Office Policies

Welcome to the office of Anthony A. Starpoli, M.D. Please read all of the information below carefully.

All Patients: If you cannot keep your appointment or should have any questions, please call our office. Please note that if you're more than a 1/2 hour late, rescheduling may be necessary. If you miss an appointment without calling ahead of time, you will be billed a missed appointment service fee of $100. Please do your best to make and keep your scheduled appointment. Be sure to have a valid insurance card, valid referral (if applicable), and your co-payment when you come for your visit.

Referrals and Prior Authorizations: If a referral is needed by your insurance company, you are expected to have one at the time of your visit. If you do not have one please be prepared to pay for your visit in full by either cash or check, based on the services rendered. If you are unable to do so, please reschedule your appointment. To receive a referral you must contact your Primary Care Physician. If you are unsure whether or not you need a new referral for your next visit, please ask, we will be glad to look into it for you. If a prior authorization is needed for your medications or procedures, we will do everything that we can to assist, but be aware that this DOES NOT guarantee an approval. If a prior authorization is denied, it is your best interest to work with your insurance company and advise us of how we can help.

Copays: Are expected at the time of service. We gladly accept CASH or CHECK.

Records: It is our office policy that to receive a copy of your chart, you must fill out a release form or submit an original document to our office with your signature. Please also be aware that our office has 20 days from the requested date to have the information available for you. All paperwork must be picked up at our office as we DO NOT fax medical records (unless it is an urgent matter).

Important: If you are unsure whether a referral is on file with us, please contact your insurance provider or call our office. It is your responsibility to find out the requirements of your HMO regarding any testing that may be ordered. This includes which facilities that can be used for ordered lab work and radiology tests. Additionally, you must have a written request for consultation from your primary care or referring doctor.

Our Office: We do our best to run on time. However, this is not always possible. If you are concerned with the time of your appointment on the day of your appointment, please call the office. If you are a new patient, you should arrive 15 minutes early, as you will have some paperwork to complete for our office records. If you find that you are unable to keep the appointment you have scheduled with our office please call at least 24 hours in advance to cancel and reschedule your appointment.

Test Results: Dr. Starpoli prefers to review all test results in person, in the office. Please contact the office to schedule a follow up appointment to review your test results. While we make every effort to provide you with your test results, if you are concerned, please call the office.

Out of Network Insurances: When we do not participate with your insurance company it is almost certain that payment will be made to you. In this situation you are required to endorse the check and send it with a copy of the explanation of benefits to Dr. Starpoli's office promptly. Most checks will be received between 2 and 4 weeks; please do not deposit this check!! It will need to be endorsed by you and forwarded to our office immediately so there is no penalty to you. As we wish not to pester you with sending bills and phone calls, please forward these checks immediately, as repeated billing is expensive and unnecessary. You may also have a balance due for deductibles and co-payment amounts that are not covered by your insurance. You will be billed for these outstanding amounts and they are due upon receipt.

Automated Reminder System: This office uses an automated reminding system that will call you to remind you of your appointment. We will also call you to remind you of any outstanding balances on your account. Lastly, the system is also used regularly to recall patients with certain illnesses that require follow up visits. To facilitate this, this system will call you at home to notify you to make an appointment with the office. If you receive this message and you believe it is an error, please understand that this is an automated system and all you need to do is call the office during office hours and we will correct the mistake. Please call after you receive the first phone call.

Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people.

Why Does Heartburn Occur?
To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.

However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:

• Nicotine (cigarettes)
• Fried or fatty foods
• Chocolate
• Coffee
• Citrus fruits and juices
• Peppermint
• Pregnancy
• Lying flat
• Hiatus hernia
• Certain prescription medications

Swallowing difficulty, medically termed dysphagia, can arise for a variety of reasons.  Firstly, reflux alone can disturb the muscular contraction or motility of the esophagus and interfere with the passage of liquids and solids.  Often, when reflux is controlled, these symptoms will disappear.

The inflammatory response of the esophagus from chronic reflux can lead to the formation of a ring of scar tissue at the end of the esophagus where it meets the stomach, an area know as the gastroesophageal junction (the location of the LES), that can lead to a mechanical obstruction causing difficultywith swallowing solids.  This entity is known as an esophageal ring or a Schatzki Ring.  In some cases the ring needs to be disrupted in order to resolve the blockage.

Of course with chronic reflux comes the risk of esophageal cancer and although the risk is low, it is very real.  Such tumors can cause significant blockage and bleeding.  The cancers are diagnosed most often by way of video upper endoscopy.  A person presenting with new-onset swallowing trouble, a history of reflux, bleeding, and weight loss should seek a medical evaluation immediately.

There are a variety of primary esophageal motility disorders that cause swallowing trouble.  Achalasia is a disorder that can be quite insidious and involves that loss of motility in the body of the esophagus and the lower esophageal sphincter (LES)fails to relax.  The physical presentation can look like reflux because the patient does not clear contents of the esophagus and those materials can backwash into the upper esophagus and mimic GERD. The diagnosis of Achalasia is made by way of esophageal manometry whereby the wave forms  of the esophagus are measured to make the diagnosis.  Achalasia can be treated surgically (laparoscopically) or by balloon dilation of the lower sphincter.

There are other esophageal motility disorders that can be described by esophageal manometry and they include diffuse esophageal spasm that is often associated wit noncardiac chest pain, the Nutcracker esophagus, and Ineffective Esophageal Motility.  Esophageal motility studies ( manometry) will require the passage of a small caliber tube into the esophagus through a nasal passage.  The test takes about 20-30 minutes to complete and is well-tolerated.  It is performed as an out-patient.