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Old 09-25-2012, 05:29 PM   #1
teacup princess
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How much does your specialist charge you?

I guess we've never been to a specialist. We've been lucky. Mostly we just visit our family practitioner. Please tell me if this cost sounds normal. I took ds to a behavioral-developmental pediatrician to get an opinion on some learning issues he's having at school. The cost of the 45 minute appointment alone just to walk in the door was $866. There was an additional $600 worth of testing on top of that. I'm not complaining about the tests (although they were just pointing to things in a flip chart and drawing things). I sort of expected that. I was not however, expecting the cost of the visit. ( I know, should have asked, but I've never in my life been charged more than $250 for an office visit). Other than the flip chart tests all she did was take a history. I sort of feel like I was double billed. I need help deciding if i should go back or start over with someone more reasonable. I definately won't be able to afford too many visits at that price. Is this the norm?
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Old 09-25-2012, 05:46 PM   #2
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Well, first, I want to say that what looks like simple testing can tell them a lot sometimes. My daughter's APD was diagnosed with a simple test where she had to repeat short vs. long tones that she heard with earphones in a rather small and unimpressive soundproof room. You know - she had to say short-long-short or short-short-long. She failed. Her Audiologist did a few other tests in a 45 minute period but mostly just more of the same that-looks-really-simple sort - but there was actually a lot of science and the appropriate equipment behind it. Cost for the appointment 4 years ago was $550, I'm sure it's gone up now (and that was after paying for other basic educational and speech testing to get us there - I got a bargain at only $400 for all of that). Plus we had to drive 2 hours for the test since no one around here did it, so I paid another $200 for a San Francisco hotel room for the night because we had an early morning appointment and I didn't want to risk being late due to traffic....And it was worth every single penny.

So, don't discount simple tests, but I would discount them if they didn't tell you WHY they were doing them and what they were looking for. And it sounds like that may be the case. Did they give you any sort of feedback or make a follow up appointment to give you results?

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Old 09-25-2012, 06:09 PM   #3
teacup princess
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She basically said these were big picture kind of tests and he came up in the normal range. She referred us to a psychologist to continue with more testing and then we have to follow up with her after that. Now I've heard those tests for dyslexia ect. are expensive and Im expecting and have no problem with that. It was just the cost of the appointment that seemed exorbitant and im not wanting to pay $900 every time we step in the door for a follow-up. I did get a detailed analysis in the mail to give to the school a couple of weeks later which was nice.

The school is doing testing on their own so maybe I'm just wasting a lot of money.
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Old 09-25-2012, 07:38 PM   #4
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The initial testing is expensive imho. For instance, dd's initial O/T consult was $500. However, the cash rate for weekly appts is only 90.00. And dd has been dx'd in the past by developmental pediatricians, but they referred us to the appropriate therapy (ie, PT, OT, Speech), and don't do the therapy themselves.

As to your question about it being a waste because the school is testing...never a waste imho. It's really important to have an independent assessment. Schools have limited resources. Most will not go out of their way to suggest an expensive accomodation they have to provide. Before anyone gets up in arms, I really like our school district. But the squeaky wheel gets the grease. Therefore, if you feel more accomodations are needed, you have an independent assessment to back up your opinion.
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Old 09-25-2012, 08:19 PM   #5
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We spent 1500$ getting a good diagnosis for my son. Entirely worth it. Based mostly on preconceived ideas the school principal had decided that my son was autistic. He had no friends at school, did not want to be touched and would have fits of rage sometimes. We saw a neuropsychologist right away. 150$ per hour. Apparently she'd need an hour for writing her report for each hour spent with our son so I guess it's reasonable. Turns out his sense of touch is overly sensitive, that's all. Took a bit of occupational therapy (and a couple more 1000$) and now he's completely fine at school, has lots of friends, and got an award last year for best academic results of his class at the end of 1st grade! Can't imagine what would have happened if we'd trusted the public school system. Our insurance paid about half, but I'd do it again if we had to pay everything.
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Old 09-25-2012, 09:59 PM   #6
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Quote:
Originally Posted by teacup princess View Post
She basically said these were big picture kind of tests and he came up in the normal range. She referred us to a psychologist to continue with more testing and then we have to follow up with her after that. Now I've heard those tests for dyslexia ect. are expensive and Im expecting and have no problem with that. It was just the cost of the appointment that seemed exorbitant and im not wanting to pay $900 every time we step in the door for a follow-up. I did get a detailed analysis in the mail to give to the school a couple of weeks later which was nice.

The school is doing testing on their own so maybe I'm just wasting a lot of money.
I know where I live the schools make it clear that they do not have to do anything about outside testing no matter what the results are. They only have to give help for the tests they give and what they come up with even if they have no way to test for what the specialists tests show. Our schools suck though and I have had to fight just to get certain teachers and specialists to understand what APD is and how to help my son with it.

