Insurance

As a service to our patients, we bill primary and secondary insurance when possible. When you call for your appointment, we will enter your insurance information into our system. We require a copy of your insurance card at the time of your appointment.  Please check your deductible and coverage for our services prior to your first visit. 

If you are seeing a Naturopath, please call your insurance company to see if this provider type is covered by your specific plan. Even if you have Aetna, Blue Cross Blue Shield or Moda, you must verify that your plan covers a Naturopathic provider.

We are in-network with Blue Cross Blue Shield, Aetna and Moda. However, please note that we do not bill Medicare, Medicaid, Tricare, or UMR.

If you agree with our payment terms and conditions, Avante requires payment of your co-pay and any outstanding deductibles at the time of service and we will then bill insurance. Otherwise, you will be responsible for paying in full at the time of service and we will bill insurance as a courtesy. If you have any questions regarding our terms and conditions, please contact our office and we will be happy to discuss them with you.

If we have not received payment from the insurance company within 60 days of the date of service, you will be responsible for the balance regardless of the insurance status. Blue Cross Blue Shield, Aetna and Moda patients are assessed on a case-by-case basis for balances that exceed 60 days.

If you are covered by Blue Cross Blue Shield, Aetna, or Moda, you may desire labs or procedures that are considered not medically necessary or are non-covered services by your insurance plan. In these cases, you fill out a form prior to the service that indicates you are requesting a non-covered service and are financially responsible for the cost of the services regardless of denial from your insurance plan. 

Avante – Billing/Pricing Overview

Below is a list of questions you will need to answer at check in for your appointment:

(All of this information should be attainable from your insurance provider.)

-What is your deductible? Has your deductible been met for the year? What month does your deductible start over?

-What is your coverage? Does your insurance provider pick up 50%? 80%? 100%?

-Does your insurance provider cover naturopathic doctors, (only applicable if seeing Dr Shauna M. Birdsall) or acupuncturists?

What if I am a Medicare patient?

Sandy Mahoney, APRN, FNP-C; Sara Krokos, APRN, FNP-C; Kelly Cerutti, APRN, FNP-C; Bethany Buchanan DNP, APRN, FNP; Kim Kubick, APRN, CNM, FNP, and Renee Buchta, DNP have opted out of Medicare.

Medicare does not contract with naturopathic doctors.

You will want to confirm that your secondary insurance covers our opted-out providers or naturopaths prior to making an appointment.   

It has been our experience that a number of secondary insurance carriers do not cover claims from providers who have opted out.

We are not responsible for changes in insurance benefits or denial of services. It is your responsibility to confirm your coverage and pay for what insurance does not cover.

In summary, we look forward to assisting you by billing your insurance when applicable.  This service is considered a courtesy in many cases. However, you are responsible to know your coverage, your deductible and being prepared to pay for your visit at the time of your visit.  Thank you in advance and we look forward to seeing you soon.

Avante Medical Center – Billing/Pricing Overview

(Prices may be subject to change – please call with pricing questions. The tables below outlines billing codes and pricing)

(Scroll/drag left & right to view full table)
Diagnostic
New PatientMinutesCharge Mental Health  
9920215-29$210 PHQ96127$30
9920330-44$295 GAD96127$30
9920445-59$450    
9920560-74$570 Lab  
Established   Draw Fee36415$15
99211 (CMA only) $65 Strep A87880$60
9921210-19$150 Rapid Covid87426$150
9921320-29$240 Rapid Covid + Flu87428$200
9921430-39$340 UA Dip81001$45
9921540-54$470    
    Injections96372$70
Additional Time   Intralesional up to 711900   $270
99417+15$100 Intralesional 8 or more11901$340
       
Telephone   EKG/ECG93005$90
994415-10$110    
9944211-20$175 Paperwork (FMLA etc.)99080$15
9944321-30$250    
    Refer:  
DOT   AcupunctureSelf-Pay 
MISCWORK + UA $165 MISCACUPNWPTNew$285
    MISCACUFollowup$195
Procedures   Dermatology  
Ear Lavage Unilateral69209$80 Nutritional CounselingSelf-Pay 
Ear Lavage Bilateral69209,50$80 MISCMNT $58/15 minNew$348
“ w/ instrumentation69210$235 MISCMNT2 $50/15 minFollowup$200
I & D Abcess (simple/single)10060$585      
Skin Tag Removal -1511200$425    
Skin Tag Removal 15+11201$150 KITS  
Lesion Destruction -1417110$525 H. Pylori Other:  
Lesion Destruction 14+17111$620    
  Preventive        
New PatientAgeCharge PAPQ0091$200
99381<1$300 Pregnancy HCG81025$40
993821-4$315    
993835-11$325 Biopsy  
9938412-17$375 Cervix/Polyp57500$700
9938518-39$365 Endocervix57505$670
9938640-64$420 Endometrium58100$600
99387>64$460 Vulva – 1 lesion56605$450
    Vulva – 2+ lesions56606$330
Established   Colposcopy  
99391<1$270 Cervix57452$600
993921-4$290 Cervix/Biopsy/ECC57454$800
993935-11$285 Cervix/Biopsy57455$750
9939412-17$320 ECC57456$725
9939518-39$330 Dilation & Curettage58120$1350
9939640-64$350    
99397>64$380    
       
       
IUDS      
KyleenaJ7296$1,110    
MirenaJ7298$1,110    
ParagardJ7300$1,110    
SkylaJ7301$1,110    
    SELF PAY SERVICES  
Insertion58300$575 Emsella $150
Removal58301$465 Mona Lisa $450
    Xeomin (RB)Per Unit:$12
NexplanonJ7307$1,110 Sclerotherapy (RB)Custom 
Nexplanon Insertion11981$575    
Nexplanon Removal11982$600    
Nexplanon I & R11983$750    
       
    Updated 09/04/24  
(Scroll/drag left & right to view full table)
Preventive
New PatientAgeCharge PAPQ0091$200
99381<1$300 Pregnancy HCG81025$40
993821-4$315    
993835-11$325 Biopsy  
9938412-17$375 Cervix/Polyp57500$700
9938518-39$365 Endocervix57505$670
9938640-64$420 Endometrium58100$600
99387>64$460 Vulva – 1 lesion56605$450
    Vulva – 2+ lesions56606$330
Established   Colposcopy  
99391<1$270 Cervix57452$600
993921-4$290 Cervix/Biopsy/ECC57454$800
993935-11$285 Cervix/Biopsy57455$750
9939412-17$320 ECC57456$725
9939518-39$330 Dilation & Curettage58120$1350
9939640-64$350    
99397>64$380    
       
       
IUDS      
KyleenaJ7296$1,110    
MirenaJ7298$1,110    
ParagardJ7300$1,110    
SkylaJ7301$1,110    
    SELF PAY SERVICES  
Insertion58300$575 Emsella $150
Removal58301$465 Mona Lisa $450
    Xeomin (RB)Per Unit:$12
NexplanonJ7307$1,110 Sclerotherapy (RB)Custom 
Nexplanon Insertion11981$575    
Nexplanon Removal11982$600    
Nexplanon I & R11983$750    
       
    Updated 09/04/24