Office Visit

I saw a post in another thread in which the person stated that she has not health insurance and pays out of pocket for an office visit to her doctor.

She pays $60 per office visit.

Is that typical?

I realize that most doctors have several ways they classify office visits depending on how much time they spend with you.  You see something that says OV I, OV II, OV III, or OV IV on your form.

I'm lucky enough to have health insurance.  So for my wellness (preventive) office visits, I just pay $15.  That's usually my annual gyn exam and I believe they charge the insurance company $250-ish plus more if they do any blood tests.

But for my sick visits, I have to meet a deductible and then pay 20%.  An OV I is $107.  An OV III is $178.  Don't know how much an OV IV is.

I was just wondering why I'm paying 40% more for my office visits than other people.  Do medical charges vary depending on whether you're rural or urban (like cost of housing)?  I'm paying more and I'm in a small town.

I think it depends largely on the location and state. I do know that insurance companies pay what is 'reasonable and customary'. Have you considered calling around and getting quotes?

I don't really know about the coding (i.e. OV I, OV II...etc), but I know that the normal charge for an office visit is about $70, no matter what the reason for going is. My insurance picks up most but my co-pay is still $30. I used to pay $0 but my contract with health insurance is always changing....weird considering I'm UAW (until the end of the month), and there's still a presumption that we have the best insurance coverage out there.

Original Post by trendstudent:

I don't really know about the coding (i.e. OV I, OV II...etc), but I know that the normal charge for an office visit is about $70, no matter what the reason for going is. My insurance picks up most but my co-pay is still $30. I used to pay $0 but my contract with health insurance is always changing....weird considering I'm UAW (until the end of the month), and there's still a presumption that we have the best insurance coverage out there.

yes, my understanding is that your insurance is 'gold-plated'

re 1:  my employer pays for my insurance, so it's hard to say if I'd somehow be better off to buy a policy in addition to that?

I've seen different costs even within the same region. Some docs around here charge $60 and another few I know of charge as much as $85 for a routine office visit.  I know the ins. co. only pays off what they "allow" and that varies from company to company, just like the co-pays do.

As a former medical claims adjuster for a W/C insurance co, I can help a little.

Mostly, it depends on the Dr, they can charge private parties (you) whatever they want.  So the same services at differnt Drs can cost differnent amounts.   This COMPLETELY sucks, because most states have laws protecting the insurance companies and making it where they CANNOT charge ins co's more than the Medicare rate + a set %, or some states have set "usual and customary" rates.   But NO ONE is looking out for those with no insurance or those like you, looking to meet a deductible.  They get charged whatever the Dr darn well feels like.  The only sort of good news is you can try to negotiate on your own.  A lot of times they are willing to accept a reduced payment, especially if you can call them with a sob story.  They'd rather get paid some, than none, and have to pay a collection agency, who would likely get a 20-25% cut anyway.

Rules to remember - The nicer the office, guess what, the more you are going to pay - example - I have no insurance now.  An appt to see a PA in our Rural Health Clinic (located in a modular building with limited Xray & lab facilities) is $60 - fine for a kid with an ear infection.  A Dr appt in the same RHC is $80.    Now we had a possible broken arm last year, so I went ahead and took her into "town" at a "real" office and was charged $100, just to see a PA! 

So it does pay to shop around.  My mom called around several Drs in our area to get a fair office visit charge.

Original Post by nomoreexcuses:

Original Post by trendstudent:

I don't really know about the coding (i.e. OV I, OV II...etc), but I know that the normal charge for an office visit is about $70, no matter what the reason for going is. My insurance picks up most but my co-pay is still $30. I used to pay $0 but my contract with health insurance is always changing....weird considering I'm UAW (until the end of the month), and there's still a presumption that we have the best insurance coverage out there.

yes, my understanding is that your insurance is 'gold-plated'

re 1:  my employer pays for my insurance, so it's hard to say if I'd somehow be better off to buy a policy in addition to that?

 

 No. I meant calling around to doctor's offices in your area and just getting quotes for office visits.

thanks for that, thmheh

I've been going to this particular family practice office for a really long time and have been very happy with the care

i hate having to go to a new doctor (especially for the .. you know.. pelvic exam stuff)

We have two major hospital/clinics in our city.  One is more expensive than the other.  Consequently, we have two tiers for our insurance.  If I want the more expensive hospital/clinic I have a $20 copay, if I choose the less expensive one I pay $10.  Standard of care is not better at the more expensive one.  I think it has more to do with the contract the insurance company could get with the two different systems. 