I actually got my son tested through our local mental health department for the APD and such but that was 10 years ago and it was much cheaper and we had insurance that covered it back then. Through them they put me in touch with a Child Neuropsychologist to get suggestions and information on how to provided what he needs for learning.

If you are getting answers you need to help your child it will be worth all the money in the world.
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Old 09-25-2012, 10:45 PM   #7
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sorry- double post
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Old 09-25-2012, 10:51 PM   #8
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I'm a doctor (a specialist) and would never charge that much for a 45-minute office visit. Having said that, I get the impression that this is not covered by insurance. If that's the case, what is happening here is that you are paying top dollar because many other patients are covered by insurance plans which have negotiated a much, much lower rate with the doctor.

It would have been better to negotiate a rate with them up front, but I would go back and offer to pay the average rate that Blue Cross Blue Shield pays, the full amount, right now, in cash.

I'm picking BCBS because they're about average in terms of payment- not the best, but better than, say, Medicaid. At my hospital, people paying cash get a 15% discount, because no insurance company ever pays the full rate- why should they?

Otherwise, tell them that you'll have to make payments and it might take a long time to pay off that big of a bill.

Also, make sure you get the CPT codes for the testing and the office visit, to ensure that you haven't in fact, been double billed. The testing cannot have occurred during the 45-minute office visit for each to be billed separately. In other words, the doctor could bill for a 30-minute office visit and testing that took 15 minutes. But she can't bill for a 45-minute office visit, and the testing on top of that if the entire time you spent there was 45 minutes. One is an office visit that is billed by time spent, and the other is a "procedure", which is completely separate.
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Old 09-26-2012, 05:49 AM   #9
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Quote:
Originally Posted by teacup princess View Post
I guess we've never been to a specialist. We've been lucky. Mostly we just visit our family practitioner. Please tell me if this cost sounds normal. I took ds to a behavioral-developmental pediatrician to get an opinion on some learning issues he's having at school. The cost of the 45 minute appointment alone just to walk in the door was $866. There was an additional $600 worth of testing on top of that. I'm not complaining about the tests (although they were just pointing to things in a flip chart and drawing things). I sort of expected that. I was not however, expecting the cost of the visit. ( I know, should have asked, but I've never in my life been charged more than $250 for an office visit). Other than the flip chart tests all she did was take a history. I sort of feel like I was double billed. I need help deciding if i should go back or start over with someone more reasonable. I definately won't be able to afford too many visits at that price. Is this the norm?


I also work in health care and just like last post are assuming your without medical coverage. Just wondering when you went for this appt?...... Alot of medical offices have what's called a self pay rate. Meaning you are charged one flat rate for anything that was done for you that day. Including office visit and any testing. My office charges for an evaluation and any other services performed that day with one fee. If that patient needs to come back in after the eval, then we have a self rate fee for that too. Can you call the specialists office and see if they have a self pay rate?....... That may be cheaper.
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Old 09-26-2012, 10:25 AM   #10
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That is on par with what I paid(ours was a bit more). Ours was not covered by insurance & total for testing & treatment was right around $40k over 3 years.
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Old 09-26-2012, 11:53 AM   #11
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Quote:
Originally Posted by QueenElinor View Post
I'm a doctor (a specialist) and would never charge that much for a 45-minute office visit. Having said that, I get the impression that this is not covered by insurance. If that's the case, what is happening here is that you are paying top dollar because many other patients are covered by insurance plans which have negotiated a much, much lower rate with the doctor.

It would have been better to negotiate a rate with them up front, but I would go back and offer to pay the average rate that Blue Cross Blue Shield pays, the full amount, right now, in cash.

I'm picking BCBS because they're about average in terms of payment- not the best, but better than, say, Medicaid. At my hospital, people paying cash get a 15% discount, because no insurance company ever pays the full rate- why should they?

Otherwise, tell them that you'll have to make payments and it might take a long time to pay off that big of a bill.

Also, make sure you get the CPT codes for the testing and the office visit, to ensure that you haven't in fact, been double billed. The testing cannot have occurred during the 45-minute office visit for each to be billed separately. In other words, the doctor could bill for a 30-minute office visit and testing that took 15 minutes. But she can't bill for a 45-minute office visit, and the testing on top of that if the entire time you spent there was 45 minutes. One is an office visit that is billed by time spent, and the other is a "procedure", which is completely separate.
Great "insider" information. The autism rate in NJ us really high and the wait list for a good developmental ped that takes insurance is on average is about 6 months. You can get an appointment with a DR. who does not take insurance in about a week but it will run a minimum of $1000.00 which does not include additional specialized tests.
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Old 09-26-2012, 01:24 PM   #12
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You cannot compare the cost directly with what other doctors in another specialty might charge. Is the doctor going to prepare a written evaluation report for you to present to the school or to use in a school board or court proceeding? I would assume so. That will take time. It's not just the time the doctor spends with the patient. Some general practitioners charge $250 for a 15 minute visit. Those charges seem to be on the low side.
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