These are some of the frequent questions we are asked. Please reach out if you have additional questions!

Q. Do you take insurance?

We accept most major Montana/regional private insurance plans and bill insurance as a courtesy. We also accept Medicare but do not accept Medicaid at this time. However, please check with your specific plan as occasionally select plans may not cover services outside their narrow network. Other plans may have deductibles that must first be met out of pocket before coverage takes effect.

Q. Will you be my primary care provider?

We are happy to be a primary care provider with the understanding that we believe in a patient centered root cause approach that requires active patient participation in their plans of care. We are also happy to serve individuals who are established with a primary care provider to provide preventative services and education as part of a collaborative team approach. 

Q. What is the difference between primary care and functional medicine?

There is no difference, or at least shouldn’t be. Functional medicine is primary care that focuses on the root cause of symptoms and disease. We believe a patient’s story is a relevant and critical aspect of achieving wellness, not just the treatment of disease. Functional Medicine is not “green medicine”, although we do incorporate extensive lifestyle interventions, individualized preventative education, and supplementation when needed. Sometimes medications, referrals, and traditional interventions are needed to provide a team based whole body approach to care. 

Q. Do I have to get a whole bunch of labs done?

Labs provide helpful information but are not a substitute for a patient’s unique history, symptoms, and clinical exam findings. When possible, we start with traditional labs specific to the patient that are most likely to be covered by insurance or purchased at a reasonable wholesale cost. When more extensive labs are clinically recommended, and are not typically covered by insurance, this is a decision decided on between the provider and patient. If you have had labs completed within the past year, bring those to your visit to avoid repeating labs you have recently completed unless indicated.

Q. Do you offer memberships for self-pay patients?

We do not currently offer memberships but this may be a future consideration. We do offer a prompt payment discount to self pay patients. Please contact us directly for specifics. We also accept HSA payments for high deductible plans. 

Q. Do you offer virtual/telehealth services?

Yes! We recognize that for people that live outside of Billings, travel can often be difficult during the challenging winter months, or for those with daytime responsibilities that make it difficult to always make it in for an in person visit. When possible, we recommend an in person visit at least once a year for a full physical exam that can be difficult to obtain virtually. If that is not possible, we recommend having a primary care provider that can see you for a preventative exam each year in addition to our services, and are happy to provide labs and work with them as part of a collaborative relationship. 

Q. I live out of state, can I see you virtually?

Currently, we are licensed to offer telehealth/virtual services in Montana, Idaho, and Oregon with Wyoming licensure coming soon! 

Q. Do you see children?

Yes! We love our little ones! We see all ages from newborn through age 18 and also offer well child exams and sports physicals. Because we are a functional medicine clinic, for establish care visits, we recommend having all parents or primary caregivers involved so care plans can positively impact the entire family by establishing prevention and wellness early on.

Q. What services do you offer?

This is a general list of services we provide through a root cause functional medicine approach: 

• Primary care from a functional medicine lens
• Wellness visits and preventative care, adult
• Well child and preventative care
• Chronic disease prevention and root cause treatments:
  • Diabetes
  • Hypertension
  • Heart disease prevention
  • Obesity/Weight loss
  • Thyroid dysfunction
  • Chronic pain, fibromyalgia
  • Chronic fatigue
  • PCOS (PMOS)
  • Perimenopause/menopause
  • IBD
  • Celiac Disease
  • IBS
  • Nutrient deficiencies
  • Hormone therapy
• Sports Physicals (Not covered by insurance)
• DOT Exams (Not covered by insurance)

Q. Will I need a bunch of supplements?

We believe a food first approach is the most important medicine, alongside adequate sleep, stress reduction, daily movement, and healthy relationships. We recommend non-pharmacological remedies as a first line approach. Sometimes temporary or long term supplements are needed to address significant deficiencies or when first line interventions alone are not enough to relieve symptoms. Sometimes supplements are also used to support treatments that require prescription medications. Because supplements are not regulated by the FDA, we only recommend products that are pharmaceutical grade and third party verified.

