$683 for an office visit with a Physician Assistant?

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fredflinstone
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$683 for an office visit with a Physician Assistant?

Post by fredflinstone » Thu Jan 26, 2012 7:20 am

I'm accustomed to expensive health care bills, but this one is tough to swallow: $683.00 for an office consultation with a Physician Assistant (CPT code 99245).

Because of a "contractual adjustment" negotiated by my insurer, the total billed to me is "only" $399.70. To talk to a Physician Assistant!?

beareconomy
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Re: $683 for an office visit with a Physician Assistant?

Post by beareconomy » Thu Jan 26, 2012 8:20 am

Maybe I should not have gone to medical school.

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Re: $683 for an office visit with a Physician Assistant?

Post by dhodson » Thu Jan 26, 2012 8:28 am

i can only hope you had a very very very complicated problem or a laundry list of problems bc that is the highest level code for a consult. I havent billed that level in several years bc it is extremely uncommon in my situation. I also find it disturbing that you could need such a high level of care and an actual physician not be involved in the office visit (i assume they are supervising this PA via the chart notes). This is also 2-3 times the cost that a typical insurance company would pay for such a level, assuming it is appropriate.

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Re: $683 for an office visit with a Physician Assistant?

Post by Grt2bOutdoors » Thu Jan 26, 2012 8:40 am

Had a simple blood test done (RBC/WBC), an outside lab would cost me $15, since it was done in a "hospital setting", insurance was billed $627.81, I had to pay $170 for it. Never again, if the doc wants tests run, I'm using an outside lab. The medical profession then wonders why people are aggravated.
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Re: $683 for an office visit with a Physician Assistant?

Post by DesertOasis » Thu Jan 26, 2012 9:16 am

GRT2BOUTDOORS wrote:Had a simple blood test done (RBC/WBC), an outside lab would cost me $15, since it was done in a "hospital setting", insurance was billed $627.81, I had to pay $170 for it. Never again, if the doc wants tests run, I'm using an outside lab. The medical profession then wonders why people are aggravated.
Totally agree. Last year I had a 15 minute consultation with a specialist doc after a routine blood test. I was billed $234 over and above my $15 co-pay for "hospital services". Just because my appointment took place in a clinic (what they call a hospital setting). I would be ok if they increased my co-pay. At least that would be above aboard.

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Re: $683 for an office visit with a Physician Assistant?

Post by HearDoc » Thu Jan 26, 2012 9:22 am

A level 5 visit with a PA? I'd find another practice. This one seems more concerned with maximizing
their billing than providing concerned care.

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Re: $683 for an office visit with a Physician Assistant?

Post by fishndoc » Thu Jan 26, 2012 9:26 am

I would send a letter to the supervising physician asking for an explanation for the charge and why your visit required such a complex evaluation. If the answer isn't satisfactory, I would find another physician.
And possibly send a letter to the insurance company explaining what happened, and why you feel the charge was not justified.

BTW, how much time face-to-face did the PA actually spend with you? Unless it's changed, there used to be a minimum time required for the more complex evaluation codes.
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Re: $683 for an office visit with a Physician Assistant?

Post by The Wizard » Thu Jan 26, 2012 9:36 am

GRT2BOUTDOORS wrote:Had a simple blood test done (RBC/WBC), an outside lab would cost me $15, since it was done in a "hospital setting", insurance was billed $627.81, I had to pay $170 for it. Never again, if the doc wants tests run, I'm using an outside lab. The medical profession then wonders why people are aggravated.
Hospitals have "overhead" that needs coverage.
Lots and LOTS of overhead.
They have people who wear SUITS who need to get paid...
Attempted new signature...

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Re: $683 for an office visit with a Physician Assistant?

Post by linuxuser » Thu Jan 26, 2012 10:04 am

fredflinstone wrote:I'm accustomed to expensive health care bills, but this one is tough to swallow: $683.00 for an office consultation with a Physician Assistant (CPT code 99245).

