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 50 minutes (new or established patients), with the exception of
women patients who know they wish to initiate the Wiley protocol, where
the initial appointment is 75 minutes. 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. 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 or check at the time of services (NO credit cards,
please). 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 account. For patients who wish to have their
visit pre-authorized by their insurance before the office visit, the
CPT code for a 50-minute new patient visit is 99204, and for a
75-minute new patient visit, 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 extremely 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 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 will usually 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 protocol can have their
HRT compounded by Wiley registered pharmacies, who have currently
agreed to cap the total monthly cost at $80. This price may be subject
to change, so please contact your nearest Wiley registered pharmacy for
an 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. Dr. Chen usually requires baseline labs to be done in someone
with symptoms but no previous evaluation or 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,
thyroid, pancreas, and pituitary hormones also. Most reputable labs
offer a cash pay discount, 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. 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.