Bio- Identical Hormone Evaluation and Testing Cost and Billing Information

Office Visits

As a courtesy we will bill insurance companies with whom we have a contract for your office visit. If you have a large deductible and you have not completely met your responsibility for that deductible we will require payment for your service at the time of the visit as you are responsible for these costs until your deductible is fully met. If you ask us to bill you for the portion of your deductible that you owe we will add a $45.00 “billing fee” to cover staff costs for billing to your total visit charge. You will be responsible for this fee as your insurance will not cover that charge.

If we do not have a contract with your carrier and you are “out of network” or you have no healthcare insurance your visit will be Self Pay. We have reasonable cash pay prices. You will be asked to pay for your visit at the time of service. Please come prepared to pay for these charges with cash, checks, or credit cards.

Our policy is as follows:

Initial visit:

  1. As a new consultation patient you will be billed an extended new patient visit charge (99205). If your visit takes longer than 60 minutes you will also be billed an extended visit code (99354).
  2. If you are an established patient you will be billed an extended office visit (99215 as well as an extended visit code 99354) for the extended length of time this initial interview and exam necessitates.
  3. If you are cash pay the initial new hour visit will be $400.00 due the day of service, and additional 15 minute blocks of time, if required, are $100.00.

Second visit:

Test review and treatment planning – This will also be an extended visit to allow us time to review your lab studies together and plan a personalized management program. We will charge an extended standard office visit (99215) due to the extra time and coordination this visit requires. If we require more than 40 minutes we will also bill an extended office visit charge (99354). Cash pay or out of network patients will be required to pay $300.00 at the time of the visit for up to a 45 minute appointment. $100.00 is charged for any additional 15 minute blocks of time required.

Third and Subsequent visits:

Generally these follow-up visits require less time.

Insurance visits: these will be billed as a regular office visit. Depending on your need to discuss and/or modify your treatment regimen, i.e. if you are having problems or require extra time to discuss your clinical situation, a higher visit code may be required. (99214 for 15 minutes or 99215 for 30 minutes).

Please be advised that if you have a high deductible policy and we are contracted with your insurer we MUST bill your visit and labs. You are not eligible for cash pay prices. These charges will go towards your deductible. Also, if you have a high deductible and it has not been met for the year you will be personally liable for any and all office charges up to and until your deductible has been met. Please come prepared to pay for these costs AT your visit as you know you are liable for them. If you ask us to bill you for a visit when you have a deductible remaining, we will add a $45.00 “billing fee” to your total to cover staff costs for billing services. Your insurance will NOT cover this and you will be responsible for this charge. We will issue a refund if your carrier pays us.

Cash pay or out of network visits: patients will be required to pay $100.00 at the time of the visit for a 15 minute visit. Depending on your need to discuss and/or modify your treatment regimen, i.e. if you are having problems or require extra time to discuss your clinical situation, additional time charges of $100 for 15 minutes would be required. (i.e. 30 minutes would be $200.00).

Testing

We will bill contracted insurance carriers only for standardized blood testing. Saliva testing is not billable. Stool and many urine tests are so poorly reimbursed by insurance that this is often below our charge from the testing laboratory. These are payable at the appointment.

We will discuss more advanced testing with you. Many we will not bill. If we have experience that some are partially covered by insurance we will ask you to sign an ABN or Advanced Beneficiary Notification. Most insurance carriers are becoming increasingly reluctant to pay for advanced testing not offered by standard laboratories often giving the reason that these tests are experimental, or are simply not covered. The ABN states that you want the test and are willing to pay for it should the insurance not pay for it. It will also list the maximum out of pocket cost you would owe us if your carrier paid nothing. Some carriers will only cover a portion of some specialty testing performed at specialized labs that we may feel is necessary to help diagnose your condition. You will be responsible for paying any cost not paid by your carrier up to the ABN maximum even if your insurance denies payment for the testing, which is the reason for the ABN form.

Lab Cost Guide

The lab work ordered for each individual will of course be variable based on their unique history and clinical situation. A list of cash prices for the most commonly ordered labs is noted below. The most common combination will be a 21-25 combo panel saliva hormone test, a stool test (the regular GI panel) and stress hormones, as well as blood work for Advanced Thyroid studies, B12, Folate, Iron, and Vitamin D and a blood draw fee. The total for these tests could be $600.00 or more for a cash pay visit. Please come prepared to pay for these at the time of service. Additional testing deemed necessary will be discussed and would be at additional cost.

Saliva/Stool Testing

Female Hormone Panel $155.00
Male Hormone Panel $165.00
Adrenal Stress Hormone Panel $195.00
Combination Panel 10-15 tests
$270.00
Combination Panel 16-20 tests $320.00
Combination Panel 21-25 tests $370.00
Female Cycling Hormone Panel $350.00
Regular GI Panel $310.00
Extended GI Panel $370.00
Saliva Gluten IgA Ab Only $65.00

Blood Testing

Blood Draw Fee $20.00
CBC $16.00
CMP $20.00
Lipid
$20.00
VAP Cholesterol
$100.00
IGF-1
$70.00
hs CRP $30.00
Thyroid – TSH, Free T4, Free T3, rT3, Thyroid Antibodies $93.00
Thyroid above + Vit D $133.00
Vitamin D
$40.00
Estradiol $33.00
Progesterone $55.00
DHEA $20.00
Sex Hormone Binding Globulin (SHBG)
$60.00
Testosterone Free and Total $75.00
Dihydrotestosterone (DHT) $99.00
LH $20.00
FSH $20.00
PSA $36.00
Pregnancy $34.00

Why are cash prices sometimes lower than billed insurance charges?

First, insurance billing requires extra staff. This increases our cost of providing your service. Second, we often must wait for months to be paid depending on the insurer. Third, each insurer marks down the billed charge to a level determined by your employer’s negotiated fee schedule, which is variable even in one carrier, say Blue Cross. Often this negotiated fee does not cover our cost of specialized testing charged by the laboratory performing the testing for us.

Supplements

We carry and sell pharmaceutical quality nutritional supplements from superior manufacturers that we have personally investigated, and take, to make sure that they will provide the benefit we intend them to. If we recommend nutritional supplements at your visit(s) to start or adjust your healing program you will be asked to pay for those at the time of your visit. We will issue you a letter to cover your use of  defined benefit plan funds if you purchase supplements from us.

If you decide to purchase supplements elsewhere we cannot know the ingredient quality or whether they will provide the benefit we know the supplements we utilize will. We will not issue a letter to support use of defined benefit plan funds for supplements not purchased from us.

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