Everything you need
to know before
your first visit.

The Next Chapter Clinic is for women in perimenopause or menopause who are looking for knowledgeable, unhurried, specialized care. If you've been dismissed, rushed, or told your symptoms are "just part of getting older", this practice was built for you.

I see women who are experiencing hot flashes, night sweats, sleep disruption, mood changes, brain fog, vaginal dryness, low libido, irregular cycles, or any combination of symptoms that feel connected to hormonal changes in midlife.

I also see women who simply want to be proactive about their menopause transition, understanding their options before symptoms become disruptive.

I am a Michigan-based provider opening early 2027. You must be physically located in Michigan at the time of your telehealth visit. I plan to expand to additional states in the future. Contact me to be notified when I expand to your state.

I am actively working to expand to additional states. If you are located elsewhere and would like to be notified when I launch in your state, please use the contact form to join my waitlist.

No referral is needed. You can book directly online without any prior authorization or referral from another provider.

That said, I do recommend staying connected with your primary care provider for routine health maintenance, annual physicals, mammograms, Pap smears, and other preventive care. I focus specifically on menopause and hormonal health, and I work alongside your existing care team rather than replacing you.

After booking, you'll receive a link to complete your intake forms through the secure patient portal. Please complete these before your visit, they include your health history, current medications, and a detailed symptom questionnaire. The more detail you provide, the more productive your first visit will be.

If you have any recent lab work, feel free to upload it to the portal or bring it up during your visit. It's helpful but not required; I can order new labs if needed.

Absolutely, in fact, some of the most important time to start menopause care is during perimenopause, which begins while you're still having periods. Perimenopause can start years before your last period, and symptoms during this transition can be just as disruptive as full menopause.

You do not need to have reached menopause (12 consecutive months without a period) to be seen here. If you're experiencing symptoms that feel hormonally driven, regardless of where you are in your cycle, you are welcome to book.

This is a cash-pay practice and I do not bill insurance directly for visit fees. I am not in-network with any insurance plan and do not submit claims on your behalf.

Here's why I made this choice: the traditional insurance billing model requires short appointments, standardized care, and an enormous amount of administrative overhead. By operating outside that system, I can offer longer visits, more personalized care, and a simpler, more transparent experience.

I know this isn't the right model for everyone, and I want to be upfront about it. If in-network insurance coverage is important to you, platforms like Midi Health or your local OB/GYN practice may be better options. If you value the kind of specialized, unhurried care I offer, the out-of-pocket cost tends to be well worth it.

Yes, I provide a superbill for every visit upon request. A superbill is an itemized receipt that includes all the information your insurance company needs to process a reimbursement claim: your provider's NPI, the date of service, procedure codes (CPT codes), and diagnosis codes (ICD-10 codes).

You submit the superbill directly to your insurance company. Whether and how much they reimburse depends entirely on your individual plan, particularly whether you have out-of-network benefits. Plans with out-of-network coverage (common in PPO plans) may reimburse a portion of your visit cost. HMO plans typically do not cover out-of-network services.

I recommend calling the member services number on the back of your insurance card to ask about your out-of-network specialist or women's health benefits before your visit, so you know what to expect.

Yes, HSA and FSA cards are accepted for all visit fees and lab review fees. Reimbursement eligibility varies by plan. I recommend checking with your HSA/FSA provider before your visit, as some plans may require a Letter of Medical Necessity.

Simply use your HSA or FSA debit card at checkout just like a regular debit card. If your plan requires a receipt for reimbursement, I provide an itemized receipt with all required information.

I am not able to accept patients who are enrolled in or entitled to Medicare, including Medicare Advantage plans, and cannot make exceptions.

Because I have not opted out of Medicare, federal law does not allow me to see Medicare patients in this cash-pay practice. This is a legal requirement, not a choice.

If you have Medicare and are looking for menopause care, I recommend speaking with your primary care provider or OB/GYN, or contacting your Medicare plan to ask about covered menopause services in your area.

I require 24 hours notice for appointment cancellations or rescheduling. Cancellations made within 24 hours of the appointment are subject to a $25 cancellation fee. No-shows without notice will be charged the full visit fee.

For membership cancellations: monthly members can cancel at any time and the membership ends at the close of the current billing month, with no additional fee. Prepaid 6 and 12-month plans are non-refundable, reflecting the discounted commitment rate.

I understand that life happens. If something unexpected keeps you from your visit, please reach out through the patient portal and I will work with you. Please note the portal is not monitored in real time. For any medical emergency, call 911 or go to your nearest emergency room. I ask for the same courtesy in return, as appointment slots are reserved specifically for you.

Appointment availability varies week to week based on my schedule. When booking opens in early 2027, you will be able to see all available times directly through the online scheduling system and choose what works best for you.

I aim to offer a mix of weekday and weekend availability to accommodate working women. Booking is done entirely online, no phone calls needed.

