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.