Working with Chris Kresser and Dr. Amy Nett
The way that Chris Kresser and Dr. Amy Nett work with patients differs considerably from the conventional medical model you may be accustomed to. Please read the following information thoroughly to familiarize yourself with their process. There is also a section at the end that describes the fee structure for Chris and Dr. Nett.
As a new patient, your treatment is broken into two phases:
Each phase is described in more detail below.
Phase One: The Case Review
The Case Review is the first step for all new patients. The Case Review process is designed to save money and time in the long-term by performing the appropriate diagnostic testing and evaluation before treatment begins. A cornerstone of our approach is “test, don’t guess.” Identifying the underlying patterns contributing to disease is the key to a successful and lasting outcome.
The Case Review serves several purposes. It enables Chris and Dr. Nett to more accurately estimate how long your treatment program will last, what it will include and how much it will cost. It gives you the chance to ask any questions you may have about your condition and what you should expect. It also provides an opportunity for us to get to know each other and determine if our clinic is a good fit for you over the long-term.
The Case Review includes:
- An initial phone or video consult to determine which labs to order.
- A thorough review of your medical history and relevant previous lab work (10-page limit).
- A review of your current diet and nutritional supplements.
- A detailed body systems assessment.
- A 60- or 75-minute in-person appointment (duration depending on your clinician) to review your results and present your treatment plan.
- A treatment plan including diet, supplements and lifestyle therapies.
- Recommendations for further testing (if necessary).
The Case Review process includes two steps, which are described in more detail below.
Step One: Initial Consult
During this 30-minute phone/Chiron video appointment, Dr. Nett or Tracey, our nurse practitioner, will interview you to determine which lab tests to order for your Case Review, based on your chief complaints and your history.
This appointment has two purposes: to make sure that we have all of the information needed to gain a comprehensive understanding of many of the factors affecting your health and to give you a head start on your treatment before you meet with us.
The exact lab testing ordered as part of the Initial Consult depends on your individual circumstances, but may include:
- A comprehensive blood chemistry panel. This is the single most efficient, effective and affordable tool for quickly evaluating your health. It screens for a wide range of conditions, including several types of anemia; gut, viral and bacterial infections; insulin resistance and hypoglycemia; liver and kidney issues; and thyroid and adrenal problems. It offers important clues for how to structure and focus your treatment to get the best results. It also provides a baseline of biomarkers that can be used to objectively track the progress of your treatment over time.
- Additional blood tests for specific conditions, such as high cholesterol, hypothyroidism, autoimmune disease and gluten sensitivity.
- Advanced stool testing to screen for parasites, fungal overgrowth, bacterial infections, intestinal inflammation, dysbiosis and a deficiency of beneficial gut bacteria.
- Urine organic acids testing to screen for small intestinal bacterial overgrowth, fungal overgrowth, problems metabolizing fat or carbohydrates, B-vitamin status, methylation issues, detoxification capacity, oxidative stress and neurotransmitter metabolism.
- Urine hormone testing for adrenal and sex hormone status.
A Patient Care Coordinator will provide you with the Case Review health history paperwork to complete. It is important that you spend time and energy completing these intake forms, as they are vital in helping us understand your case. This paperwork includes:
- A detailed health and medical history questionnaire
- A survey of your chief complaints and most important health goals
- An assessment of your most troubling and frequently experienced symptoms
- A diet survey and questionnaire
- A survey of your current supplements and medications
Finally, the Patient Care Coordinator will provide you with dietary guidelines to follow after your Initial Consultation. These are extracted from Chris’s New York Times Bestseller The Paleo Cure, as well as his online programs, and include:
- Detailed instructions on how to perform a 30-day Paleo elimination (reset) diet
It is critical that you implement the 30-day reset diet to the best of your ability. When you speak with Chris or Dr. Nett, your experience with the diet will be as important as any lab findings in guiding the next steps in your care plan.
Once we’ve received your lab results and completed Case Review paperwork, you will move on to Step 2: the Case Review consultation. This typically occurs between 60 and 90 days after the Initial Consult, because some of the labs we use can take up to 8 weeks to deliver the results to us after receiving your sample. While you wait for your lab results to come back, you will be implementing the 30-day reset diet and making forward progress.