Initial consultations are 60 minutes. This is intentional. Menopause care done well requires time, time to review your full health history, understand your symptoms in context, discuss your concerns and goals, explain your options clearly, and build a care plan together. I don't rush that process.

Follow-up visits are 30 minutes. Once I know your history and have an established care plan, follow-ups are focused check-ins to monitor your response to treatment, review any new symptoms or labs, and adjust your plan as needed.

A follow-up visit is required approximately 6–8 weeks after any new medication or dose change to make sure your treatment is working safely and appropriately. Once your medications are stable, follow-up is recommended every 6–12 months depending on your treatment, or sooner if needed.

All patients can reach me directly through secure messaging in the patient portal. When you message, you are messaging me, not a call center or a phone tree.

For non-urgent questions, you can expect a reply within one to two business days. Because this is a solo practice, I do not offer 24/7 or after-hours coverage. Anything urgent or a medical emergency should go to 911 or your nearest emergency department.

Yes, always. This is one of the most important things that distinguishes The Next Chapter Clinic from large telehealth platforms. You will always see Megan Nelson, CNM, MSCP, every visit, every time.

Continuity of care matters enormously in menopause treatment. Your provider needs to know your full history, understand how you've responded to previous treatments, and remember what you discussed last time. You should never have to re-explain your story at every visit.

No, there is no predetermined treatment plan. Your care is built entirely around your individual health history, risk factors, symptoms, and preferences.

Hormone therapy is the most effective treatment for most menopause symptoms and is appropriate for the majority of healthy women, but it isn't right for everyone, and I never push any treatment. If you have concerns about hormones, are not a candidate for HRT, or simply prefer a non-hormonal approach, I have effective options for you as well.

You will always be an active participant in your treatment decisions. I explain your options, discuss the evidence, and make a plan together.

Prescriptions are sent electronically to the pharmacy of your choice. Any retail pharmacy, CVS, Walgreens, Rite Aid, Costco, your local independent pharmacy, can fill them.

If cost is a concern, I can recommend strategies to minimize your out-of-pocket pharmacy costs, including GoodRx and other discount programs that often make hormone therapy very affordable even without insurance coverage.

Prescriptions are sent electronically to the pharmacy of your choice, including any retail pharmacy like CVS, Walgreens, Costco, or your local independent pharmacy. You don't need to do anything special to set this up; just let us know your preferred pharmacy at your visit.

Many of the medications I prescribe, including hormone therapy, are covered by insurance. At the pharmacy, you'll pay your standard copay or coinsurance just as you would for any other prescription. I use appropriate diagnosis codes on your clinical notes to support insurance coverage wherever possible.

If cost is a concern, I can also suggest discount programs like GoodRx which often make hormone therapy very affordable even without insurance coverage. I'll walk you through your options at your visit.

It varies by symptom and treatment type, but here's a general guide:

• Hot flashes and night sweats, most women notice improvement within 2–4 weeks of starting hormone therapy, with full effect by 8–12 weeks
• Sleep, often improves alongside hot flash relief, typically within the first month
• Mood and energy, usually 4–8 weeks
• Vaginal symptoms, local estrogen can take 8–12 weeks for full improvement, though many women notice some relief earlier
• Libido, typically takes 3–6 months to fully assess

If you're not seeing the response you hoped for, I adjust. Getting the right dose and formulation sometimes takes a visit or two, which is completely normal.

Yes, I see many patients who are already on hormone therapy but feel their current regimen isn't working well, or whose provider doesn't have time to optimize it properly.

Please bring your current medication list, any recent labs, and a summary of your current regimen to your first visit. I'll review everything and work with you to refine your treatment if needed.

Yes, hormone therapy is not appropriate for everyone. Absolute contraindications include:

• Active or recent hormone-sensitive cancers (certain breast, uterine, or ovarian cancers)
• Unexplained vaginal bleeding
• Active blood clots or a history of clotting disorders (though transdermal estrogen has a much lower clot risk than oral)
• Active liver disease
• Pregnancy

Women with certain personal or family health histories may need a more personalized risk-benefit conversation. This is exactly why a thorough intake and health history review is part of every first visit; I assess your individual situation before making any recommendations.

If HRT is not appropriate for you, there are effective non-hormonal options, you won't leave without a plan.

The old guidance that "HRT should only be used for the shortest time at the lowest dose" is being actively revised by menopause specialists. Current evidence supports long-term use for many women when the benefits outweigh the risks and treatment is periodically reviewed.

There is no arbitrary time limit. Many women benefit from hormone therapy for a decade or more. I review your treatment annually and adjust my recommendations as new evidence emerges and as your health circumstances change.

The decision about duration is yours to make in partnership with your provider, not a blanket policy applied to all women.

No, labs are not required before your first visit. If you have recent labs (within the past 6–12 months), feel free to bring them or upload them to the patient portal. They provide helpful context.

If you don't have labs, that's completely fine. I'll discuss whether labs would be useful in your situation and order them if appropriate. For many patients, menopause is a clinical diagnosis based on symptoms and history, labs are supportive but not always required to start treatment.

