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)
Diagnostic | ||||||
New Patient | Minutes | Charge | Mental Health | |||
99202 | 15-29 | $210 | PHQ | 96127 | $30 | |
99203 | 30-44 | $295 | GAD | 96127 | $30 | |
99204 | 45-59 | $450 | ||||
99205 | 60-74 | $570 | Lab | |||
Established | Draw Fee | 36415 | $15 | |||
99211 (CMA only) | $65 | Strep A | 87880 | $60 | ||
99212 | 10-19 | $150 | Rapid Covid | 87426 | $150 | |
99213 | 20-29 | $240 | Rapid Covid + Flu | 87428 | $200 | |
99214 | 30-39 | $340 | UA Dip | 81001 | $45 | |
99215 | 40-54 | $470 | ||||
Injections | 96372 | $70 | ||||
Additional Time | Intralesional up to 7 | 11900 | $270 | |||
99417 | +15 | $100 | Intralesional 8 or more | 11901 | $340 | |
Telephone | EKG/ECG | 93005 | $90 | |||
99441 | 5-10 | $110 | ||||
99442 | 11-20 | $175 | Paperwork (FMLA etc.) | 99080 | $15 | |
99443 | 21-30 | $250 | ||||
Refer: | ||||||
DOT | Acupuncture | Self-Pay | ||||
MISCWORK + UA | $165 | MISCACUPNWPT | New | $285 | ||
MISCACU | Followup | $195 | ||||
Procedures | Dermatology | |||||
Ear Lavage Unilateral | 69209 | $80 | Nutritional Counseling | Self-Pay | ||
Ear Lavage Bilateral | 69209,50 | $80 | MISCMNT $58/15 min | New | $348 | |
“ w/ instrumentation | 69210 | $235 | MISCMNT2 $50/15 min | Followup | $200 | |
I & D Abcess (simple/single) | 10060 | $585 | ||||
Skin Tag Removal -15 | 11200 | $425 | ||||
Skin Tag Removal 15+ | 11201 | $150 | KITS | |||
Lesion Destruction -14 | 17110 | $525 | H. Pylori Other: | |||
Lesion Destruction 14+ | 17111 | $620 | ||||
Preventive | ||||||
New Patient | Age | Charge | PAP | Q0091 | $200 | |
99381 | <1 | $300 | Pregnancy HCG | 81025 | $40 | |
99382 | 1-4 | $315 | ||||
99383 | 5-11 | $325 | Biopsy | |||
99384 | 12-17 | $375 | Cervix/Polyp | 57500 | $700 | |
99385 | 18-39 | $365 | Endocervix | 57505 | $670 | |
99386 | 40-64 | $420 | Endometrium | 58100 | $600 | |
99387 | >64 | $460 | Vulva – 1 lesion | 56605 | $450 | |
Vulva – 2+ lesions | 56606 | $330 | ||||
Established | Colposcopy | |||||
99391 | <1 | $270 | Cervix | 57452 | $600 | |
99392 | 1-4 | $290 | Cervix/Biopsy/ECC | 57454 | $800 | |
99393 | 5-11 | $285 | Cervix/Biopsy | 57455 | $750 | |
99394 | 12-17 | $320 | ECC | 57456 | $725 | |
99395 | 18-39 | $330 | Dilation & Curettage | 58120 | $1350 | |
99396 | 40-64 | $350 | ||||
99397 | >64 | $380 | ||||
IUDS | ||||||
Kyleena | J7296 | $1,110 | ||||
Mirena | J7298 | $1,110 | ||||
Paragard | J7300 | $1,110 | ||||
Skyla | J7301 | $1,110 | ||||
SELF PAY SERVICES | ||||||
Insertion | 58300 | $575 | Emsella | $150 | ||
Removal | 58301 | $465 | Mona Lisa | $450 | ||
Xeomin (RB) | Per Unit: | $12 | ||||
Nexplanon | J7307 | $1,110 | Sclerotherapy (RB) | Custom | ||
Nexplanon Insertion | 11981 | $575 | ||||
Nexplanon Removal | 11982 | $600 | ||||
Nexplanon I & R | 11983 | $750 | ||||
Updated 09/04/24 |
Preventive | ||||||
New Patient | Age | Charge | PAP | Q0091 | $200 | |
99381 | <1 | $300 | Pregnancy HCG | 81025 | $40 | |
99382 | 1-4 | $315 | ||||
99383 | 5-11 | $325 | Biopsy | |||
99384 | 12-17 | $375 | Cervix/Polyp | 57500 | $700 | |
99385 | 18-39 | $365 | Endocervix | 57505 | $670 | |
99386 | 40-64 | $420 | Endometrium | 58100 | $600 | |
99387 | >64 | $460 | Vulva – 1 lesion | 56605 | $450 | |
Vulva – 2+ lesions | 56606 | $330 | ||||
Established | Colposcopy | |||||
99391 | <1 | $270 | Cervix | 57452 | $600 | |
99392 | 1-4 | $290 | Cervix/Biopsy/ECC | 57454 | $800 | |
99393 | 5-11 | $285 | Cervix/Biopsy | 57455 | $750 | |
99394 | 12-17 | $320 | ECC | 57456 | $725 | |
99395 | 18-39 | $330 | Dilation & Curettage | 58120 | $1350 | |
99396 | 40-64 | $350 | ||||
99397 | >64 | $380 | ||||
IUDS | ||||||
Kyleena | J7296 | $1,110 | ||||
Mirena | J7298 | $1,110 | ||||
Paragard | J7300 | $1,110 | ||||
Skyla | J7301 | $1,110 | ||||
SELF PAY SERVICES | ||||||
Insertion | 58300 | $575 | Emsella | $150 | ||
Removal | 58301 | $465 | Mona Lisa | $450 | ||
Xeomin (RB) | Per Unit: | $12 | ||||
Nexplanon | J7307 | $1,110 | Sclerotherapy (RB) | Custom | ||
Nexplanon Insertion | 11981 | $575 | ||||
Nexplanon Removal | 11982 | $600 | ||||
Nexplanon I & R | 11983 | $750 | ||||
Updated 09/04/24 |