What are Typical Insurance Negotiated Rates for Endo visit?

I am cash pay, so before I followed my Endo to her new clinic I was quoted office visits ‘New Patient $140’ and ‘Established Patient $100’. 1st visit was NO problem but a couple months after my 2nd visit I receive Statement for $270 on top of the $100 I paid at the office, total $370 (for same services I received at 1st visit).
99214 Office Visit, Est Patient, Level 4 $220 (falls in line with HealthCareBlueBook.com fair price)
95251 Gluc Monitor, Download, Interp, Report $150 (half of HealthCareBlueBook.com fair price)
Balance Due $270 (after $100 we initially agreed on)
After mentioning what I was quoted to Billing and Office, no response or withdrawal of initial quote. If I did not LIKE and trust my Endo I would actively be searching for another.
Can anyone share what their Insurance Negotiated Rates are for 99214 & 95251 so I can have $$ in mind if/when I ask for a discount??

Just seems IF I was quoted $100 and charged $370 for anything else I can simply refuse service or product RATHER than be shocked by additional costs later!!!

many may not know what the insurance negotiated rates are. and for those who dont know what the codes are, they are CPT cods. those are the office visits and procedures, etc. have you spoken to the medical biller of the office? that is who you should be talking to or whoever handles the billing. level 4 is going to be higher than some of the other ones. its standard on that. if you were quoted that much they should honor that. did you have any blood work done? that could be added to what you were there for. there could be a reason why it may be higher. again talk to the person who does the billing. they can help you the best vs anyone else in the office.

I need to locate my Insurance Statements from a couple years ago. They regularly mailed a statement with all codes, description, billed rate, reduced (negotiated) rate, non covered items and my share of everything. Good thing cause found a (previous) doctor filing fraudulent claims.
All labs are handled by me out of office at about 1/3 the lab’s LIST price by purchase from WalkInLabs.com. EXCEPT 1st lab was taken in office - I paid the $100 they wanted for Lab, then received bill for over $1000 from LabCorp with no mention of my office payment. After resolving with doctor office they paid and stated ‘1st labs only’ thereby withdrawing what I understood was $100 for all labs.
A person can easily lose confidence if ‘what they are told is not the truth’.

i would defnitely talk to a biller that is in the office

I just checked recent EOB, and was billed for 99214.

Billed 175, insurance allowed 125.

I generally download my own data, otherwise they tack on another charge for that.
And if they do A1C in office, there is another charge.

Your “Billed 175, insurance allowed 125.” justifies the $100 I was originally quoted.
With Dexcom Studio and Dexcom Clarity, wonder what response when I hand them my own printouts rather than my meters. It’ll be interesting. After initial visit they even issued me access code so they can receive Clarity whenever I run it while online.
Absolutely NO lab, nor A1C on problem visit. TALK only.
Yes, will discuss with billing person AGAIN when I get all ducks in order.

Generally 3 bills, for me. That sounds about what I pay.

There are a number of factors which affect things. There is the CPT code which defines what procedures or services you got. Often you are required to submit a diagnostic code ICD-10 for the procedure. That can be used by insurance to determine whether the procedure/service is covered. And then there is a negotiated rate and whether you have co-insurance or a co-pay.

I bring my Dexcom 14 day printouts, and my labs are covered 100% if physician ordered. My endo charged $300 for CPT 99214. I presume it was coded E10.9, Type 1 without complications as has been her practice (note that they no longer code controlled/uncontrolled). The negotiated rate was $107.58 and my insurance paid all of that except $25 which is my co-pay.

The biggest thing that hit @JJM1 was that he paid cash. The system is totally rigged against cash customers. In network Dr’s can charge whatever they want, but they will be paid the negotiated rate, usually a fraction of the “ask.” Hospitals are even worse and they can and will destroy you financially. This is one reason that it can make sense to have an insurance policy, even a totally crappy very high deductible plan because the insurance can get you better rates. Using a really crappy insurance coverage to get in-network services will usually cost you much less than a walk up cash deal. Dr’s and hospitals are usually not “transparent” about this stuff and often refuse to negotiate. They won’t tell you the routine reimbursement rates and we as patients are just left standing there feeling ripped off by the system.

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They don’t have to negotiate with first parties (i.e patients) because they know they will still get paid even if some people can’t afford their prices because the insurance companies are where they get their money from. It is absolutely ridiculous.

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I do have Catastrophic coverage as protection against potential Ambulance, ER, Hospital or other large events with reasonable deductible per event since such can/does result in bankruptcy.
2016, at doctor’s original clinic I was charged $340 cash for Office Visit + Lab + Educator/Nutritionalist + Extremities Circulation Tests. And therefore thought that last year’s quote of $100 visit + $100 lab was very reasonable. ($100 lab was taken off the table and not part of this issue).
Located the 2015 Statements (before ‘regular’ insurance company closed.
Code ---- Billed — Allowed — Deductible — CoPay
99214 — $250 ---- $89.02 ------- $0.00 ------- $35
95251 — $106 ---- $33.34 ------ $33.34 ------ $0
Labs ----- $231 ---- $63.56 ------ $63.56 ------ $0 (total of 8 different lab codes)
TOTAL – $727 — $205.92 ---- $116.90 ------ $35 (including a S0316 charge)
Insurance paid $54.02 and my responsibility was $151.90
Insurance Negotiation results in pay vs billed: 50% of 99214, 32% of 95251 and 28% of Labs, and 28% of total billed.

Think I’ll research Medicare reimbursement rates as well before I determine a ‘cash now’ offer. And then final decision to stay or leave.
Unfortunately looks like formatting with multiple spaces in reply doesn’t stay in place.