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Insurance and Fees

The Sound Clinic is dedicated to providing thorough and holistic care to patients. This includes continuing to take the majority of insurance plans (Medicare and Medicaid are not accepted). We spend more time than the average traditional clinic with each patient to understand overall needs and to put together an integrative care plan. However, due to frequent changes and the complexity of our health care system, we are not able to understand each policy. We feel that this is the patient’s responsibility. Please research your personal out of pocket expenses including prescription coverage and laboratory coverage prior to receiving care.

Physician Fees

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:

  1. New Patient Office Visit: It is dependent on time and complexity of the visit; $243-$300 – Insurance codes – 99204 (moderate complexity) and 99205 (high complexity)

  2. Established Patient Office Visit: It is dependent on the time and complexity of the visit; $157-$212 – Insurance codes – 99214 (moderate complexity) and 99215 (high complexity)

  3. Osteopathic Manipulation Evaluation and Treatment: New patient – $220-290 Follow up – $175-220 – Insurance codes: 99204 (new) or 99214 (follow up) and procedure code of 98928 or 98929.

  4. Therapies: These are generally not covered by insurance. However, refer to each individual therapy for more details and specific costs.

Phone Consults Vs TeleHealth Visits

We understand that patients have busy schedules and cannot always schedule an appointment to review labs or to ask additional questions.

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.

TeleHealth Visits: These appointments are currently available ONLY for patients of the primary care team (Lyndsay Naylor DO, Donna Diamond DO, Sarah Tyler NP and Sonia Mookherjea PA-C). 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. A link is sent via email to the patient for the online "waiting room." Please keep in mind that not all primary concerns are appropriate for a TeleHealth appointment and are limited to 15 and 25 minute time slots. In addition, there are a limited number of TeleHealth appointments available with each practitioner.

Billing Questions

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)

Phone: #303-857-4397

Email: billing@soundclinic.com

 

Insurance Definitions 

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.