Question 1

What is the philosophy behind "Precision care for lifelong independence"?

Accepted Answer

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.

Question 2

I am currently healthy; why would I see an Internal Medicine physician?

Accepted Answer

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.

Question 3

What lab tests do you typically order?

Accepted Answer

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.

Question 4

Do you prescribe GLP-1 medications like Ozempic, Wegovy, Mounjaro, or Zepbound?

Accepted Answer

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.

Question 5

Do you see patients after bariatric surgery?

Accepted Answer

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.

Question 6

Do you offer pre-operative clearance evaluations?

Accepted Answer

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.

Question 7

Do you manage menopause-related care?

Accepted Answer

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.

Question 8

What are the visit rates?

Accepted Answer

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.

Question 9

Do you accept insurance or Medicare?

Accepted Answer

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.

Question 10

What happens if my "Acute Visit" becomes complex?

Accepted Answer

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.

Question 11

Can Medicare patients pay cash for direct care?

Accepted Answer

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.

Question 12

Can I use HSA/FSA for my membership?

Accepted Answer

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.

Question 13

How much do labs and tests cost?

Accepted Answer

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.

Question 14

How do you perform an exam or order tests virtually?

Accepted Answer

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.

Question 15

What states do you serve?

Accepted Answer

Present Future Health is currently licensed in Wisconsin & Massachusetts and serves Wisconsin & Massachusetts 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!

Question 16

How does messaging work for members?

Accepted Answer

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.

Question 17

Do you prescribe controlled substances?

Accepted Answer

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.

Question 18

What is your refill policy for chronic medications?

Accepted Answer

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.

Question 19

How are prescriptions sent to my pharmacy?

Accepted Answer

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.

Question 20

What if I have a genuine emergency?

Accepted Answer

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.

Question 21

What happens if I need to cancel or reschedule

Accepted Answer

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.

Question 22

Is there a fee for late cancellations or no-shows?

Accepted Answer

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

Question 23

Why do you charge a fee for missed appointments?

Accepted Answer

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.

Question 24

How do I cancel my appointment?

Accepted Answer

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

Frequently Asked Questions