The Bone Whisperer

Information about medical billing and breakdown on cost:

A visit to a doctor includes a code for the doctor visit (99213 or 99214 for follow ups to be specific). In the case of seeing Dr S, it also includes a code for the procedure (e.g. OMT). This is why each visit has two parts in the Superbill. Different insurance companies will pay varying amounts for each code. Generally speaking, within each category a lower number is paid less then higher numbers. This is why you will get reimbursed differing amounts for each visit. We have simplified this as much as possible, charging a flat fee for each category:

1. Office Visits “talking part”
   • New Visit: $200.00
   • Follow up Visit: $100.00
2. Procedures “treatment part”
   • OMT (Osteopathic Manipulative Treatment): $100.00
   • PRP (Platelet Rich Plasma) Therapy: $400.00
   • Prolo Therapy: $200.00
   • Trigger Point Injection: $100.00

• Self Pay
  • Will include two charges, the office visit and procedure (see above). Therefore a follow up OMT visit is $200.
  • Dr S can give you a Superbill to submit to your insurance. How much they reimburse depends on your individual plan. Dr S recommends calling and asking how much they reimburse for an out of network physician.
  • Dr S offers a 50% discount for pregnant patients.
  • Dr S offers a 50% discount for children through 12 years old.
• Insurances
  • Private (e.g. Blue Cross, Pacific Source, UHC, etc): You will be Self Pay and you can submit to your insurance for reimbursement. Dr S is NOT in network for ANY private insurances.
  • Medicare:
    • Original Medicare without supplemental:
      • copay of $60 for new visit
      • copay of $40 for follow up
    • Original Medicare with supplemental: no cost to you.
    • MedAdvantage Plan: Dr S is NOT in network for ANY MedAdv plans. Therefore, YOU are responsible for checking to see what coverage your insurance provides as each individual plan is different, you and the insurance company have an agreement Dr S is not part of. You can call and ask what their coverage is and what your copay is for a doctor that takes Medicare but is out of their network. If your insurance does NOT cover Dr S, you will be considered Self Pay.
  • Medicaid aka OHP: At this time you will be Self Pay, and unfortunately they will NOT reimburse you for costs.
  • MVA: If injury due to car accident, Dr S will bill them directly. However, if visits are NOT covered you will be responsible for cost as Self Pay.
  • Worker’s Comp: Dr S cannot do care for Worker’s Comp injuries.