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Insurance and Fees

The Sound Clinic is dedicated to providing thorough and holistic care to patients. This includes continuing to take the majority of insurance plans (Medicare and Medicaid are not accepted). And, while this may be obvious to many, a quick reminder for all - taking insurance does not equal free. We spend more time than the average traditional clinic with each patient to understand overall needs and to put together an integrative care plan. Due to the frequent changes and the complexity of our health care system, we are not able to understand each policy. We feel that this is the patient’s responsibility. Please research your personal out of pocket expenses including prescription coverage and laboratory coverage prior to receiving care. We understand that patients may have a high deductible, not have coverage for services that are considered ‘out of network’ or not have insurance at all. In the spirit of transparency to assist with planning ahead, below is a general outline of the fees, visit types and commonly asked billing questions. 

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Visit Types   •    Fees    •    Billing Questions

 

Visit Types

 

Insurance and Fees

Visit Types

In-Office, Telemedicine & Portal Visits

In-Office Visits: These appointments are currently available for ALL patients. They take place in either the Denver or Louisville office locations. There is a traditional check-in verifying medications, obtaining vitals and consultation with the practitioner.  These appointments are billable to insurance. Deductibles, copays and coinsurance apply. Not all integrative services, specialty labs, injections and therapies recommended by the practitioner are billable to insurance. These are discussed individually with patients during the appointment prior to performing.

Telemedicine Visits: These appointments are currently available for MOST patients. They take place through an online platform with video and audio. Good wifi access and a device with video is needed (smart phone or computer). There is a phone call check-in prior to the visit by the practitioner’s medical assistant to review medications and to ensure that you are in an appropriate location to have the Telemedicine Visit (no driving during the appointment, please). These appointments are billable to insurance although deductibles and copayments still apply. Please keep in mind that not all concerns are appropriate for a Telemedicine appointment. Refer to our Telemedicine page for additional information and to access the online “waiting room” for your scheduled telemedicine appointment.

Portal Visits: This visit type is for ESTABLISHED patients only. It is a digital communication initiated by the patient through the patient portal. This visit type is a series of back-and-forth messages between the patient and the practitioner. It does not involve a specific meeting time, speaking on the phone or over video. It does require the practitioner’s expertise and billed to insurance. This visit type is a good option when the patient has 1 non-urgent concern/question/request that does not involve a lot of additional history taking. There are times that the practitioner will recommend an in office visit or Telemedicine appointment rather than a portal visit. For more information and to sign the Portal Visit Consent, please click the link below.

Portal Visit Consent Form »

Insurance and Fees

 

Fees

 

Insurance and Fees

In-Office Visits

  • New Patient: It is dependent on time and complexity of the visit; $371-$465 – Insurance codes – 99204 (moderate complexity) and 99205 (high complexity)
  • Established Patient: It is dependent on the time and complexity of the visit; $242-$326 – Insurance codes – 99214 (moderate complexity) and 99215 (high complexity)
  • Osteopathic Manipulation Evaluation and Treatment: Osteopathic manipulation is billed to insurance as a procedure while the evaluation and medical management is billed as an office visit; both codes are always sent to insurance. Verification of coverage can be determined by asking your insurance carrier of the frequently used osteopathic procedure code of 98928 and the office visit of 99204 or 99214. Please contact your insurance carrier prior to your first appointment to better understand your benefits and out of pocket expenses. Cash Prices (Paid at time of appointment) New patient – $275 and Est. patient – $225. More information on this service can be found under therapies.
  • Annual/Well Child Plus Exams: At this time, our Annual and Well Child Exams are scheduled as PLUS exams. This is a Preventive Visit + Office Visit. The preventive part of the exam is to review all traditional age appropriate screening tests and labs. The office visit is for our integrative counseling services, review of other questions/needs. Both the Annual Exam/Well Child Check and the office visit are billable to insurance. The Annual Exam is frequently a “covered” benefit by insurance carriers and is paid in full by the insurance company under preventive services. However, the office visit may trigger copay/fee based on a patient’s insurance plan and deductible. Cash Prices and cost if not covered by insurance: Annual New patient – $328-$454 and Annual Est. patient – $302-329. Actual cost depends on age. The office visit insurance codes – 99213 (low complexity) or 99214 (moderate complexity); $164-$242.
  • Hormone Pellets: Pellet therapy is not usually covered by insurance. The total cost for women ranges from $399-$429. The total cost for men ranges from $625-$736. The difference in cost is dependent on dosage, complexity of the visit and insurance coverage. Insurance may cover a portion of the visit and the out of pocket expense would be less in that situation. Please contact our office or billing service for more information on billing. More information about this service can be found under functional medicine services.
  • Dietitian Services: At this time, Holly DeLong, Registered Dietitian is credentialed with Cigna and United Healthcare. The Sound Clinic is working with Anthem/BCBS next. When a practitioner is credentialed with an insurance company, this means that it is billable to insurance. It is recommended that patients contact their insurance company to confirm that they have dietitian services included in their plan and to determine any out of pocket expenses prior to the visit. Dietitian insurance codes: 97802 and 97803. These are billed for every 15 minutes of the dietitian’s time.
    Cash Prices:
    Initial Assessment: 60 minutes. $175
    Follow Up: 45 minutes. $120
    Follow Up: 30 minutes. $90
Insurance and Fees