Q. Can you refill my prescription medications?

Yes, but it also depends if those medications are prescribed by a specialist also involved in a patient’s care, such as cardiology or psychiatry. In cases where outside providers are providing speciality care, we work alongside them to ensure treatments are synergistic and not contraindicated with their current prescription therapies. We can manage routine medications used in primary care. However, we only incorporate medications as needed while maximizing first line root cause interventions, when first line therapies alone are not sufficient, and per patient share decision making. 

Q. How do I schedule an appointment?

You can schedule online or call to make an appointment. You can find our contact information and online scheduling link on our website at https://rophefm.com. Please read over our website to ensure this is the right fit for you and reach out with any questions you may have.

Q. Do you provide urgent care services?

Generally no, as we are a small clinic and do not offer acute care in house services such as point of care lab testing, suturing, imaging, or splinting. However, for established patients needing to be seen virtually for common complaints that do not require in house imaging or point of care labs, such as mild viral illness symptoms, sinusitis, or other minor complaints, call and if an appointment slot is available, we are happy to squeeze you in. Otherwise we recommend utilizing your nearest urgent care for same day services or visit the emergency department for immediate critical needs.

Have you ever been legitimately frightened, perhaps you dodged a car at the last minute that didn’t see you, were chased by a vicious dog or other wild animal, or your heart escalated at the sight of shadows outside your house that might be a thief trying to enter? Perhaps your fear was even deeper rooted from trauma or physical abuse.

Your sympathetic nervous system went into play, and your body released catecholamines in preparation for a flight or fight response. Your heart rate sped up, your blood pressure increased, you developed acute tunnel vision, and blood flow shunted way from your stomach to the largest muscles in your body in preparation to run. Once the emergency was over, your parasympathetic nervous system took over. You heart rate slowed down, your blood pressure lowered, blood flow returned to your gut, and you were able to relax. This is a natural and healthy physical response that empowers our survival instinct.

However, when this response becomes chronic due to ongoing stress, even though a life threatening emergency doesn’t exist, it can be catastrophic to the heart, moods, immune function, hormone function, gut health, and just about every other system in our body. In the developed world, we are surrounded by chronic stress, work responsibilities and deadlines, social pressures, caregiving roles, negative social media and news, and the effects of past traumas. Our sympathetic nervous system often does not turn off. 

When this happens, we continue to release cortisol from the little adrenal glands that sit on top of the kidneys, which can raise blood sugar levels, lead to weight gain, poor sleep, depression and anxiety, chronic stomach upset, hormone dysfunction, heart disease, and reduced ability to recover from infections.

Meet the vagus nerve! It is the part of our nervous system that is responsible for turning the faucet off of an overactive sympathetic nervous system, and reminds our bodies to turn on the parasympathetic nervous system. It’s the body’s indicator that it’s time to “rest and digest”. In our overly busy westernized world this is no longer a natural response for a large number of people. It’s been badly blunted. 

The good news is that training the vagus nerve can pull your body back into its normal rhythms, recognizing a true life-threatening emergency from a chronic stress response. However, it requires training, just like learning to play the piano, ride a bike, build endurance at the gym, or learn a new hobby. In fact, retraining the vagus nerve is so powerful it can lower blood pressures, relieve insomnia, assist with weight loss efforts, improve blood sugar control, decrease heart disease risks, and increase overall well-being, often without pharmaceutical interventions.

7 ways to stimulate the Vagus nerve, your body’s powerhouse to resiliency:

1. Practice mindful breathing: Start by sitting quietly or laying on your back. Slowly inhale for a full five seconds through your nose, briefly hold the breath once lungs are fully expanded, and then slowly exhale through you mouth and nose for a full five seconds and briefly pause once lungs are fully emptied of air. Average about 5 breaths a minute. Repeat 10 times, while relaxing facial muscles, neck, and shoulders with each breath.
2. Practice humming throughout the day.
3. Sing, listen to music, dance.
4. Practice breathing through gentle exercises like yoga or stretching.
5. Turn the shower to cold during the last 30 seconds or go for a cold water plunge.
6. Try gargling. 
7. Belly laugh!

