Frequently Asked Questions

At Present Future Health, I practice physician-led, Internal Medicine–forward care. Rather than focusing on isolated visits or single problems, I serve as your central medical strategist — integrating your history, trends, labs, and medications over time Care is grounded in thoughtful use of data, longitudinal trend tracking, and medication stewardship, with the goal of preserving strength, function, and independence as you age.

Even for healthy adults, traditional care often waits for disease to declare itself before intervening. I offer comprehensive prevention consults to evaluate cardiovascular, metabolic, and functional risk using family history, lifestyle, and relevant biomarkers. The goal is to identify modifiable risk early and give you a clear, personalized roadmap to slow or prevent disease trajectories long before they become life-altering.

Lab work is individualized to your clinical situation, but a typical comprehensive prevention workup includes: Standard lipid panel plus ApoB (a more complete measure of cardiovascular risk than LDL alone) Lp(a) — an inherited cholesterol particle worth checking at least once in your lifetime Hemoglobin A1c and fasting insulin Comprehensive metabolic panel including liver and kidney function Thyroid panel (TSH, often with FT4) Vitamin D, B12, and iron studies Inflammatory markers when clinically indicated For patients in higher-risk groups, I also consider a coronary artery calcium (CAC) scan — a CT-based measure of actual plaque buildup that's particularly useful for refining cardiovascular risk in primary prevention. Lab orders are sent electronically to the facility of your choice (Quest, LabCorp, or local hospitals), and your insurance can be used for these external costs even though I don't bill insurance for visits. In additon, referrals for significantly discounted labs are available depending on local availability.

Yes, when clinically appropriate. As a board-certified Obesity Medicine physician, I prescribe GLP-1 medications including semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound) — but only as part of comprehensive obesity medicine care that monitors your blood pressure, glucose, thyroid function, bone health, and muscle mass as your body composition changes. GLP-1 therapy isn't a standalone product here; it's one tool within a broader plan focused on sustainable fat loss and muscle preservation. Learn more about my approach to medical weight management.

Yes. Post-bariatric medical management is a core part of our Obesity Medicine services. Many patients lose access to their surgical center's follow-up after the first year, leaving important monitoring gaps. I provide ongoing care for post-bariatric patients including: Nutritional monitoring (vitamin B12, iron, vitamin D, calcium, protein status) Weight maintenance support Care for weight regain, including medical therapy when appropriate Comorbidity management as your body composition changes Bariatric surgery itself is performed by surgical specialists; I focus on the longitudinal medical care that surrounds it.

Yes. Pre-operative medical clearance is part of our Internal Medicine services. I evaluate cardiovascular, metabolic, and functional risk before surgery, optimize chronic conditions where possible, and provide your surgical team with a clear clinical assessment. Common scenarios include clearance for orthopedic surgery, bariatric surgery, and elective procedures in patients with significant medical complexity. The Initial Comprehensive Consultation is the right starting point.

Yes. I provide menopause-related care, including symptom management and hormone replacement therapy (HRT) when clinically appropriate. I prescribe standard FDA-approved HRT formulations — oral, transdermal, and other regulated options. I do not prescribe compounded HRT, pellet therapy, or non-standard regimens; patients seeking those should consult a gynecology specialist. If you're navigating perimenopause or menopause and want a thoughtful, evidence-based conversation about your options, the Initial Comprehensive Consultation is the right starting point.

90-Minute Video Visit: $525 60-Minute Video Visit: $350 30-Minute Video Visit (Established Patients Only): $200 15-Minute Acute Video Visit (Established Patients Only): $115 For patients requiring frequent oversight or management of complex conditions, our Comprehensive Care Membership may be a more sustainable option: $425/month.

Present Future Health is a cash-pay practice and does not participate in any insurance networks, Medicare, or Medicaid. However, you can still utilize your health insurance for external medical costs. While our professional fees are paid directly, you can use your insurance coverage for: Prescription Medications: Sent to the pharmacy of your choice. Laboratory Tests & Imaging: Ordered by the physician and performed at the facility of your choice (e.g., Quest, LabCorp, or local hospitals). Durable Medical Equipment (DME): Such as glucose monitors, ambulatory devices or catheters. We also provide Superbills upon request, which you may submit to your insurance for potential out-of-network reimbursement. Our services generally qualify for HSA/FSA spending. Or, for patients without insurance or with high-deductible plans, we can offer discounted cash-pay lab pricing that's often a fraction of standard rates.

To preserve care quality and responsiveness, membership enrollment is limited. A Founding Member rate (10% off the standard monthly fee) is available to the first 10 enrolled members.

