Movement, Stress Resilience Building, and Relationships/Community. Optimizing each of these pillars requires a lot of knowledge and support for anyone.

Dr. Bera-Miller assesses and addresses these foundational pillars of health with all her patients. As an Integrative/Functional Medicine physician, Dr. Bera-Miller has much training and experience in assessing and coaching patients in nutrition, lifestyle, and behavior change. However it can be particularly cost-effective for some patients to work with non-physician practitioners too such as a health coach, nutritionist, and/or therapist. Thus she also refers patients to and collaborates with skilled non-physician holistic practitioners (e.g. nutritionists, health coaches, mind-body professionals, therapists, etc) who support her patients.

Additionally, Dr. Bera-Miller has a network of other non-physician colleagues such as acupuncturists and chiropractors that she refers to if/as needed. These professionals are also very effective in supporting people in their healing trajectories. Last but definitely not least, Dr. Bera-Miller is extremely grateful to have her office support staff: our Office Manager Nila Santos who has training and experience as a nurse and also in customer service, and our New Patient Coordinator Shauna Aguilar who also helps with processing lab results and medication refills.

With an ongoing patient wait list, Dr. Bera-Miller continues to think about how to offer workshops and Group Medical Visit (GMV) programs to meet the needs of more patients at once in a cost effective way that also harness the healing power of supportive connection and community. Dr. Bera-Miller is looking to again offer her HEAL (Health Essentials for Abundant Living) retreat or components of it in 2025 and 2026 to jumpstart or reset people’s healing journeys. We regularly update our HEAL webpage so we hope you will check back periodically for more details; you can also email our New Patient Coordinator Shauna to let her know of your interest in HEAL or group workshops, so that she can add you to our email list when we send out announcements. HEAL retreat and group visit programs are inspired by existing effective holistic group medical programs such as the Cleveland Clinic’s Fit for Life SMA program and the Ornish Lifestyle Medicine program to reverse heart disease (covered by MediCare, Aetna, Blue Shield of California) of which Dr. Bera-Miller’s UCSF medical school classmate - Dr. Ben Brown - is Medical Director. In the past, Dr. Bera-Miller developed and implemented the “Blossom Group” (an educational/peer support program), the “Caregiving and Loss: Giving, Grieving, and Growing” workshop (inspired by the five year period of Dr. Bera-Miller losing her own husband and parents), and the HEAL 8-week GMV program in 2023.

What happens at the first visit?

At your initial physician appointment (whether one-on-one or group visit), Dr. Bera-Miller will review your in-depth intake forms including your timeline. It is important for both her and you to understand all of the factors, going back to early childhood and even pre-birth, that have contributed to your present state of health or illness. After thoroughly evaluating and understanding your history, labs, and any needed current physical exam, then with your participation an initial assessment can be made of likely root causes at play and thus a determination of what laboratory testing would be most helpful to further clarify imbalances. In our practice, we strive to be mindful of each person’s budget and focus on testing that will have the highest yield for helping guide most effective personalized recommendations.

At your first visit, you will also receive an initial “recommendations roadmap” including recommended diagnostic testing, nutritional/dietary and often nutraceutical/supplement recommendations customized for your situation, and other key lifestyle recommendations including for enhancing your mind-body connection and healing. 

Initial one-on-one visits usually last ~2 hours though can be shorter for simpler cases and may be longer if agreed on for more complex cases. The first follow up visit occurs approximately 4-6 weeks later to discuss your initial laboratory results in detail and refine your individualized healing plan based on testing results.  The first follow up visit is usually 1 to 1 1/2 hours and the subsequent visits are usually 1 hour give or take 15-30 minutes depending on complexity of the case and questions patients have.
 

How much do visits cost?

As of January 1, 2025, the fee to see Dr. Bera-Miller is $535 per hour. She brings to each patient her 30 years of experience as a physician including 18 years experience in private practice in Integrative/Functional Medicine. This hourly rate is near the average U.S. rate for a Functional/Integrative Medicine MD/physician although physician rates in California are usually higher for experienced MDs. Her hourly rate reflects not only the time she spends face to face in office visits but also the substantive time that she spends behind the scenes preparing for and/or processing patient visits which can include reviewing past labs/records, formulating root cause diagnoses, and writing up her comprehensive holistic “recommendations roadmap”. This behind the scenes time can take up as much time as the office visit itself, and at the very least one third the time of an office visit. Her rates increase a bit each year as office overhead does. Patients are encouraged to submit the itemized receipts from their visits with Dr. Bera-Miller to their insurance to request reimbursement, except for Kaiser and MediCare. Patients are also welcome to request shorter visits if that fits better with how their insurance reimburses out of network providers, and depending on the insurance carrier shorter more frequent visits can sometimes be better reimbursed. We have heard from patients who submit claims for reimbursement that they receive anywhere from 25% up to 80% (United Healthcare PPO); it all of course depends on the insurance carrier and plan.

Payment is required at time of service for all appointments. There will be no exceptions to this. If you anticipate that you are unable to pay at the time of your visit then please reschedule to another time, giving us sufficient notice (as per below) to allow us to schedule in another patient and to avoid your incurring a fee for a last minute appointment change. 

• A $535 deposit and a signed Policy/Consent form are required to schedule a new patient appointment with Dr. Bera-Miller. The deposit will be applied to your new patient visit fee at the time of your first visit. If you need to cancel your new patient appointment for any reason, your deposit will be refunded unless we do not get 5 business days notice (the time we need to schedule in another new patient from our waiting list).

