Availability and Cost

Our health care system makes cost mysterious to both patients and providers. This is purposeful and shady. It was my desire to post clearly what to expect on my website depending on your insurance. After working on this business for a year, I honestly cannot tell you what to expect.

The closest number you can get is by telling your insurance company that I charge $300 for a “99215” code, and see what they say this will cost you.

Insurance companies make it impossible for me to make this simple and clear, which is why I am an advocate for universal healthcare.

To give you more information, and also more complexity

My own rates depend on the “medical complexity” of a visit or the time I spend with the patient on the day of the visit. Additional cost is dependent on any time spent on documentation, correspondence with the patient’s outside providers, review of records, and treatment planning.

Your bill is based on what I “code” a visit with. In medicine, we use codes to communicate with insurance what I was doing during a session in shorthand so that the insurance company knows what to reimburse me with, and the insurance company calculates what you owe.

The most common code I use for a follow-up visit is 99215. In short, this means I saw a patient for <=40 minutes, but it took at least 40 minutes for me to prescribe meds, document, send messages to outside providers, review records before or after the visit.

When you receive an explanation of benefits (EOB) from your insurance company, you will see a bunch of numbers that are hard to follow. Here is an example:

Example from United Health Care

Charge $300

$300 charge for a follow-up visit. This is not what my actual charge is (this is my billing company saying what Jordan Hobbs should get for this code).

Allowed $138.01

Next to “Charge,” you should see an “Allowed Amount.” This is what your insurance company says I am worth for that code.

Adjusted Amount $161.99

“Adjusted Amount” this is: Charge – Allowed = 161.99 This is money that I will never receive from insurance of yourself.

PO $24.71

“Patient responsibility” (PO) is also called a “Copay.” This is the amount a patient owes based on whatever percentage of the “Allowed Amount” insurance will not pay for.

Percentage patient owed of Allowed Amount = 22% of $138.01 = 24.71

In this example, the patient pays just over 22% of this bill. This percentage may be different depending on what “option” of United Health Care the patient has signed up for. This means some United Health Care patients may pay a smaller or larger percentage if they are under United Health Care “Individual Plan” or “Family Plan.”

Additional Costs:

Another charge you may see on your bill is

Charge $60 (Or you will see some number divisible by $60 such as $120, $180, $240, $300, $360, etc.)

The $60 dollar incriments is based on me using the code 99417 in addition to a 99215 code.

99417 is billed for 15 min increments of “Preparing to see the patient (e.g., reviewing tests) • Counseling or educating a patient, family or caregiver • Reporting test results to a patient by phone • Ordering medications, tests or procedures • Documentation work performed at home • Care coordination (when not separately reportable) • Getting and/or reviewing separately obtained history • Referring the patient to and communicating with other health care professionals (when not separately reportable)” as defined by Center for Medicare and Medicaid Services (CMS) in conjunction with the American Medical Association.

To continue with the United Health Care example:

Charge $60

Allowed $30.88

Adjusted Amount $29.12

PO $6.79

If you would like to be aware of other costs you can ask your insurance company about, here are the charges for other services/”codes” I provide:

Established patient For 40 Minutes 99215 300.00

Established patient For 25 Minutes 99214 200.00

Established patient For 15 Minutes 99213 150.00

New patient For 60 Minutes 99205 350.00

Documentation/case management without patient present 99358 300.00

This cost of 99358 is not covered by insurance.

Documentation/case management without a patient present every 30 min after 99358 criteria are met.2 99359 150.00

The cost of 99359 is not covered by insurance.

Prolonged Service With or Without Direct Patient Contact on the Date of an Office or Other Outpatient Service 99417 60.00

Psychiatric Diagnostic Assessment Documentation 90792 350.00

I welcome all patients to ask me questions about their bill including why a charge was made, and a justification for that charge. Please contact me if needed.