We understand that patients may have a high deductible, not have coverage for services that are considered ‘out of network’ or not have insurance at all. In the spirit of transparency to assist with planning ahead, below is a general outline of the fees for office visits for new and established patients. This does not include any service or procedure provided by the practitioner.
The prices listed below represent a 20% discount that is offered in exchange for payment in full at the time of service. Adjusted rates allowed by insurance carriers are typically similar or slightly less.
Office Visits and Therapies
New Patient Office Visit: It is dependent on time and complexity of the visit; $331-$414 – Insurance codes – 99204 (moderate complexity) and 99205 (high complexity)
Established Patient Office Visit: It is dependent on the time and complexity of the visit; $216-$291 – Insurance codes – 99214 (moderate complexity) and 99215 (high complexity)
Osteopathic Manipulation Evaluation and Treatment: Osteopathic manipulation is billed to insurance as a procedure while the evaluation and medical management is billed as an office visit; both codes are always sent to insurance. Verification of coverage can be determined by asking your insurance carrier of the frequently used osteopathic procedure code of 98928 and the office visit of 99204 or 99214. Please contact your insurance carrier prior to your first appointment to better understand your benefits and out of pocket expenses. Cash Prices (Paid at time of appointment) New patient - $250 and Est. patient - $203
Annual/Well Child Exam and Annual/Well Child Plus Exams: At this time, most of our Annual and Well Child Exams are scheduled as PLUS exams. This is a Preventive Visit + Office Visit. The preventive part of the exam is to review all traditional age appropriate screening tests and labs. The office visit is for our integrative counseling services, review of other questions/needs. Both the Annual Exam/Well Child Check and the office visit are billable to insurance. However, the office visit may trigger copay/fee based on a patient's insurance plan and deductible.
Hormone Pellets: Pellet therapy is not usually covered by insurance. The total cost for women ranges from $355-$450. The total cost for men ranges from $600-$695. The difference in cost is dependent on dosage, complexity of the visit and insurance coverage. Insurance may cover a portion of the visit and the out of pocket expense would be less in that situation. Please contact our office or billing service for more information.
Group Sessions: These are billed to insurance as an office visit. The most commonly used code is 99214. Copays and coinsurance apply. Please contact your insurance company to understand your out of pocket expenses.
Therapies: These are generally not covered by insurance. However, refer to each individual therapy for more details and specific costs.
Phone Consults Vs Telemedicine Visits Vs Portal Visits
Often times patients have busy schedules and cannot schedule an in office appointment to review labs or to ask additional questions. This is the opportunity to consider a Phone Consult or Telemedicine appointment with your practitioner.
Phone Consults: These appointments are available to ALL patients from ALL Sound Clinic practitioners. A phone is all that is needed. Phone consults are not covered by insurance.
Telemedicine Visits: These appointments are currently available for ALL patients during COVID-19 high alert period. They are billable to insurance although deductibles and copayments still apply. Good wifi access and a device with video is needed (smart phone or computer). These appointments are made with the front office. Please keep in mind that not all primary concerns are appropriate for a Telemedicine appointment and are limited to 15 and 25 minute time slots. In addition, there are a limited number of Telemedicine appointments available with each practitioner. Refer to our Telemedicine page for additional information and to access the online “waiting room” for your scheduled telemedicine appointment.
Portal Visits: A portal visit is digital communication with the practitioner and billed at $15 for 5-10 minutes of the practitioner time (outside of the appointment) or $31 for 11-21 minutes. They are billable to insurance. These visits are not appropriate for all questions. There are times that the practitioner will recommend an in office visit or Telemedicine appointment rather than a portal visit.
The Sound Clinic has a billing service that assists with processing all bills. They are happy to assist with questions regarding your bill and insurance. However, it is important for each patient to assume responsibility for understanding their insurance plan.
KV Physicians Billing Service Hours: Monday – Thursday 9am-4pm (MST)
Deductible: The amount you have to pay out-of-pocket for expenses before the insurance company will start to cover their portion.
Coinsurance: Percentage that Insurance does not cover. 70/30 plan=Insurance pays 70% of allowed and Patient pays 30%. This typically comes into play after you have met your deductible.
Copay: Fixed fee for your office visit that is due from the patient. Depending on services acquired Coinsurance or Deductible may still be owed on additional services outside of an office visit.