Still struggling with efforts to calm stress and improve metabolic function? Schedule an appointment with us: https://rophefm.com

Additional Reading:

https://www.ifm.org/podcast/vagus-nerve-parasympathetic-response

https://health.clevelandclinic.org/vagus-nerve-reset

https://health.clevelandclinic.org/what-does-the-vagus-nerve-do

https://www.uvahealth.com/healthy-balance/5-vagus-nerve-exercises

Food is your most important medication. Eat the rainbow from whole food sources every day, aiming for 7-9 servings, especially from above the ground high fiber veggies!

Helps lower inflammation, blood pressure, and improve memory:

Red Whole Foods: red apples, red peppers, red grapes, tomato, red onions, red berries, radishes

Reduces type 2 diabetes risk, asthma, osteoporosis, and some cancers, improves healthy sperm counts: 

Orange Whole Foods: apricots, orange peppers, pumpkin, butternut squash, sweet potato, turmeric

Reduces risk of asthma, type 2 diabetes, metabolic syndrome, promotes healthier vision: 

Yellow Whole Foods: yellow apples, banana, ginger, olive oil, summer squash, yellow peppers, jack fruit

*Emphasize this list! Reduces risk of many cancers, depression, heart disease, cell damage, detoxification, healthy estrogen: 

Green Whole Foods: green apples, artichoke, avocado, green sprouts, broccoli, broccolini, celery, bokchoy, green cabbage, herbs, spinach, snow peas, green olives, leafy greens, green tea, cucumbers, Brussels sprouts, green beans, green peppers

Promotes healthy cognition, improves blood pressure, reduces blood sugar and risk of heart disease, improves immunity: 

Blue/Purple Whole Foods: Blue, purple, and black berries, purple grapes, prunes, purple cauliflower, purple cabbage, eggplant, plums, purple and black rice, purple peppers, purple potatoes, black olives

Decreases some cancers, reduces cholesterol, type 2 diabetes, and risk of heart disease: 

White/Tan/Brown Whole Foods: apples, legumes, cauliflower, cassava root, coconut, garlic, jicama, mushrooms, nuts, onions, pears, seeds, dragon fruit, tea, organic soy (GMO-free), whole grains (i.e. barley, whole oats, quinoa, teff, amaranth, brown rice)

Craving sugar and processed foods and breads? Replace with the above food choices for more energy, mental clarity, weight maintenance, and improved overall health. Need more guidance on the root cause of your symptoms and disease management? Schedule an appointment with us! RopheFM.com 

Reference: The Institute of Functional Medicine. ifm.org

Vitamin D, what many people may think of as the “sunshine vitamin”, has been increasingly on the radar as to its vital importance to a multitude of bodily functions¹²³. Without adequate vitamin D, the body is unable to properly absorb the calcium needed for strong bones⁴. Low vitamin D levels can also contribute to stiffer blood vessels and increased risk of high blood pressure and cardiovascular disease⁵. Low levels can affect thyroid health, contribute to depression, bone loss, and impede the body’s natural ability to respond to infection and chronic inflammation⁵⁶.

Vitamin D is found in many foods that we eat, such as salmon, eggs, many mushrooms, and fortified dairy and fortified plant-based milk. Of course, one of the best sources of vitamin D is sunshine⁶. However, this certainly has to be balanced with skin cancer risks, and can be challenging for folks living in northern hemispheres of the United States, or in highly polluted areas that shade the sun.

Importantly, lack of sunshine is only one contributor to low vitamin D levels. There is a correlation between obesity and low vitamin D levels, although it is not fully known what optimal supplementation level is needed to achieve appropriate active levels of circulating vitamin D⁷. Issues such as Crohn’s disease, ulcerative colitis, celiac disease, age, ethnicity, history of bariatric surgery, chronic gastritis, certain medications, and poor gut health from an overly process diet, can also contribute to inadequate absorption of vitamin D⁵⁸. Further, this can also cause a deficiency in a multitude of other vitamins and minerals that are essential for regulating our body’s systems and controlling chronic inflammation⁶.