Because of a "contractual adjustment" negotiated by my insurer, the total billed to me is "only" $399.70. To talk to a Physician Assistant!?
My primary care physician is a one-person practice. Just the doctor, the nurse, and a part-time receptionaist.
My last year's annual exam that the doctor claimed from the insurance company was $320. The blood and urine work was done in-office and insurance claim was $15. I'm in NJ.

Your office visit seems extremely high.

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Re: $683 for an office visit with a Physician Assistant?

Post by dhodson » Thu Jan 26, 2012 10:20 am

fishndoc wrote:I would send a letter to the supervising physician asking for an explanation for the charge and why your visit required such a complex evaluation. If the answer isn't satisfactory, I would find another physician.
And possibly send a letter to the insurance company explaining what happened, and why you feel the charge was not justified.

BTW, how much time face-to-face did the PA actually spend with you? Unless it's changed, there used to be a minimum time required for the more complex evaluation codes.

amount of face time is not a requirement for billing. you can bill based on face time but for a level 5 it would be a long time.

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Re: $683 for an office visit with a Physician Assistant?

Post by HearDoc » Thu Jan 26, 2012 10:26 am

linuxuser wrote:
fredflinstone wrote:I'm accustomed to expensive health care bills, but this one is tough to swallow: $683.00 for an office consultation with a Physician Assistant (CPT code 99245).
My last year's annual exam that the doctor claimed from the insurance company was $320. The blood and urine work was done in-office and insurance claim was $15. I'm in NJ.
.
That's an warning sign. It would be highly unusual that a solo practice would have the sophisticated blood analysis equipment that I'd expect on an annual physical
workup. Are you sure the blood panel was done in office?

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Re: $683 for an office visit with a Physician Assistant?

Post by nisiprius » Thu Jan 26, 2012 10:30 am

It seems out of line to me, not because it was with a PA, rather than an MD--I don't know what that differential should be--but because it was an office visit.

Unless that bill included a bunch of lab work and imaging and things that were all lumped together. During that visit, how many rooms did you sit in and how many different people in white coats besides the PA (doctors, nurses, technicians, phlebotomists) did things with you?

I am in a "market" with a reputation for good health care and high costs. I see that for a "25 minute visit" my PCP (an M.D.) billed $160 and accepted $115. A specialist billed $425 and accepted $160. Another specialist billed $270 and accepted $160 for the exam, and on the same billed $140 and accepted $50 for making a picture with a tabletop high-tech device.
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Re: $683 for an office visit with a Physician Assistant?

Post by nisiprius » Thu Jan 26, 2012 10:35 am

HearDoc wrote:
The blood and urine work was done in-office...
It would be highly unusual that a solo practice would have the sophisticated blood analysis equipment that I'd expect on an annual physical workup. Are you sure the blood panel was done in office?
That does seem odd.

I used to go to a doctor who did his own blood and urine work--hand room full of centrifuges, microscopes, and hemoglobin spectrometers.

But that was in 1950.

More recently I used to visit a doctor who did his own lab work, had a blood-gas analysis machine and the whole nine yards. But he was a veterinarian, and the patient wasn't me.
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Re: $683 for an office visit with a Physician Assistant?

Post by HueyLD » Thu Jan 26, 2012 10:41 am

A few years ago, I went to my PCP' s office for a flu shot. I thought it was going to be a quick in-and-out visit, just like my previous flu shot visits to a different PCP in another state.

Well, I was forced to sit down with a PA for about 7 minutes (not counting the wait time for the PA) to update my chart because that was what they recommended for all simple flu shot visits. So, instead of billing the insurance company for about $20 of allowed cost, they billed the insurance company for a full office visit at about $300.

I considered their action unacceptable and on the verge of insurance fraud. Needless to say, I have not returned to that PCP office ever since.

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Re: $683 for an office visit with a Physician Assistant?

