On my last endo visit bill, I noticed a billing under “Ambulatory Continuous Glucose Monitor” for $80. I’ve been question this charge for a month and just got this response from my Endo.
“Insurance companies have started covering CGM interpretation as a separate billable item in addition to the office visit. This is similar to EKG interpretation that a cardiologist would do in their office”.
Has anyone else been charged for this? I’m seriously fuming as this is absolutely ridiculous. I won’t be handing over my dexcom at my next visit, I’m planning to hand over an old school log book in protest.
What the in world?!! I have never heard of such foolishness!! They’ll probably try to assess another fee for “Glucose Log Interpolation and Data Extraction.”
Comparing a Dex download to an EKG is idiotic. I pay for my sensors, my transmitter and receiver and now I’m going to be charged for making his job easier? I guess he doesn’t remember how tedious those log books use to be. Guess this is my kick in the butt I needed to get over my burn out and start being more proactive in my self management.
My endo is fine with the 2 reports I print out from Clarity. Same with my pump. Ditto for my meter. I no longer have his MA download my pump and meter data in the office.
From my understanding, it’s the interpretation of the data, which, is pretty much his job description. I wouldn’t care if he billed my insurance and then cleared my portion off the books, but I’m being billed for making his job easier. I swear, I feel like handing over an old school logbook to him at my next appointment or just finding another Endo.
One of my previous endos did have that charge itemized on my bill – however, his total bill did not increase as a result of that charge. Interestingly, he subsequently had to fight for a “prior authorization” AFTER the fact, because the insurance required that paperwork for payment. I assume he did get it authorized, because I was never back-billed for the fee, plus there was no copay on the line item.
I had the same charge and Insurance stated that it was the AMA that created it. the charge was 75.00 then insurance negotiated it down to 53.00 but of course I have not reached my deductible so I am on the hook for it. for now the whole excursion will cost me just under a grand each year. At least I can still get strips for free.
I too was charged on my last visit and I was recently told that it depends on what “Code” they use when sending to insurance Diagnostic vs treatment (?) -Via insurance company. Ask your Dr. which one they are entering, it may have changed in the insurance system and the will need to change as well.
I still think this is a scam. My doctor is happy with the 3 printed reports I hand him every 90 days. A pump settings report, a glucose monitor report, and a CGM report, consisting of 2 different types of reports. If he and Medicare are both happy with that, why are YOUR doctors charging you for downloads in the office?? oh, and even when he did download them (prior to me realizing I could simply hand him printed reports), he STILL didn’t charge for that service.
Endocrinology is one of the lowest paid specialities. As a Medicare patient, my visit reimbursement is capped and that may get disastrously lower for specialists as CMS is now considering reimbursing all office visits at the same price regardless of whether primary care or brain surgeon. Already there is a vast shortage of endocrinologists.
My endocrinologist is an expert at reviewing my CGM graphs. I personally am OK with the charge and realize that it is something that used to be included in the office visit. But my doctor also needs sufficient reimbursement to keep the doors open for patients, especially Medicare and Medicaid patients.
It has been a long time since any medical bills actually reflected the cost of the service.
How do you determine the actual cost of a service? Isn’t that a pretty elusive bit of data? Every doctor I know lives in exclusive areas, in VERY expensive homes, goes on costly vacations, etc etc. Do NOT feel bad for doctors–even the endos. My doc just bought a property and is building a home in Discovery Bay, California. If you know anything about that, you wouldn’t feel sorry for my endo!!
PS: My wife is an OR nurse, so when I say I know lots of doctors, that is not an exaggeration.
There are lots of charts out there with average physician salaries by specialty. If your wife is an OR nurse, then you know the rich ones because surgeons are usually at the top of most charts.
I am not saying that my endo is a pauper, but you have to remember that she went to college, then medical school, then residency, and then fellowship. Lots of debt and lots of years not earning much money.
Again, I know more than just surgeons. Numerous specialties and they are all very well off.
Regardless of the cost of their education, the doctors are living the high life around here. EVERY SINGLE ONE OF THEM THAT WE KNOW. We should all be so lucky. Maybe you live in a poorer area of the US, but around here, there is no need to worry about doctors’ financial states.
They’ll probably try to assess another fee for “Glucose Log Interpolation and Data Extraction.”