But what is an optimal level of vitamin D? Medical professionals have long known of vitamin D’s importance. Yet, it’s often overlooked during an annual exam and not routinely tested for in many cases. Depending on a particular lab, normal values are generally considered to be between 30 and 100 ng/mL⁹. 

However, a vitamin D level of 35 might be “normal” but is it optimal? Functional medicine experts suggest optimal levels should reside somewhere between 50 and 80 ng/mL depending on the inidividual. Yes, vitamin D toxicity can occur with very high vitamin D supplementation, although this is rare in comparison to the chronically low vitamin D levels that often exist today. Traditional recommendations are Vitamin D3 supplementation from 400 to 800 units of vitamin D3 daily, although in many cases, this is not adequate to bring a person up to optimal levels. It is generally thought that anything at or less than 5,000 units daily is safe, although much higher short-term doses may be needed for somebody with extremely low levels of vitamin D⁴⁹. However, supplementation requires an individual approach that considers an individual’s unique needs, risk factors, response to supplementation, and a combination of other lifestyle interventions through adequate nutrition, exercise, sleep, and other supplements and medications⁶.

If vitamin D levels were more carefully considered on an individualized basis as part of a comprehensive treatment plan, it could prevent some of the polypharmacy that is often the first “go to” to for presenting conditions, if nutrition imbalances were first optimized. Many medical insurance companies will cover vitamin D lab testing if there is a risk of low levels or reduced absorption of this key nutrient. Remember to ask your provider about your vitamin D levels, particularly in the presence of IBD, IBS, chronic gastritis, bariatric surgical history, obesity, thyroid, disease, osteopenia, depression, reduce energy, or other mood concerns, especially if exposure to natural sunlight is limited. 

Remember that optimizing vitamin D levels is not a lone cure for chronic conditions, but coexists with other lifestyle factors, such as adequate sleep, a non-processed whole food diet, regular movement, stress reduction, and mental and spiritual health. Traditional medicine has its value in treating many conditions, but it should never be a substitute for treating the root causes that may be contributing to those conditions in the first place. Want to learn more? Check out my blog post on functional medicine!

1.         Fakheri RJ. Vitamin D Supplementation: To D or Not to D? Mayo Clinic Proceedings. 2024;99(4):529-533. doi:10.1016/j.mayocp.2024.01.003

2.         Sha T, Wang Y, Zhang Y, et al. Genetic Variants, Serum 25-Hydroxyvitamin D Levels, and Sarcopenia: A Mendelian Randomization Analysis. JAMA Network Open. 2023;6(8):e2331558-e2331558. doi:10.1001/jamanetworkopen.2023.31558

3.         Bluher AE, Kearney T, Vazifedan T, Baldassari CM. Vitamin D Deficiency and Pediatric Obstructive Sleep Apnea Severity. JAMA Otolaryngology–Head & Neck Surgery. 2025;151(1):72-77. doi:10.1001/jamaoto.2024.3737

4.         Sfeir JG, Drake MT, Khosla S, Farr JN. Skeletal Aging. Mayo Clinic Proceedings. 2022;97(6):1194-1208. doi:10.1016/j.mayocp.2022.03.011

5.         Rebelos E, Tentolouris N, Jude E. The Role of Vitamin D in Health and Disease: A Narrative Review on the Mechanisms Linking Vitamin D with Disease and the Effects of Supplementation. Drugs. 2023;83(8):665-685. doi:10.1007/s40265-023-01875-8

6.         Mavar M, Sorić T, Bagarić E, Sarić A, Matek Sarić M. The Power of Vitamin D: Is the Future in Precision Nutrition through Personalized Supplementation Plans? Nutrients. 2024;16(8):1176. doi:10.3390/nu16081176

7.         Tobias DK, Luttmann-Gibson H, Mora S, et al. Association of Body Weight With Response to Vitamin D Supplementation and Metabolism. JAMA Netw Open. 2023;6(1):e2250681. doi:10.1001/jamanetworkopen.2022.50681

