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Topic: Cost of a follow up visit

Forum: Stage I Breast Cancer — Meet other members with a Stage I breast cancer diagnosis to share information and support.

Posted on: Feb 25, 2012 06:42PM

dense wrote:

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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Feb 25, 2012 07:18PM chickadee521 wrote:

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

Dx 4/15/2011, IDC, 1cm, Stage I, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Feb 25, 2012 07:42PM sewingnut wrote:

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.

Dx 12/2010, IDC, 5cm, Stage IIIA, Grade 3, 1/7 nodes, ER-/PR-, HER2+
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Feb 25, 2012 08:09PM - edited Feb 25, 2012 08:09PM by dense

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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Feb 25, 2012 08:10PM susan_02143 wrote:

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

*susan* 

anotherplan.blogspot.com... and its back. May 3, 2010 mets found. Five years NED on Faslodex * 4/2015 progression to bone * 6/11/2015 Femara/Ibrance * 12/27/2015 Xeloda * 2/24/2016 Xgeva * another progression, another drug Taxol 2/14/2017 Dx 6/8/2005, IDC, 3cm, Stage IIB, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Feb 25, 2012 08:25PM chickadee521 wrote:

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.

Dx 4/15/2011, IDC, 1cm, Stage I, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Feb 25, 2012 09:18PM GottaloveNED wrote:

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.

Dx 4/1/2009, IDC, 5cm, Stage IIIA, Grade 2, 1/5 nodes, ER+/PR-, HER2+
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Feb 27, 2012 06:07PM DocBabs wrote:

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.

DocBabs Dx 4/28/2011, IDC, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/12/2011 Lymph node removal: Right; Mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 5/12/2011 Lymph node removal: Right, Sentinel; Mastectomy: Left, Right Hormonal Therapy 7/14/2011 Aromasin (exemestane)
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Feb 27, 2012 06:26PM sewingnut wrote:

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.

Dx 12/2010, IDC, 5cm, Stage IIIA, Grade 3, 1/7 nodes, ER-/PR-, HER2+
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Feb 27, 2012 09:13PM coraleliz wrote:

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

Dx 2/28/2011, IDC, Right, 1cm, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 3/15/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 2/4 nodes, ER+/PR+, HER2- Surgery 4/15/2011 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right
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Feb 27, 2012 09:17PM - edited Feb 27, 2012 09:18PM by 1openheart

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. 

"The wound is the place where the light enters you." ~ Rumi Dx 4/28/2011, DCIS, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 6/15/2011 Lymph node removal: Left, Sentinel; Mastectomy: Left; Reconstruction (left): Nipple reconstruction

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