Step Two: In-person Case Review
The Case Review consultation is a 60-minute (with Chris) or 75-minute (with Dr. Nett), in-person appointment. If you live outside of the San Francisco Bay area, you must make arrangements to travel to our clinic for the appointment.
Prior to the consultation, Chris or Dr. Nett will review the results from the labs that were ordered along with your Case Review paperwork, medical history, diet and supplement survey, assessment forms and relevant prior lab work. They will use all of this information to provide the following:
- A summary of the underlying patterns that are contributing to your symptoms.
- An outline of the suggested treatment plan, including dietary, supplement and lifestyle recommendations.
- Recommendations for further testing (this will typically be minimal, if necessary at all, because of the completeness of the Case Review process)
During your consultation, Chris or Dr. Nett will present you with their recommended treatment plan. They will also review all of your test results with you, discuss the results of your 30-day Reset, and answer any questions you have about the findings or the treatment plan.
Phase Two: Ongoing Treatment
Once the Case Review is complete, you’ll have follow-up appointments on an as-needed basis throughout the remainder of your treatment plan.
The first follow-up appointment generally occurs between six and ten weeks after your Case Review consultation. At that time, Chris or Dr. Nett will review your progress on the treatment plan, along with any follow-up test results, and make additional recommendations as necessary.
From there, the frequency of your follow-up appointments will depend upon the severity of your condition as well as your response to the treatment.
You may schedule follow-up appointments in office or by phone or Chiron video. We ask that you return for an in-person visit at least once per year.
The Case Review is the fastest and most efficient way to determine the underlying causes of your health problems and design an effective treatment plan. While a Case Review may cost more than a typical initial visit to a physician, it is designed to save you money and time over the long-term by performing the appropriate diagnostic testing and evaluation before treatment begins.
Here is a breakdown of the costs involved in the Case Review and follow-up visits so you can plan accordingly. All of these are billed at the conclusion of the appointment.
Initial Consult: $295. Includes the 30-minute phone/Chiron appointment with a staff clinician.
Case Review: $1,195. Includes a detailed Report of Findings and a suggested treatment plan with dietary, supplement, and lifestyle recommendations during a 60-minute in-person appointment with Chris.
Regular Follow-ups: $240 for 30 minutes.
Dr. Amy Nett
Initial Consult: $295. Includes the 30-minute phone/Chiron appointment with Dr. Nett or a staff clinician.
Case Review: $995. Includes a treatment plan, that may use a combination of supplements, dietary recommendations, lifestyle interventions, and prescription medication when appropriate, during a 75-minute in-person appointment with Dr. Nett.
Regular Follow-ups: $240 for 30 minutes, $360 for 45 minutes and $480 for 60 minutes.
We strive to offer individualized care, including the recommended lab testing. We take into consideration your indications, preferences and budget. The cost of laboratory tests recommended during the case review process can range from $500 – $4,200. We can work with you to find a level of testing that feels comfortable to you and we can stagger the testing over time, so it is more affordable. This cost depends on the complexity of your condition, level of diagnostics required, and what your insurance may (or may not) cover. The cost of some testing includes a test administration fee.
The cost for supplements prescribed as part of your treatment plan during the case review process is typically $170 – $2,300. This can be customized based on budgetary constraints. This cost depends on the protocol(s) recommended to treat your condition, and these estimates represent 1-4 months of treatment (depending on the protocol).
Grand Total of Case Review Fees
The total you should expect to pay for the entire case review process is roughly between $2,200 – $6,000. This includes the first two appointments (Initial Consult and Case Review), lab testing tailored to you, and supplements for the initial three to four months of treatment.
Please note that you will have the opportunity to decide which of the laboratory and supplement recommendations you wish to proceed with, and you will only pay for those that you approve. The only fee that you commit to is the fee for the visit.
Estimated Costs for Supplements for Ongoing Treatment
Ongoing supplement costs vary considerably depending on your specific treatment plan, but average approximately $150 – $350/month.