How much do allergy tests cost? One woman’s reporting

Filed Under: Costs, Health plans, Patients

A friend said recently that she needed to get allergy tests in the New York area, but she wasn’t certain they would be covered under her insurance. She was planning to make inquiries, and I asked her to keep notes. I told her I’d post them without using her name. She writes:

I’ve gotten around to culling together what I’ve found re: allergy test pricing over the past few weeks from three different NYC doctors (pasted below). It was an interesting, confusing and at times wacky exercise, to say the least!

I’m glad I did it because it gave me a clearer idea of what kind of information I should be asking in the future.

Some highlights:

  • A Hoboken doctor’s office refused to tell me any rates (“I was told by my bosses that we can’t give you a price estimate until we’ve billed the insurance after the appointment.”) So ultimately I won’t be going there!
  • I tried getting rates for an allergist at Mount Sinai hospital, but the system was so unorganized — I kept getting rerouted to the wrong departments over a half hour — that I gave up trying.
  • A Manhattan office, after telling me I was in network with my insurance (which I later confirmed with my insurance), told me a week later that I was not actually in network. They said they had some arrangement where they could exceptionally work with my insurance… still waiting to hear back completely on that…
  • When I called my insurance to find out what the contracted rates were for an out-of-network doctor, they insisted that I needed to give them the self-pay rates that the doctor charges. I asked why they would need that information, and all they’d tell me is that it was required for them to be able to give me the information I requested. So I gave them the self-pay rates I had been cited by the doctor. The insurance called me back a few days later citing the same exact costs for my out-of-pocket fees.
  • The out-of-network doctor uses different codes from the ones I had been cited by my two in-network doctors, seemingly because they are different kinds of tests.

 

ENT Allergy & Associates​, NYC​

Costs with my insurance, according to ENT​’s billing office​ and my insurance plan (UnitedHealthcare Oxford HSA Direct Liberty Network. I have a $2000 deductible, which I haven’t met):

  • 99243 – Consult, NP LVL 3 – $139.17
  • 95004 – Skin Testing – $7.74 each prick test (there are up to 60 environmentals)
  • 94010 – PFT Breathing Test – $42.18

Without insurance, self pay rate for ENT:

  • 99243 – Consult, NP LVL 3 – $177.80
  • 95004 – Skin Testing – $10.50/per test
  • 94010 – PFT Breathing Test – $59.50

Dr. Jennifer Collins, Gramercy Allergy, NYC

According to Oxford insurance, these are the contracted rates which would all go toward my deductible:

  • 99243​ consult​​ ​- $92.98
  • 94010 – PFT Breathing Test – $76.85
  • 9500​​4​ skin testing​- $8.38

Self-pay rates, according to billing office:

  • Dr Collins charges a flat ​$300 ​rate for office visits. This fee would include allergy skin testing for up to 30 allergens. The code for skin testing is 95004, but costs $0 because it’s included in the $300 flat fee. If you need to be tested for more than 30 allergens, it’s $7 per test.
  • 94010 – PFT Breathing Test – $50
  • There should not be any other costs to read the test, to receive the results, etc.
  • Said I would likely be charged more if went through insurance but didn’t have rates. (So I later called Oxford, and got the rates above.)

New York Allergy & Sinus Centers West Village – out of network

According to Oxford, these are contracted rates with New York Allergy and Sinus Centers (they gave me these figures after I gave them the self-pay rates that the doctor’s office had cited me, otherwise they wouldn’t give me the rates):

  • 94010​ PFT breathing test​​ ​​ ​- $44 per unit
  • 95044​ ​​​allergy test​ ​- $7 per unit
  • 95004​​ ​allergy test – $5 per unit
  • 95024​ ​allergy test​ ​- $5 per unit

Self pay rates, according to  the doctor’s office:

  • Costs $150-$250 for initial consult – depending on how much time, how many problems you have, coordination of care. The tests cost extra.
  • 95004, 95024, or 95044 allergy testing ​are​ ​$5 per unit, up to 120 tests
  • 95044 allergy patch test ​is​​ ​$7 per unit
  • 94010 PFT breathing test ​is​ $44
  • Office doesn’t know how much it would cost with insurance, which they bill at a different rate. Said it would be cheaper to go through self pay rate. (That doesn’t appear to​ ​be true, because Oxford ​later cited me the same rates as an out-of-network patient.)​

The final bill: Not surprisingly, the quote was wrong — because allergists in the same practice charge differently

When she went and received her final bill, she sent us this note:
I ended up going to ENT Allergy, a practice with offices in NJ and NYC. I went to the NJ office not realizing that the prices would be different there. They billed me for a test that I hadn’t been quoted on, so I inquired about it. After a few emails and calls, the doctor’s billing office said I had been quoted prices for an allergist at the NYC office, rather than the NJ office. Apparently the doctors bill the same tests differently even within the same practice. In my case, the NJ office added an additional code that I hadn’t been informed of prior.

​So here is the full bill.
(Hoboken, NJ office):

  • 99243 – Consult, NP LVL 3  – $105.59
  • 95004 – percut allergy skin testing –  $228.20
  • 95024 – ICUT allergy test drug/bug – $49.14

By comparison, here is what I had been quoted for the NYC office at 261 Fifth Ave.

  • 99243 – Consult, NP LVL 3 – $139.17
  • 95004 – Skin Testing – $7.74 each prick test (there are up to 60 environmentals)
  • 94010 – PFT Breathing Test – $42.18

 

In the end, I plan to go to ENT Allergy for allergy shots to treat my allergies. Overall, the office staff at this practice treated me better than any of the other allergists that I called. The staff patiently answered my questions regarding costs. Notably, they helped sort out the confusing pricing with my current insurance. That helped me figure out that I would actually save about $1,000 by waiting to get the allergy shots until 2018, when I could qualify for a more comprehensive insurance plan under my job.