• The fee for visits with nutritionists we collaborate with ranges from $100 - $180/hour depending on the number of years of experience. HSAs may be able to be used for nutrition consultations.

• The fee for visits with the Certified Health Coaches we collaborate with ranges from $65-200/hour depending on the number of years of experience and their geographic locations. HSAs may be able to be used for health coaching.

• The fee for visits with therapists and therapy options we refer to ranges from $75-$200/hour, some of which take insurance.

The hourly fees above apply to in person as well as video and phone appointments.
 

Do you take insurance?

Our office does not have billing staff and thus does not take/process insurance. However, for visits with Dr. Bera-Miller she is very thoughtful to code appropriate diagnostic and procedure codes for each patient visit. Thus for non-Kaiser/non-MediCare patients with private medical insurance we encourage patients to submit the physician office visit receipt we provide to your insurance carrier to request reimbursement. There is no guarantee that any individual insurance carrier will reimburse for Integrative/Functional Medicine services but we believe it is very worthwhile to try because patients have told us they receive anywhere from 25-80% reimbursement for our physician office visit fees.

Here are some tips to keep in mind to make holistic healthcare more affordable:

• Find out from your health insurance exactly what they cover for out-of-network providers such as integrative physicians, masseuses, acupuncturists, chiropractors, etc. The good news about working with a licensed integrative MD like myself is that we can assign insurance-accepted diagnostic and procedural codes in our receipts that you submit to your insurance plan to request reimbursement, versus other/non-MD providers that insurances may not recognize. Some of my (non-Kaiser/non-MediCare) patients eventually find out that they can get up to 80% reimbursement for visits with me if their visits with me are shorter but more frequent. There is usually always a lot to cover in any visit with me or any holistic MD including the psychosociospiritual aspects of life that affect physical health, but we can always decide what to prioritize in each visit if your insurance coverage per visit is such that you need to have shorter follow up visits more frequently instead of less frequent longer visits. If you have MediCare, be sure to research/call to see what your main and supplemental MediCare benefits are and if they would include some holistic healthcare services.

• If you can't get what you need with your current health insurance plan, consider switching to or supplementing with a different health plan or even different health insurance company. I've had various patients over the years decide it was worth it to switch plans to have less of a copay or deductible when seeing an out of network provider like myself. Some of my patients have decided to switch out of Kaiser to a for-profit health insurance/delivery plan to have more flexibility and even coverage of integrative care providers and services.

• For Kaiser patients (like myself), one can over time search for and choose a more holistic open-minded primary care doc and take advantage of many other Kaiser support services. Over the years I've accumulated some names of more holistic primary care docs within Kaiser so definitely if needed check in with me about that. Also, Kaiser has a variety of providers and programs including physical therapy, lifestyle and other group classes, health coaches, free access to the Calm app, mental health professionals, etc. We can talk about how to maximize your usage of available Kaiser resources that your monthly premium covers. 

• For lab tests, be extra thoughtful and discuss with me re: if and when to do specialty/functional medicine tests and which ones to do first versus later. Pretty much most specialty tests are not covered by health insurance, though sometimes they are covered by HSAs. For this reason, we need to be extra thoughtful about what we order and when. Over the 15+ years I've practiced integrative medicine, I always like to discuss with patients the conventional and more specialized/functional medicine tests that are relevant for them. But then we can be thoughtful together to come up with a list of the ones that give "the biggest bang for the buck" and thus which ones to prioritize for sooner versus later. Sometimes when someone is not too ill or symptomatic, we can instead use the available conventional lab results (usually covered by insurance to some degree, beyond copay and deductivel) to implement the most likely treatment plan that will help and then do testing later if/as needed. When someone is more ill with more symptoms, that is a scenario where more testing earlier can give us needed answers to determine a more targeted treatment plan and save time and money in the long run. 

• If you have access to an HSA but don't yet use it, I highly recommend to enroll in an HSA to support supplements needs and other holistic services. Many of my patients utilize their HSAs to cover supplements, doctor visits, and sometimes even utilization of other services I refer to (e.g. acupuncture, chiropractic, massage, etc). For instance with supplements, once you have an HSA that covers supplements you just need to write a draft letter of the supplements you're on and why and then email to me to review, edit and sign. Then you submit that letter to your HSA to request reimbursement. 

• For patients with Medicare and as of 1/1/2016, we do require your completion and signature of the Opt Out private contract form which states that we do not and you must not bill Medicare for services provided by Dr. Bera-Miller.
   

How do I get started?

Note: Dr. Bera-Miller has a waitlist, however she is beginning to again see new patients starting in February/March 2025. To get on her waitlist you just need to email our New Patient Coordinator Shauna Aguilar to let her know of your interest: info@pacificfunctionalmedicine.com. Please be sure to include your full name, email address, and phone number as well as a few options of days/times that she could call you back to speak with you if needed.

Shauna keeps track of patient inquiries in the order in which they’re received. She assists Dr. Bera-Miller weekdays 10am to 1pm. She can let you know more about our practice and an estimate of the wait time. Once new patients are able to be scheduled again, she will reach out to you and get you set up in our electronic medical records system CharmEHR and go over the forms, including our office policy/consent form which is necessary to complete in order to confirm your first appointment. She will also collect the deposit required to reserve an appointment with Dr. Bera-Miller. These deposits are applied to your first/intake visit with the doctor.  We are also looking into offering online scheduling soon.

I and my support staff look forward to helping you in your health journey!