I worked with Dr. Bismah Irfan as an out-of-pocket nephrology patient via telehealth through her 12-week Health Optimization Program, which was priced at $15,000. While I appreciated her functional perspective, I ultimately had concerns regarding communication, clarity of care, and program transparency. Communication through the patient portal was often brief and frequently required follow-up on my part. For example, I sent a message on October 9, 2025 expressing concern about hypertensive crisis levels of blood pressure and the strain this was placing on my body. After receiving no response, I followed up on October 13, 2025. I received a brief acknowledgment on October 14, 2025, and a concrete medication change was not proposed until October 17, 2025. When I later raised concerns about response timing, I was told I should not expect replies within two days if the physician was attending a conference and was also reminded that she had other patients. This raised concerns for me about continuity of care and coverage during absences. During my time in the program, it was never clearly explained what Dr. Irfan believed to be the underlying cause of my chronic kidney disease or how her recommendations were intended to address it. I did not receive a clearly outlined treatment plan, which made it difficult to understand the overall direction of care. There were also instances where prior information appeared to be forgotten or revisited inconsistently, such as medications I had already tried or whether certain recommendations (for example, sodium bicarbonate for low CO₂ levels) had previously been discussed. This contributed to delays in addressing specific issues. Regarding program scope, the written outline I received for the $15,000 Health Optimization Program listed five one-on-one visits and specific advanced diagnostic tests as included. Several of the listed tests were not ultimately ordered. At one point, after some test results were received, I was advised to purchase an additional test out-of-pocket because Dr. Irfan stated it was not included in the program and seemed uncertain how to proceed with my care without it. The program also advertised a fully personalized nutrition plan with recipes and a shopping list. What I received consisted of a small number of basic recipes generated through EatLove, a third-party digital nutrition platform. The materials did not reflect a level of customization specific to my situation beyond general recommendations, which differed from my expectations based on how the program was described. I also encountered discrepancies regarding pricing transparency. The patient portal reflected a $12,000 program option, while I was charged $15,000. After I raised this concern, the lower-priced option was removed from the patient portal without being updated or replaced. After raising concerns regarding communication and pricing, my care was terminated. Dr. Irfan stated that continuing to work with me would be too stressful for her and that there was “no love between us.” The termination occurred without assistance in transitioning to another nephrologist. Patients considering this practice may find benefit depending on their needs but may want to ask detailed questions upfront about communication expectations, care planning, pricing transparency, what testing is included versus billed separately, and transition-of-care policies.
Tamara Manson · Published January 26, 2026