Post by brianH » Thu Jan 26, 2012 11:38 am

GRT2BOUTDOORS wrote:Had a simple blood test done (RBC/WBC), an outside lab would cost me $15, since it was done in a "hospital setting", insurance was billed $627.81, I had to pay $170 for it. Never again, if the doc wants tests run, I'm using an outside lab. The medical profession then wonders why people are aggravated.
I can recommend these guys: http://www.directlabs.com/ Even with insurance, their prices are lower than what the typical OOP charge is after insurance. Another benefit is doing whatever test you want; no doctor required. Something is way wrong with the system.

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Re: $683 for an office visit with a Physician Assistant?

Post by fredflinstone » Thu Jan 26, 2012 11:46 am

dhodson wrote:i can only hope you had a very very very complicated problem or a laundry list of problems bc that is the highest level code for a consult. I havent billed that level in several years bc it is extremely uncommon in my situation. I also find it disturbing that you could need such a high level of care and an actual physician not be involved in the office visit (i assume they are supervising this PA via the chart notes). This is also 2-3 times the cost that a typical insurance company would pay for such a level, assuming it is appropriate.
in fairness, it is a complicated problem. The PA spent nearly an hour with my daughter Pebbles. We would have preferred that she see a physician but none was available at the time. I believe the PA left the room and consulted with one or more physicians during the visit.

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Re: $683 for an office visit with a Physician Assistant?

Post by fredflinstone » Thu Jan 26, 2012 11:47 am

fishndoc wrote:I would send a letter to the supervising physician asking for an explanation for the charge and why your visit required such a complex evaluation. If the answer isn't satisfactory, I would find another physician.
And possibly send a letter to the insurance company explaining what happened, and why you feel the charge was not justified.

BTW, how much time face-to-face did the PA actually spend with you? Unless it's changed, there used to be a minimum time required for the more complex evaluation codes.
As I mentioned above, it is a complicated case and the PA spent nearly an hour with my daughter. I still feel that the charge is quite high, but perhaps I am overreacting?

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Re: $683 for an office visit with a Physician Assistant?

Post by linuxuser » Thu Jan 26, 2012 11:52 am

HearDoc wrote:
linuxuser wrote:
fredflinstone wrote:I'm accustomed to expensive health care bills, but this one is tough to swallow: $683.00 for an office consultation with a Physician Assistant (CPT code 99245).
My last year's annual exam that the doctor claimed from the insurance company was $320. The blood and urine work was done in-office and insurance claim was $15. I'm in NJ.
.
That's an warning sign. It would be highly unusual that a solo practice would have the sophisticated blood analysis equipment that I'd expect on an annual physical
workup. Are you sure the blood panel was done in office?
I wasn't clear. The blood and urine were drawn in the office, but the analysis was done by Quest Diagnostics.

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Re: $683 for an office visit with a Physician Assistant?

Post by linuxuser » Thu Jan 26, 2012 11:54 am

HueyLD wrote:A few years ago, I went to my PCP' s office for a flu shot. I thought it was going to be a quick in-and-out visit, just like my previous flu shot visits to a different PCP in another state.

Well, I was forced to sit down with a PA for about 7 minutes (not counting the wait time for the PA) to update my chart because that was what they recommended for all simple flu shot visits. So, instead of billing the insurance company for about $20 of allowed cost, they billed the insurance company for a full office visit at about $300.

I considered their action unacceptable and on the verge of insurance fraud. Needless to say, I have not returned to that PCP office ever since.
Do you go see the PCP annually? If they haven't seen you in awhile, most doctors won't just give you a flu shot. There are complications from a flu shot.

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Re: $683 for an office visit with a Physician Assistant?

Post by dm200 » Thu Jan 26, 2012 1:16 pm

fredflinstone wrote:
fishndoc wrote:I would send a letter to the supervising physician asking for an explanation for the charge and why your visit required such a complex evaluation. If the answer isn't satisfactory, I would find another physician.
And possibly send a letter to the insurance company explaining what happened, and why you feel the charge was not justified.

