These examples are for commercial insurance, not Medicare or Medicaid (Apple Health in Washington). Medicare and Medicaid have rates fixed by the government and patients never pay above these.

Base Office Visit Cost:

• Insurance copay/co-insurance for a specialist visit. You usually pay around $70 out of pocket. This typically covers the base office visit–not the facility fees or added procedures. The average cost of a specialist doctor visit in Seattle likely ranges from $258 to $414¹.

Out of Pocket Fees:

These out of pocket fees are often applied to your deductible. The deductible is the amount you must pay out of pocket before your insurance coverage begins. These range from $500 to as high as $15,000 for families.

• The hospital facility fee added to your doctor visit in the Puget Sound region ranges from $65 to $724 (average is $219). These are not always covered by insurance.
• A simple in office procedure can be as much as the base cost of a doctor visit. Some of these in office exams include nose and airway scoping, ear exams, wax removal, and nosebleed management. Scope exams range from $343 to $575. Earwax can cost $76 to $158.
  
  Doctors are incentivized to perform procedures to compensate for declining reimbursements from insurance. These procedures can expensive enough to hit your deductible quickly. The prices for these procedures conducted under insurance or within larger healthcare organizations are likely considerably higher than the discounted rates we offer you.
  
  Because you directly pay us, we are incentivized to minimize the hit to your wallet and deliver great value. We want to solve your problem in as few visits and procedures as possible.‍

Hidden Costs

Bouncing Around Between Subspecialists. Your visits in a hospital based doctor are more likely to be split over several visits to sub-specialists. For example, doctors who specialize solely in ear conditions may refer you to a different ENT for any sinus issues. Our clinic can address both in a single visit.

Doctors Who Own Their Own Surgery Centers. This isn't inherently bad, however, studies show that physicians who own their own surgery centers are more likely to recommend procedures in that surgery center. We do not own a surgery center. We work hard to be transparent and explain our value to you.

Conclusion

Compare our rates for ear, nose, and throat conditions to the costs we estimate above. Seeing how much other doctors in the Seattle-Tacoma area costs convinces us of the value that we offer our patients. Seeing doctors out of network can be less expensive than using your insurance. This is particularly true for patients with high deductible plans. Check out this helpful post on how to calculate whether the total costs of healthcare under your plan. We are convinced of the value we offer, and hope to see you soon.

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1. The American medical system uses Medicare as a reference point. Insurance prices are usually expressed in multiples of the government Medicare rate. In Seattle-Tacoma the insurance market is likely 140 to 225% of Medicare based on our research.This research includes comparisons to a proprietary, well-respected dataset of insurances claims in the Seattle-Tacoma area. For the CPT 99204 base visit code, Medicare reimburses $184. The 140 to 225% times Medicare rate works out to be $258 to $428 for this type of visit. For the upper range estimate, we report the higher value of the proprietary data set which is slightly more than the 225% Medicare rate.

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