Lab costs depend on your insurance. Labs are ordered through Labcorp or Quest and billed directly to your insurance, completely separate from your visit fee.

• If you have insurance that covers diagnostic labs: You'll pay your plan's normal cost-sharing (copay, coinsurance, or deductible). Many standard menopause labs are covered under medical necessity with the appropriate diagnosis code.
• If you're on a high-deductible plan and haven't met your deductible: You'll pay the negotiated rate, typically much lower than the sticker price.
• If you're paying cash: A thorough menopause panel typically runs $150–$300 at self-pay rates.

I will always use appropriate diagnosis codes to support insurance coverage of your labs. I cannot guarantee what your specific plan will cover; I recommend contacting your insurer if you have questions about lab coverage.

Results are sent directly to me and will appear in your patient portal. I review every result in full, not just the flagged values, and contact you with a summary and any recommended next steps.

Labs are reviewed promptly between visits; you will never wait weeks for results. Every review includes a written summary of findings, what they mean for your care, and clear next steps.

Lab review and results communication are included for all patients, both pay-as-you-go and membership. You will never be charged separately for receiving and understanding your lab results. Any new dose or medication change will be followed up at approximately 6–8 weeks to assess your response.

You need a smartphone, tablet, or computer with a camera and microphone, and a reliable internet connection. That's it. No app download is required, your visit link will be sent to you before your appointment and you simply click to join.

I recommend finding a private, quiet space for your visit where you can speak freely. A set of earbuds or headphones can help with audio clarity.

For menopause care specifically, yes. The vast majority of menopause evaluation and management is conversation-based: understanding your symptoms, reviewing your history, discussing options, and monitoring your response to treatment over time. None of that requires you to be in the same room.

Physical examination is not a routine part of menopause care the way it is for other conditions. I can see you, hear you, review your labs, prescribe and adjust medications, and provide the same quality of clinical care through a screen as in person.

Yes. All visits are conducted through a HIPAA-compliant telehealth platform. Your health information is encrypted and protected. I have Business Associate Agreements in place with every technology vendor that handles patient information.

Your health information is never shared with third parties without your explicit consent, in accordance with HIPAA privacy rules.

Yes, you must be physically present in a state where I hold an active license at the time of your telehealth visit. This is a legal requirement, not a preference. Please contact me before booking to confirm I serve your state.

If you are traveling outside of these states on the day of your visit, please reschedule. I'm happy to accommodate rescheduling requests with adequate notice.

Yes. GLP-1 medications are part of my practice because weight changes during perimenopause and menopause are directly connected to hormonal shifts, not just lifestyle factors. For women whose menopause transition has significantly affected their metabolism and weight, GLP-1 therapy can be a meaningful part of their overall care plan.

I prescribe Zepbound (tirzepatide) and Wegovy (semaglutide), brand name medications sent electronically to the pharmacy of your choice. I assess whether GLP-1 therapy is appropriate for you as part of your initial or follow-up consultation.

GLP-1 medication costs are separate from your visit fee. I prescribe both brand name and compounded options, and will help you identify what makes the most sense for your situation at your visit.

• Brand name medications: Zepbound (tirzepatide) and Wegovy (semaglutide) are available through standard pharmacies. LillyDirect offers Zepbound starting at $299/month for cash-pay patients.
• Compounded medications: Compounded tirzepatide and semaglutide are available through licensed compounding pharmacies at significantly lower cost than brand name options. These are a legitimate and commonly prescribed alternative.
• GoodRx: Can reduce costs on brand name medications at your local pharmacy.

Yes. I submit prior authorizations for GLP-1 medications at no additional charge — it's included as part of your care. I also work with you to find the most affordable options available, whether that's through insurance or cash-pay alternatives.

Depending on your situation, this may include:

• GoodRx: often significantly reduces the cost of brand-name medications at your local pharmacy
• LillyDirect: Eli Lilly's direct program for Zepbound starting at $299/month for cash-pay patients
• Cost Plus Drugs (Mark Cuban): costplusdrugs.com offers some medications at significantly reduced prices

I will walk you through your best options at your visit based on your insurance situation.

Yes. I prescribe both brand name and compounded semaglutide and tirzepatide, depending on what makes the most sense for your situation. Compounded GLP-1 medications are available through licensed 503A compounding pharmacies and can be a significantly more affordable alternative to brand name options.

At your visit I will go through your options and help you decide between brand name medications through standard pharmacies or compounded versions through a compounding pharmacy, based on your preferences, budget, and clinical needs.

I follow a structured monitoring schedule to make sure your treatment is safe and effective:

• Initial phase: A follow-up visit after your first 2–3 months to assess your response, manage any side effects, and adjust your dose as needed
• Once stable: Follow-up every 6 months

Because I'm already managing your menopause care, your GLP-1 monitoring is integrated into your overall care plan rather than being a separate program. One provider, one complete picture.