As for the original question, my physical last year was $157.89.  That was for the yearly physical...which I don't have a copay for.  The lab for the pap was another 85.33.  I think it is less to go in for a shorter appointment. 

They charge everyone the same, the difference in what they charge and what they are paid is a matter of their contract with the insurance company.  I don't think it would be legal to charge a person without insurance more than they charge someone with insurance. 

Yes it depends on the doctor. I do billing for a doctor and we charge our new no insurance patients anywhere from 75-135 it depends on there condition. He is a eye surgeon so if a patient has more problems the he charges more for the office visit and then usually he does not charge for the tests.Which basically means they are getting a 400-500 dollar work up for 135. But I do know alot of doctors who don't give discounts for that. (My doctor says over and over again they he did not become a doctor to make money)

As far as your ded. goes yes in most cases you are paying more than cash patients. Doctors have a negiotated (sp?) rate and that is what they charge you. But it is because they have the contracts with insurance companies that they can give cash patients the discount.

Also when I don't have insurance my derm. only charges me $40 a visit and my daughters doctor only charges me $55 which isn't bad.

My copays for doctor visits are $25. My Gyn charges $100 for a regular visit. My primary physician charges $120. I looked through my latest med claims and only saw those charges for office visits, so I don't know if they have tiered charges depending on services provided. The gyn listed other charges besides her fee so I'm assuming $100 is just to see her and then everything else is itemized.

I'm not sure how often this works but you could try and negotiate a cash price. For some weird reason, I had Blue Cross / Blue Shield insurance and I could see whichever doctor I wanted. However, if it was at all foot-related, I was covered under National Foot Care and you had to go to one of their doctors for treatment - unless it was a trip to ER.

Well, I'm embarassed to say that I didn't know this and I went to my GP for a swollen foot and broken toe. I got a full-rate bill about 2 months later. I called the doctors office and explained what happened. I asked "Is there a discount if I can pay this in cash?" She said yes and we negotiated about 30ish% off.

Asking for discount does work most doctors will give discount. I give all my ER cash patients 30% off automatically. (even though they usually don't pay)

I was uninsured but I only went to local clinics.  It cost me $40 for a Pap at the women's health clinic.  Then I had to get a tetanus shot so I went to the county health clinic and it was free. 

My primary doctor can't take my insurance.  I pay anywhere from $50 to $120 depending on the type of visit. She is willing to wait for her money though.  I don't go often because she can't write me lab slips or order tests and most of what I need is from specialists. The one time she wanted a test ordered she took me down the hall to her husband's office (he's a surgeon) and had him write it and give her the results.  They are really good people.  In January I'll have new insurance so it won't be a problem. 

Our out of pocket is only $20... but our doctor charges more than our insurance will cover and we almost always end up with a bill. The last physical we had was supposedly worth $400! Ridiculous for five minutes with the doctor and a couple of simple blood tests and pee-in-the-cup.

I do medical billing for docs and the family practice docs I billed for usually gave a %20 discount for cash pays.  I also billed for one nurse practioner who billed $100 for a new patient and $75 for each other visit.

If you are going to a provider who isn't contracted with your insurance carrier then they can basically charge you their fee schedule but if they are contracted then they can only charge you the contracted allowable.  

To get an idea of what a dr gets paid by medicare you can check online the Medicare website for providers for your state.  for example the state of AZ allows anywhere from $20 to $65 for a established patient office visit depending on the level of care ( your I, II, IIetc....) most private pay insurance companies base their allowables on Medicare's fee schedule as well, however its usually 105% - 110% - now if you have Aetna their allowable is based on Medicares fee schedule in 2002.  I think most doc offices try to offer some discount for cash pays.  I also know most docs really prefer cash pays cause then they don't have to fight with any insurance company for their money.

Just $60? Good gawd.

My primary care physician costs $120, but I pay a co-pay of $20.

The specialists average around $150 a visit, but I pay a co-pay of $30.

$60, to me, doesn't really sound that bad considering she doesn't have insurance.

I would just never want to chance it not having insurance. I've never been more sick than bronchitis or a broken foot. But on the off chance that I could develop cancer or need gall bladder surgery or anything more severe, I would not want to accumulate those medical bills. The out of pocket cost with insurance is bad enough.

20 dollars here with insurance. 30 for specialists. Without insurance it was 80-250.  Co pays are better than the unknown for sure. Hospitalization...I don't even want to think about that.

Some doctors' offices charge patients without insurance a lower price that's more affordable.  My chiropractor does that for me because my insurance doesn't cover chiropractic.  Of course they're going to get as much out of the insurance companies as they can!