BTW, how much time face-to-face did the PA actually spend with you? Unless it's changed, there used to be a minimum time required for the more complex evaluation codes.
As I mentioned above, it is a complicated case and the PA spent nearly an hour with my daughter. I still feel that the charge is quite high, but perhaps I am overreacting?
IMO, that changes the picture quite a bit. It appears, from this description, that a physician was involved in the process (even if the assistant was 'hands on')

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Re: $683 for an office visit with a Physician Assistant?

Post by Hector » Thu Jan 26, 2012 1:28 pm

Its horrifying the way medical costs are rising. A lot of us plan our retirement and try to hit the magic #, but the way medical costs are rising I wonder how many would actually wont run out of money in retirement. Its good that you are able to afford this fees. Unfortunately a lot of people would have hard time coming up with this kind of money.

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Re: $683 for an office visit with a Physician Assistant?

Post by dhodson » Thu Jan 26, 2012 2:09 pm

most elderly use medicare

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Re: $683 for an office visit with a Physician Assistant?

Post by ejvyas » Thu Jan 26, 2012 2:21 pm

I changed my company so my insurance changed. I had to pay $25 for a Vit D blood test.
Since then I am very careful and ask the insurance and doctor/assistant 2-3 times before they touch/talk how much it would cost. Take estimates wherever possible before the procedure. I know it looks cheap but their bills aren't and I dont want to take any chances!

Finally it all depends on your plan, whether HDHP etc. , network and coverage <<<<-------------------doctors, hospitals and insurance agents seem to like this statement

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Re: $683 for an office visit with a Physician Assistant?

Post by mslaw » Thu Jan 26, 2012 3:13 pm

fredflinstone wrote:
dhodson wrote:i can only hope you had a very very very complicated problem or a laundry list of problems bc that is the highest level code for a consult. I havent billed that level in several years bc it is extremely uncommon in my situation. I also find it disturbing that you could need such a high level of care and an actual physician not be involved in the office visit (i assume they are supervising this PA via the chart notes). This is also 2-3 times the cost that a typical insurance company would pay for such a level, assuming it is appropriate.
in fairness, it is a complicated problem. The PA spent nearly an hour with my daughter Pebbles. We would have preferred that she see a physician but none was available at the time. I believe the PA left the room and consulted with one or more physicians during the visit.
Basically this coding would be considered appropriate if you were, for example, in cardiac distress, when you were seen at the office and the PA arranged immediate transport to a tertiary facility, i.e. hospital with cardiac care. However, you can also bill based on time.

A more aggressive interpretation:

http://emuniversity.com/Level5OfficeConsult.html
A Level 5 Office Consult (99245)

The 99245 represents the highest level of care for consultations taking place in the office. This is the third most popular code used to bill for these encounters among internist who used this level of care to bill for 20% of office consults in 2003. To get an idea of the frequency of use of this code among sub-specialists, nephrologists used this level of care for 32% of consults performed in the office during that same year (which added up to 50,435 visits). The 99245 ranked 111th among the most frequently used CPT codes by all physicians in 2003. Usually the presenting problems are of moderate to high severity. The reimbursement for this level of care is approximately $218.00.

The documentation for this encounter requires THREE out of THREE of the following :

1) Comprehensive History
2) Comprehensive Exam
3) High Complexity Medical Decision-Making

Or 60 minutes spent face-to-face with the patient if coding based on time. The appropriate documentation must be included.

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Re: $683 for an office visit with a Physician Assistant?

Post by specabecca » Thu Jan 26, 2012 4:12 pm

Maybe call and talk to the office - explain that this is bizarre, explain what transpired in your appointment, and explain the duration. Perhaps all they need is to hear your perspective to realize that they crossed some wires and should have billed either another patient for that amount, or fat fingered their billing entry and can fix it for you while you wait on the phone with them.

I'm curious to hear how it turns out - please let us know how this gets resolved.

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