As of this year, when I see my endocrinologist for my routine “office visit” they charge me extra for CGM review, which always used to be covered under office visit. So now in addition to the copay I have to pay for the actual doctor’s appointment, plus the copay for the “hospital facility fee,” I now owe another copay for CGM review. This seems extremely unfair to me, especially since I’ve had type 1 diabetes for 31 years, manage just fine on my own, and the only purpose of my last two appointments was to maintain care so that I have a doctor to write my prescriptions when I need them. We didn’t even discuss my blood sugars and she made no suggestions whatsoever. Of course I did raise the issue with the provider’s office directly, and they basically told me tough sh*t. My last appointment, I tried to refuse to give them my Dexcom clarity share code so that they couldn’t even review my blood sugars, but they said then they wouldn’t be able to write my prescriptions. I’m being held hostage and ripped off, being charged additional fees unnecessarily. Has this happened to anyone else recently, and if so, did you get it resolved?
There are plenty of good endocrinologists around so it sounds like you are about ready to shop around for one that meets your needs. I don’t have any copays to see my endocrinologist and certainly never had a CGM review fee.
Hospital systems are particularly good at optimizing their billing, and in the process over-billing and reducing services…
Endocrinologists are one of the most poorly reimbursed specialties. And there is a great shortage of endos in the US.
The CGM interpretation fee is one way for these doctors to optimize their billing. I am on Basic Medicare with a Supplement plan and have no out-of-pocket costs for my endo visit or her CGM interpretation charge. So I don’t mind the charge and want my endo to be optimally reimbursed for her time. But if I were paying a copay for the charge, I might feel differently.
Sort of, and I’m hoping it is close enough to what is happening to you to help. I send my Endo PDF’s of the Clarity reports they want to look at through the Endo’s web portal a couple of days before my appointment.
My HMO sent me a notice they approved a prior authorization for the CGM data review. I called my HMO and said my Endo wasn’t providing the data review and they cancelled that line off the PA. The Endo’s office never complained.
Since you mentioned the Hospital Fee I’ll also add two things. One is ask your Endo if they ever have appointments at a different office. Maybe there’s another location that isn’t attached to the hospital and that fee.
The other thing is that I’ve chosen to evaluate doctors based on quality of services provided for the cost. Both my Endo and Retina specialists are Walmart quality docs with Walmart quality offices and that’s okay because I know their limitations and I’m paying Walmart prices. I know I can change to better docs but it has to be worth >$8K per year for a better insurance plan.
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My endo has never asked me to share my clarity report with her. But willing reviews it when I down loaded to the hospital patient portal. I haven physically see my Doc. For some time but she does order labs and sends me the results on a regulate basis.
Yes. That is crazy. I would challenge it. Call your insurance. Tell them you don’t need the cgm review if they insist on that. I only pay one copay for everything at mine and I see my cde also. Cde usually does not charge me which is great. A lot of my other doctors cardiologist GYN if I go there to get a test they charge me two $50 co-pays one for the test and one because I see the doctor after which is ridiculous.
They also never get the billing right- I try to pay them when I am there and they say I don’t have to pay anything and then they end up sending me bills after. Then I send a payment and they keep sending bills even though I already sent a payment.
I finally got one office to admit that yes I had paid already and I didn’t have to pay a co-pay the next time. It should’ve been refunded to me but they just gave it to me as a credit lol.
It takes a few phone calls, and or sending paper bills to get this all resolved which is a total waste of my time.
@hollymateluber , you did not share the type of insurance your have.
Traditional Medicare as @Laddie shared drives the insurance reimbursement GAME for most physicians. That said, Medicare has approved the separate, stand alone, charge and assigned it a procedure code. Call your endo, learn the code, call your insurance provider, ask about the code coverage.
A second issue may be your insurance has not added the code to their billing system under your insurance contract. If this is an employer policy, check with your insurance coordinator or insurance specialist.
Third, verify your insurance. Most have a limit on the number of copays made for the same visit.
Hope this helps.
I would ask insurance company whether CGM review is part of office visit.
Maybe time to look for a different endo.