FAQ on the costs of HRT
Q. What will be the cost of my consultation(s) with Dr. Chen?
A.
Due to concern for possible collusion, current costs are not posted
on this website. Please contact the office directly at 831-462-6013
for current fee structure. All appointments run 1-hr. long, with the
exception of women patients who know they wish to initiate the Wiley
ProtocolTM, where the initial appointment is 1 ½ hr.
Follow-up appointments are generally within 3-6 months, and at a
minimum of every 6-12 months, depending on the complexity of each
individual patient's medical situation, in order for Dr. Chen to
continue authorizing prescription refills, and provide the best
medical care. All follow-up appointments are usually 1-hr long,
with very rare exceptions, to be determined individually per Dr.
Chen. Follow-up phone appointments (for those who require a long
commute to the office) are charged at the same rate as in-person
appointments. Please refer to my office
policy section for more details.
Q. Does Dr. Chen take insurance?
A. No, Dr. Chen does not
bill insurance. In addition, she is a medicare opt-out physician,
and legally, none of her services may be billed to medicare for
reimbursement. Payment is due in full by cash, check, VISA, or
Mastercard at the time of services. Patients will receive a receipt
(superbill) documenting payment for services received. This receipt
includes ICD-9 diagnoses codes, CPT procedure codes, dollar amount
paid, and Dr. Chen's tax ID information, so that the patient can
then submit this to his/her own insurance for possible
reimbursement, or apply towards a deductible, or towards a health
savings/flexible spending account. For patients who wish to have
their visit pre-authorized by their insurance before the office
visit, the CPT code for a 1-hr. new patient visit is 99204, and for
a 1 ½ hr. new patient visit (such as the new patient appointment to
initiate the Wiley Protocol), it is 99205. The ICD-9 diagnostic code
is typically 627.2 for menopausal symptoms, and additional
diagnostic codes pertaining to the individual patient may vary. It
should be noted that reimbursement is unlikely if the insurance is
an HMO plan (examples include Kaiser, Health Net, Pacific Care, and
other HMO plans, as Dr. Chen would be considered an out-of-network
provider). Please refer to my office
policy section for more details regarding potential
reimbursements based on your insurance coverage.
Q. What is the cost of my prescriptions?
A. This will vary
depending on your treatment plan. Low dose FDA-approved
bio-identical hormone products such as patches, gels, creams, and
pills will typically be covered by major insurance plans, and
therefore, the patient's cost will depend on each individual's
co-pay plan. Bio-identical hormones specifically compounded by a
compounding pharmacy may or may not be covered by insurance, and the
cost will depend on each pharmacy's price. Prices for such
compounded HRT are generally competitive with co-pay costs for
FDA-approved brand name hormones. Patients who choose the Wiley
ProtocolTM must have their HRT compounded by Wiley
registered pharmacies, who provide standardized hormones as well as
cost per agreement with T. S. Wiley. The monthly cost for these
hormones are typically very competitive with the copay costs of
FDA-approved brand name hormone products. This price may be subject
to change by Wiley Systems, so please contact your nearest Wiley
registered pharmacy for updated cost. You can locate your nearest
Wiley registered pharmacy at T. S. Wiley's official website at
thewileyprotocol.com.
Q. What is the cost of labwork?
A. This will vary
depending on your treatment plan, as well as how much work-up has
already been done by your previous physician(s). Dr. Chen usually
requires baseline labs to be done in someone with symptoms but no
previous evaluation or incomplete testing. Blood testing is
preferred, and the extent of testing depends on each patient's
medical situation, i.e., it could be as simple as sex hormone
levels, or as complicated as someone requiring extensive testing to
include adrenals, nutritional status, gut health, thyroid, pancreas,
and pituitary hormones evaluation also. Most reputable labs offer a
cash pay discount if lab work is paid at the time of service, so
you'll need to check with individual labs near you. Dr. Chen has
accounts both at Quest Diagnostic Labs and Labcorp, but her generic
lab requisitions are valid at any licensed laboratory. Patients who
have HMO insurance plans (examples include Kaiser, Health Net,
Pacific Care, or other HMO plans) will need to pay out-of-pocket for
any labs ordered by Dr. Chen, unless they are working with a primary
care physician within their specific HMO plan who is supportive and
will order the requested labs for the patient. HMO plans, by design,
try to keep all expenses within a system of contracted providers,
for cost containment purposes; hence will typically not cover
expenses incurred as a result of seeing an out-of-network provider.
It should be noted that The Santa Cruz Medical Foundation has
specifically sent a letter to Dr. Chen as of October 2006 stating
that they will not order labs requested by Dr. Chen, for their HMO
patients who consult with Dr. Chen on their own.