Acute visits are reserved for single, straightforward concerns. If additional issues arise that require chronic disease management or more extensive clinical decision-making, the visit may be converted to a standard follow-up appointment.

Yes. Medicare patients can pay cash to see Dr. Shiari for visits. Two things to know: First, your visit fees cannot be submitted to Medicare for reimbursement. Superbills work for commercial and private insurance, but not for Medicare. However, you should always check with your specific insurance carrier. Second, you can still use Medicare to cover external costs — prescriptions sent to your pharmacy, labs at facilities like Quest or LabCorp, imaging, and referrals to specialists. Only the visit fee itself is paid directly to Present Future Health. We recommend keeping a local primary care physician for in-person care needs that require physical examination.

Yes. HSA and FSA accounts can typically be used for both visit fees and the Comprehensive Care Membership. We recommend confirming eligibility with your specific HSA/FSA administrator, as plan terms vary. Receipts and documentation are provided for any submission you need to make.

Lab costs vary based on what's ordered and where you have your blood drawn, but here are your three options: 1. Use your insurance: Lab orders are sent electronically to facilities like Quest, LabCorp, or local hospital labs. Your insurance covers labs according to your plan's out-of-pocket rates. 2. Pay cash through provider-negotiated rates: Through provider-negotiated cash-pay lab rates, patients can access discounted pricing for Quest and LabCorp tests. A typical comprehensive prevention workup (CBC, comprehensive metabolic panel, TSH, vitamin D, lipid panel) often runs about $67, plus a $10–25 phlebotomy fee at a local draw site. That's typically far less than hospital cash-pay rates for the same labs. 3. HSA/FSA: Lab costs are eligible for HSA/FSA reimbursement regardless of which payment method you use. We'll discuss which option makes the most sense for your specific tests and insurance situation during your visit.

For many Internal Medicine concerns, a detailed medical history and observed examination provide reliable clinical information. When appropriate, your physician may guide you through checking vitals or performing simple movements. Laboratory and imaging orders are sent electronically to local facilities of your choice.

Present Future Health is currently licensed in Wisconsin and serves Wisconsin residents only. All visits are virtual at this time, with in-office options planned for the future. Wherever life could take me, I could still continue caring for your health and follow our plan as long as I'm licensed in your state. Not available in your state, there’s a waitlist!

Comprehensive Care Members have direct messaging access to Dr. Shiari for non-urgent medical questions, with typical response within 24–48 hours on business days. This is for clinical questions, medication concerns, lab results discussion, and care coordination — not for emergencies. For medical emergencies — chest pain, stroke symptoms, severe injuries, or any life-threatening concern — call 911 or go to your nearest emergency room. Telemedicine is not a substitute for emergency care.

No. Present Future Health does not prescribe controlled substances. This includes, but is not limited to, opioid pain medications, benzodiazepines (e.g., Xanax, Valium), and stimulant medications for ADHD (e.g., Adderall, Ritalin). These medications require in-person evaluation and monitoring that fall outside our current practice model. We are happy to coordinate with your local primary care physician or specialists for these specific needs.

For patient safety, refills for chronic medications require a scheduled follow-up visit. This ensures adequate time to review symptoms, labs, side effects and response to treatment. Medication refills are not addressed during brief acute visits, which are reserved for single, non-complex concerns.

All prescriptions are sent electronically to the pharmacy of your choice. Because we focus on longitudinal management, we prioritize medication stewardship—ensuring you are on the minimum effective dose and deprescribing medications that no longer serve your health goals.

Present Future Health does not provide emergency care. For medical emergencies — chest pain, stroke symptoms, severe injuries, breathing difficulty, or any life-threatening concern — call 911 or go to your nearest emergency room. Telemedicine is not a substitute for emergency care.

We understand that life is unpredictable. If you need to make changes, we kindly ask for at least 24 hours' notice. This allows us to offer that time to another patient who may be waiting for care.

Yes. Because we reserve a significant block of time specifically for you, the following flat fees apply to appointments changed or missed with less than 24 hours' notice: 90-Minute Sessions: $262 60-Minute Sessions: $175 30-Minute Sessions: $100 15-Minute Sessions: $57

Our Guarantee: Unlike high-volume clinics, we do not double-book. When you schedule, that time is reserved exclusively for you. The Policy: Because we provide dedicated one-on-one care, a late cancellation or no-show leaves a gap that cannot be filled on short notice. To maintain this model of personalized service and ensure fairness to patients on our waitlist, a flat fee is applied to any appointment changed with less than 24 hours' notice.

The easiest way is to use the link found in your confirmation text or email, or you can email our office directly.