8.         Luttmann-Gibson H, Mora S, Camargo CA, et al. Serum 25-hydroxyvitamin D in the VITamin D and OmegA-3 TriaL (VITAL): Clinical and demographic characteristics associated with baseline and change with randomized vitamin D treatment. Contemporary Clinical Trials. 2019;87:105854. doi:10.1016/j.cct.2019.105854

9.         Williams SE. Vitamin D supplementation: Pearls for practicing clinicians. Cleve Clin J Med. 2022;89(3):154. doi:10.3949/ccjm.89a.21021

“Food is your most important prescription” is what I often tell my patients. A pill might be necessary but should be implemented at the top rungs of the ladder climb to wellness, not as first line therapy or mono therapy. Proper nutrition, sleep, movement, and emotional and spiritual health are the key to achieving maximum wellness and quality of life. A pill is created for preventing or muting a disease process but does not guarantee wellness or improved well being. Traditional medicine focuses on treating disease while functional medicine looks at the root causes of disease and focuses on achieving maximum wellness.

The important thing is to take charge of one’s health by starting with small changes. When grocery shopping, a good rule of thumb is that if it exists in a bottle, can, box, or bag the food is automatically questionable. The best place in the grocery store to find the most nutritious foods is the outer perimeter. This is where fresh whole vegetables, fruits, meats, seafood, eggs, and dairy are generally located. 

Grocery stores with bulk food options are also a great way to save money on whole grains, nuts, and seeds that can be purchased in larger quantities. Organic, local, and non-GMO foods are always preferred but understandably these are not always options in some areas. Frozen vegetables without added ingredients can be a good affordable alternative where fresh produce may be lacking. Yes, processed foods may cost less, but the cost of healthcare continues to escalate and will likely outpace the added cost of taking healthy preventative measures now.

Daily movement is also necessary to maintain physical function, improve sleep, increase metabolism, and improve emotional health. I have my patients start with small sustainable goals, such as walking at lunch, walking the golf course, or joining a local dance class with a friend. Yoga is an alternative that can be done with an online video at home and is easily adaptable to a variety of abilities. The important thing is to move every day, starting with as little as 10 minutes and increasing from there.

Sleep is critical and a non-negotiable element of optimizing health. If sleep is difficult, improving nutrition and increasing daily physical activity is often enough for some people to discover dramatic improvement. Sleep hygiene is also critical. Sleep should occur in a relaxing environment, in a cool dark bedroom that is absent from electronic devices, televisions, and mobile phones. It’s important to establish a regular bed time and rising time. Supplements such as magnesium glyconate 350-400mg and melatonin 3-6mg taken 30-60 minutes before bed can also help promote a restful nights sleep. 

Tobacco and alcohol use can also disrupt cellular health that contributes to heart disease, chronic respiratory illnesses, heart disease, bone loss, and poor mental health. For example, tobacco cessation can often stunt or reverse the course of chronic illness, and in some cases, decrease an individual’s pill burden, while improving well being and quality of life. It’s important to ask why dependence on alcohol or tobacco has become so important and then seek guidance from a health care professional for cessation support.

At this point, many of my patients who start with these initial changes find they are losing weight, sleeping better, have increased energy, and their mental health improves dramatically. Mental, spiritual, and physical health cannot be separated. The body is a whole and must be treated as such. People will model those they spend their time around. The first goal is to engage in healthy affirming relationships, breaking off those that are toxic, and seek help from a counselor, minister, healthcare provider, and/or a trusted family member. It’s also vital to take care of one’s own mental and physical health first. 

An emotionally drained and physically compromised person can offer little benefit to someone else. This may require learning to say “no”, taking regular work breaks to breathe deeply, eating a healthy meal, or standing to stretch. Spiritual health is vital; knowing one’s purpose and worth is a key element in determining readiness for change and being able to release unhealthy control. It’s also important to recognize the signs of burnout and seek help early. 

Sometimes lifestyle changes, while the most important first step to achieving maximum wellness, may not be enough alone. A functional medicine practitioner can assist with balancing hormones, detoxification, incorporating traditional medicine when needed, and weeding out root causes of persistent health disrupters. All is required is a readiness to change and to value maximum health over simply treating disease.