Pricing

Just like other chronic diseases, we believe the treatment of obesity should be covered under the umbrella of the traditional healthcare system.  However, not all insurance carriers feel this way.  They are allowed to exclude certain things, such as some or all treatments for obesity, including medical services, medications, and/or surgery.  Health insurance represents a contract between you and your insurance company.  Understanding what your insurance plan will and will not cover is your responsibility.  These contracts specify several things that you need to be aware of:

1. What type of services are covered by the contract (and which are excluded)
2. Which providers are considered to be in-network.  (Being in-network means that the insurance company and the providers have agreed to a predetermined fee schedule for services.  This protects you and your insurance company from being obligated to pay outlandish fees for in-network providers, but it doesn’t guarantee that the insurance company will pay the fees. That falls under #3.)
3. What portion of the services that each of you is obligated to pay (deductibles, copays, coinsurance, etc.)

Office visits with Obesity Medicine specialists are billed using traditional medical office visit CPT codes.  These vary based on the complexity of the medical decision-making required during the visit, and/or the time spent performing and charting the visit.  We cannot tell you in advance what CPT code we will be using as we don’t know how much medical decision-making will be done and/or how much time it will take, but the vast majority of our visits and their associated charges are:

• 99204 (new patient, moderate complexity):  $247.97
• 99214 (established patient, moderate complexity): $161.67

Occasionally, visits are more or less complicated or take minimal to additional time and are billed differently:

• 99205 (new patient, high complexity): $312.27
• 99213: (established patient, minimal complexity): $109.47
• 99215: (established patient, high complexity): 225.00

*If we bill these charges to your insurance company and they consider it a non-covered service, you will be financially responsible for the full amount billed.  You may switch to self-pay at the subsequent visit, but we will not adjust the fee retroactively. 

Simply – yes. However, it’s essential to note that all prescribed medications play a supplementary role alongside the science-based diet intervention treatment we emphasize at Heartland Weight Loss.

We always try to find a patient’s individual drivers we need to attack and choose the right medication for the right driver.  If we can do that successfully, “magic” can happen. Again, not magic fat-burning, but a different kind of magic. Using the right drug for the right person can create space – space for the person to work on all of the things that need to be done long-term to get and keep the weight off.

Some people use the anti-obesity medication differently. Some people use these medications to decrease their appetite or curb their cravings, but they don’t actually do the hard work of changing anything. They simply eat less of the same things they ate before the medications were on board. Which does cause weight loss – initially. However, more often than not, instead of losing body fat, these people lose primarily lean mass. It’s one of the major reasons we do body composition analyses every month – so we can identify this and interrupt it.

Dr. Younglove provides a comprehensive exploration of Anti-Obesity Medications and their application within our clinic in greater depth: please feel free to WATCH THE FULL VIDEO.

If we are utilizing one or more anti-obesity medications, we require monthly office visits and monthly body composition analyses. We do not fill prescriptions for patients that are not being seen regularly. 

We require a $50 non-refundable deposit to hold all new appointment appointments. At the time of the visit, this will be applied to any balance due.

Appointments that are missed and any appointment that is canceled/rescheduled less than 48 hours prior will result in a $50 fee.  This cannot be deducted from future scheduled payments and must be paid prior to scheduling future appointments.  

FSA and HSA plans have a variety of rules regarding how they function.  It is up to you to understand the nuances of your own FSA/HSA plan, including what services they will reimburse you for and what documentation they require for reimbursement.  Although we are happy to provide you with a receipt listing services provided, we cannot guarantee reimbursement and we do not submit claims directly to FSA/HSA plans the same way we submit them to traditional insurance companies.

Lab tests and prescription drug coverage are completely separate from coverage for medical office visits.  Regardless of whether our medical office visits are covered, most people with health insurance have some benefits for these services and we will always do our best to work within the existing system.  When applicable, we send prescriptions to the pharmacy of your choice.  When applicable, we provide lab orders with appropriate codes so that you can get lab work done at any lab that is in-network for you