Cost of a follow up visit

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dense
dense Member Posts: 48
edited June 2014 in Stage I Breast Cancer

I have a high deductible insurance plan.  I went for a 3 month follow up visit with the NP at my oncologist's office.  I guess the visit lasted about 1/2 hour.  She examined me, we talked about tamoxifen treatment side effects that I have been experiencing, and she gave me a prescription for vitamin D and an anti-depressant to help with hot flashes.  The bill came in at $230.  Is that reasonable?  Seems very high to me.

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  • chickadee521
    chickadee521 Member Posts: 564
    edited February 2012

    Dense-I just got the EOB from my insurance company for my 6 month visit.  I saw the MO not a NP.  Spent about the same amount of time with her, infact had almost the same discussion and outcome (except I didn't get an anti-depressant because my hot flashes aren't that bad).  Anyhow the bill was 229, but the negociated rate with the insurance company was 99.  I also had bloodwork done.

    To me your 230 seems high especially if you didn't have blood work

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  • sewingnut
    sewingnut Member Posts: 1,129
    edited February 2012

    Even with high deductable plans the office should submit the claim.  Insurance companies have a Usual Customary charge. You should be paying that instead of the full amount.

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  • dense
    dense Member Posts: 48
    edited February 2012

    That is AFTER insurance adjustment.  Before the insurance adjustment it was $383. The cancer center at the hospital had 2 fees: 280-oncology, and 969 - other pro fee.  I have no idea what this means.  Is that normal billing?

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  • susan_02143
    susan_02143 Member Posts: 7,209
    edited February 2012

    My oncologist vists are billed at $382 for a half hour and then insurance-negotiated at $233.70. Yes. This is very normal.

    *susan* 

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  • chickadee521
    chickadee521 Member Posts: 564
    edited February 2012

    Ok you peaked my curiousity so I went and grabbed my EOB to make sure I was right.  The medical facility billed $390 (neg to $74) and the MO billed 229 (neg to $99).  I also paid a $25 co-pay.  So if you add up the 3 I was at about $200.

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  • GottaloveNED
    GottaloveNED Member Posts: 211
    edited February 2012

    Mine is roughly the same. My onc charge is $125 and the cancer center charges in the range of $100-$250 depending on services/bloodwork. I also have a HDHP with a $2500 cap, so I'm on the buy 3 get one free plan by the time you count my other medical costs.

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  • DocBabs
    DocBabs Member Posts: 775
    edited February 2012

    I pay $375 each time I see my oncologist. So far I've had no bloodwork or xrays and I'm 9 months post diagnosis and I've seen her 3 times.

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  • sewingnut
    sewingnut Member Posts: 1,129
    edited February 2012

    Dense,

    I would question the "oth prof fee". Sounds like you had a straight up office visit. That should have been the only thing they billed for.  Call your insurance company and ask them what codes they billed . The codes will vary according to time spent with you and degree of medical decision making. You can type the code into your search engine and it will tell you about that code.

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  • coraleliz
    coraleliz Member Posts: 1,523
    edited February 2012

    My most recent MO bill was $230. I saw the MO. I paid a $35 copay & my insurance paid $55.14. The rest was written off because it was "in network". Maybe ask for a reduction. I've done that in the past with out of network claims.

    "other pro fee" might mean nurse practioner or PA

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  • 1openheart
    1openheart Member Posts: 765
    edited February 2012

    I just got my EOB from my insurance company today and my last 6 mos. visit to onc was $230.  No blood work.  She just felt my boobs up, and talked about my tamoxifen SEs....all in all...about 15-20 minutes.  I had a $30 copay. 

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