Telemedicine

  • New Patient: It is dependent on time and complexity of the visit; $371-$465 – Insurance codes – 99204 (moderate complexity) and 99205 (high complexity)
  • Established Patient: It is dependent on the time and complexity of the visit; $242-$326 – Insurance codes – 99214 (moderate complexity) and 99215 (high complexity)
  • Annual Plus Exams: Some insurance companies allow for adult patients to review preventive medicine concerns in a Telemedicine visit. This became an option during Covid and has continued for some insurance carriers. Please consult your insurance prior to having a Telemedicine Annual Exam to verify your benefits. As noted in the “In-Office Fees,” these visits are scheduled as Annual Plus exams. This is a Preventive Visit + Office Visit. The preventive part of the exam is to review all traditional age appropriate screening tests and labs. The office visit is for our integrative counseling services, review of other questions/needs. Both the Annual Exam/Well Child Check and the office visit are billable to insurance. The Annual Exam is frequently a “covered” benefit by insurance carriers and is paid in full by the insurance company under preventive services. However, the office visit may trigger copay/fee based on a patient’s insurance plan and deductible. Cash Prices and cost if not covered by insurance: Annual New patient – $328-$454 and Annual Est. patient – $302-329. Actual cost depends on age. The office visit insurance codes – 99213 (low complexity) or 99214 (moderate complexity); $162-$242.
  • Dietitian Services: At this time, Holly DeLong, Registered Dietitian is credentialed with Cigna and United Healthcare. The Sound Clinic is working with Anthem/BCBS next. When a practitioner is credentialed with an insurance company, this means that it is billable to insurance. It is recommended that patients contact their insurance company to confirm that they have dietitian services included in their plan and to determine any out of pocket expenses prior to the visit. Dietitian insurance codes: 97802 and 97803. These are billed for every 15 minutes of the dietitian’s time.
    Cash Prices:
    Initial Assessment: 60 minutes. $175
    Follow Up: 45 minutes. $120
    Follow Up: 30 minutes. $90
Insurance and Fees
Insurance and Fees

Portal Visit

  • Portal Visits: This visit type is billed to insurance at $28 for 5-10 minutes (99421 code), $56 for 11-20 minutes (99422 code) and $90 for 21-30 minutes (99423 code) of the practitioner’s time for evaluation and management of the patient’s concerns. For more information and to sign the Portal Visit Consent, please click the link below.

Portal Visit Consent Form »

Insurance and Fees

Therapy and Specialty Labs

  • Therapies: The Sound Clinic therapies are outlined in detail on the therapies page. Refer to each individual therapy for specific costs.  Therapies offered at the Sound Clinic range from nutritional IV support to regenerative medicine injections to acupuncture to osteopathic manipulation.  While acupuncture and osteopathic manipulation can be billed to insurance, most therapies are out of pocket for the patient.
  • Specialty Labs: These are out of pocket for patients.  Individual costs and explanations for these tests are outlined on the specialty labs page.
Insurance and Fees

 

Billing

 

Insurance and Fees

Billing Questions

The Sound Clinic has a billing service that assists with processing all bills.  They are happy to assist with questions regarding your bill and insurance. However, it is important for each patient to assume responsibility for understanding their insurance plan.

KV Physicians Billing Service Hours: Monday – Thursday 9am-4pm (MST)

Phone: 303.857.4397

Email: billing@soundclinic.com

Insurance Definitions 

Deductible: The amount you have to pay out-of-pocket for expenses before the insurance company will start to cover their portion.

Coinsurance: Percentage that Insurance does not cover.  70/30 plan=Insurance pays 70% of allowed and Patient pays 30%.  This typically comes into play after you have met your deductible.

Copay: Fixed fee for your office visit that is due from the patient.  Depending on services acquired Coinsurance or Deductible may still be owed on additional services outside of an office visit.