Functional Medicine and Hormone Evaluation and Testing Cost and Billing Information
Insurance Office Visits
As a courtesy we will bill insurance companies with whom we have a contract for your office visit. 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 or an extended visit code may be required.
Please be advised that if you have a high deductible policy and we are contracted with your insurer, we MUST bill your visit. 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 responsible to pay for any and all office charges ON THE DAY OF SERVICE until your deductible has been fully met. We will NOT bill you for these charges so please come prepared to pay for these costs AT your visit. We will issue a refund if your carrier pays us.
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. You will be given a receipt for your payments BUT we will NOT issue specialized billing paperwork as you were given a self pay discount and preparation of this specialized billing paperwork requires inordinate amounts of staff time.
Cash pay or out of network visits
You will be required to pay for your visit that day. Our cash pay prices are simple – $100.00 for a 15 minute visit, or $200 for a 30 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. 45 minutes would be $300.00, 60 minutes $400.00, etc.).
Our policy is as follows:
- As a new insurance 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).
- If you are an established insurance 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.
- If you are cash pay the initial new hour visit will be $400.00 due the day of service. If your visit takes longer than 60 minutes you will also be charged for the extended time needed for this which is billed in 15 minute increments of $100.00.
Test review and treatment planning – This will also be an extended insurance 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 $200.00 at the time of the visit for up to a 30 minute appointment. $100.00 is charged for any additional 15 minute blocks of time required for us to plan your treatment program.
Third and Subsequent visits:
Generally these follow-up visits require less time.
As a courtesy we will bill insurance companies with whom we have a contract for some “basic” labs. There are many laboratory studies we utilize in our functional medicine assessment to discover the ROOT CAUSE(S) of your health problem that your know insurance will NOT cover and you will be asked to pay for these at the time of your visit.
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.
|Female Hormone Panel||$155.00|
|Male Hormone Panel||$165.00|
|Adrenal Stress Hormone Panel||$195.00|
Combination Panel 10-15 tests
|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 Draw Fee||$20.00|
|Thyroid – TSH, Free T4, Free T3, rT3, Thyroid Antibodies||$93.00|
|Thyroid above + Vit D||$133.00|
Sex Hormone Binding Globulin (SHBG)
|Testosterone Free and Total||$75.00|
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.
We carry and sell “physician quality” nutritional supplements from superior manufacturers that we have personally investigated, and personally 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.
Remember – you are buying supplements to improve your health – which is a priceless commodity, and shopping by price alone is foolish. The supplements sold at Walmart, Sams, Walgreens, CVS, etc. often contain cheaper ingredients as the motivation is to maximize profit. They may be fine for the “lone rangers” trying to help themselves, but you are paying for my expertise to help your body heal. Shop for your maximum health potential.