Topic: Specialist copay vs "clinic" visit cost at NCI

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Posted on: Nov 8, 2022 02:28PM - edited Nov 8, 2022 03:13PM by mumuriri

Posted on: Nov 8, 2022 02:28PM - edited Nov 8, 2022 03:13PM by mumuriri

mumuriri wrote:

I'm wondering why my MO and SO consults were billed as "clinic" visits (several hundred dollars) instead of a specialist copay ($40 on my plan). Is it because of the way they're billing the insurance? Is it because it's occuring at an NCI hospital location? I don't understand why conversations with a doctor is costing $500 more than me talking to, say, an OB GYN or ENT in their office. It's not an issue right now because I'm way past my deductible, but next year, when the deductible resets, my next visit with MO at the NCI I got treated at is going to cost me $675 out of pocket. Does that sound normal ?

They are in-network (entire NCI is) and the NCI is a "Preferred" provider for my insurance too.

Edit:

So it looks like my insurance is billed for each of these visits as "Outpatient Clinical: Non-surgical 0510 ". I read that means it includes any hospital/facility fees + the doctor's fee itself. Next year my first followup visit with the MO is going to cost $675 since my deductible resets. Please someone tell me if it normally costs this much to go talk to your MO with each visit. After the deductible is met, I will still be paying $136 out of pocket. I don't understand why it costs so much more to talk to a doctor there than my local health clinic which only charges a co-pay.

Dx IDC, Right, 1cm, Grade 2, ER+/PR+, HER2-
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Nov 8, 2022 03:14PM - edited Nov 8, 2022 09:07PM by quietgirl

I'm not going to say if it's only NCI or not but yes if a practice is associated with a hospital and the office is considered an outpatient clinic of that hospital then there can be a fee for the doctor and a fee for the clinic use. At some point you should have been asked to sign a document that was called truth in billing or something similar where they let you know that it was a possibility (not saying that they were clear communication when they ask you to just that they are suppose to have you do it) I'm on a high deductible plan so it hits me differently for different doctors so I'm not sure what I will do after the first of the year. The outpatient clinic for my endocrinologist is a higher amount then the breast cancer center even though they are both associated with the same hospital.

Surgery 2/7/2022 Lumpectomy (Right) Radiation Therapy 3/9/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 4/18/2022 Arimidex (anastrozole) Dx DCIS, Right, 3cm, Stage 0, Grade 2, ER+/PR+
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Nov 8, 2022 03:54PM maggie15 wrote:

It would cost me an extra $120 to see my MO at a clinic 10 miles closer to home than at the main hospital so I just schedule all appointments where it is cheaper to avoid the "clinic fee." Ask your doctor's office staff where to schedule appointments to save money.

DX 2/15/2021, IDC, Right, 3 cm, stage 2A, ER+/PR+, HER2-

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