How is Functional Medicine different from conventional medicine?

Dr. Bera-Miller and Dr. Liu practice Integrative and Functional Medicine. In the Functional Medicine (FM) paradigm there is one core system (the Nervous System, i.e. the Mental, Emotional, Spiritual realms of our lives) with which seven other systems interact to support our optimal functioning and health: 

• Assimilation/Gastrointestinal function

• Defense/Immune function

• Energy regulation/Mitochondrial functioning

• Biotransformation/Detoxification

• Transportation/Circulation

• Communication (hormones, neurotransmitters, etc)

• Structural Integrity (musculoskeletal/spinal health at the macro level, and intestinal permeability at the micro level).

Dr. Bera-Miller, Dr. Liu, and the whole team explore and address the key factors that contribute to your health and well-being, including:

• Nutritional sufficiency and deficiencies

• Hormonal balancing

• Sleep

• Stressors and stress resilience

• Relationships at home and work

• Toxins

• Genetics

Integrative Medicine means that Dr. Bera-Miller and Dr. Liu integrate in their recommendations all types of healing modalities including diet, nutraceuticals, herbs, mind-body medicine, acupuncture, massage therapy/body work, Ayruveda, homeopathy, and energetic healing.  They also can and do prescribe medications including hormones (thyroid hormone preparations, bioidentical hormones) and other medications if/as needed and desired.

Functional Medicine means that Dr. Bera-Miller and Dr. Liu practice “root cause” medicine, an approach that identifies which of the eight systems above are out of balance. This then guides how to help an individual get out of their inflamed state and in balance. This root cause approach can help most patients, however it cannot guarantee any outcome and does not cure everyone. Whether someone improves with the Functional Medicine approach 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, and sometimes specialty referrals as needed.

It is very important to note that with the Integrative/Functional Medicine approach and for the patients who benefit from it, they often feel better within the first couple/few 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. 
 

Who are the practitioners?

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.

Thus Dr. Bera-Miller and Dr. Liu work with a team which includes a Certified Health Coach Carla Moss, a Functional Medicine Nutritionist and Herbalist Susan Blanc, and an Integrative Psychotherapist Kiran Easwarachandran. Our Office Manager Nila Santos has training and experience as a nurse and also in customer service. Our New Patient Coordinator is Shauna Aguilar and Shauna also helps with processing lab results and medication refills.

Non-physician team members, as well as our colleagues in the broader community, are extremely effective in supporting people towards optimizing their pillars of health. While Dr. Bera-Miller and Dr. Liu, as Integrative/Functional Medicine physicians, have much training and experience in coaching and supporting patients in behavior change, it can often be more cost-effective for patients to work with non physician providers too, and thus both doctors regularly refer to other/non-physician colleagues too.

With an ongoing patient wait list, Dr. Bera-Miller continues to refine how to offer more Shared Medical Appointment (SMA)/Group Visit 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 will also be offering at least one HEAL (Health Essentials for Abundant Living) retreat in 2024 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 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 SMA program in 2023.

What happens at the first visit?

At your initial one-on-one physician appointment, Dr. Bera-Miller or Dr. Judy Liu will review your in-depth intake forms including your timeline. It is important for them 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 and past labs and current physical exam, then 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 as well as other lifestyle recommendations including for enhancing your mind-body connection and healing. 

Initial one-on-one visits usually last 2 hours though for more complex cases can easily be longer if a patient is open to that. 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, 2024, the fee to see Dr. Bera-Miller is $500 per hour and the fee for Dr. Judy Liu is $465/hour. These hourly rates reflect the average rate for a Functional/Integrative Medicine MD/physician and reflect not only the time we spend face to face in office visits but also the substantive time that we spend behind the scenes preparing for and processing patient visits including formulating our root cause diagnoses and writing chart notes/reports including our holistic recommendations. This behind the scenes time can take up as much time as the office visit itself, and at the very least one third to one half the time of an office visit. Dr. Bera-Miller also spends a substantive amount of time, including in weekly team meetings, coordinating the care that patients receive from her team members collaborating in her practice’s multidisciplinary approach to healing. Patients are encouraged to submit the itemized receipts from their visits with Dr. Bera-Miller and Dr. Liu to their insurance to request reimbursement, except for Kaiser and MediCare.

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 $500 deposit and a signed Policy/Consent form are required to schedule a new patient appointment with Dr. Bera-Miller A deposit of $465 is required to schedule a new patient appointment with Dr. Judy Liu. 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 our Certified Health Coach Carla is $150/hour.

• The fee for visits with our Nutritionist-Herbalist Susan Blanc is $175/hour or prorated for shorter or longer visits. The initial nutrition visit is 60-90 minutes in length and follow up visits are often one hour although shorter or longer follow up visits can be arranged as well.

• The fee for visits with our Integrative Psychotherapist Kiran Easwarachandran LCSW is, as of January 1, 2024, $190 per hour or prorated. Initial visits are 1 1/2 hours ($285).

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 does not take/process insurance. However, for visits with the licensed clinicians on our team (Dr. Bera-Miller, Dr. Liu, and Kiran Easwarachandran) we are 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 Functional/Integrative Medicine services but we believe it is worthwhile to try because patients have told us they receive anywhere from 20-75% reimbursement of physician office visit fees. For visits with our Integrative Therapist Kiran you may also pursue requesting some reimbursement from MediCare.

For patients with Medicare and as of 1/1/2016, we physicians 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. Dr. Judy Liu is not able to see MediCare patients at this time.
 

How do I get started?

Our New Patient Coordinator Shauna Aguilar can help you get started.  Her phone# is 925-658-0661 and she is available weekdays usually from 9am to 12noon. She can let you know more about our practice and when is the next available appointment with Dr. Liu or Dr. Bera-Miller. She will get you set up in our electronic medical records system and go over the forms, including our office policy/consent form, necessary to complete in order to confirm your first appointment. She will also collect the deposit required to reserve an appointment with Dr. Liu or Dr. Bera-Miller as well as the fee for the one required visit with our Certified Health Coach Carla. These deposits are applied to your first/intake visit with the doctor and also your visit with our Health Coach. 

We look forward to supporting you in your health journey!