In order to establish the doctor-patient relationship, the first visit must be in person. After that virtual and phone visits are possible. If you are unable to come in person to the first visit, Dr. Karney may be able to help you as a health coach, but not as a physician. In the case of you needing any prescriptions filled, Dr. Karney would need to be your physician. Insurance companies may reimburse for physician visits but not health coaching visits.