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Medical Services
We are excited to be opening two new clinics in your area; one in Gilpin and one in Nederland. Both clinics will provide basic medical care and access to behavioral health services, although some services will differ by location. As a Clinica patient, you will also have access to dental services at our Lafayette clinic as well as the pharmacy at our People’s clinic location. Here is a list of some of the services you can expect at both clinic locations.
Medical Services
• Well exams, flu shots & vaccinations for all ages
• Growth and development assessments for children
• Diagnosis and treatment of illnesses & injuries
• Cancer screenings and treatment
• Health education & Nutrition counseling
• Referrals to specialists
• Care for seniors
• Telehealth care
• Select medications on hand
Pregnancy Services
• Pregnancy prevention & testing
• Prenatal care and delivery services
• Care during and after pregnancy
• Pregnancy and parenting classes
• Family planning
Pricing for the 15 most common services we provide
Colorado Law requires us to post the full-fee price for the 15 most common services we provide. These are not necessarily the actual prices you will end up paying.*
The prices listed below are an estimate of what you might pay if:
- You do not have insurance (including Medicaid and Medicare);
- The service isn’t covered by your insurance; or
- You are not enrolled in Clinica’s Discount Program or other program offered at Clinica Family Health.
Most people who receive the services noted below at Clinica do not pay the prices listed.
| CPT | Full Fee | Service Description |
|---|---|---|
| 99214 | $228.77 | Office/Outpatient Visit, Establish, Detailed |
| 99213 | $157.85 | Office/Outpatient Visit, Establish, Moderate |
| 81002 | $26.84 | Urinalysis, Non-automated, w/o Scope |
| D1206 | $1.00 | Topical Application of Fluoride Varnish |
| D1351 | $50.00 | Sealant – Per Tooth |
| 90688 | $47.10 | Flu Vacc 4 Val 0.5 mL Dosage IM |
| 83036 | $77.97 | Hemoglobin A1C |
| D0190 | $15.91 | Screening of a Patient |
| 81025 | $39.67 | Urine Pregnancy Test |
| 82962 | $25.60 | Glucose Blood Test |
| 99393 | $210.63 | Preventive Checkup, est, 5-11 yrs |
| D0120 | $40.00 | Periodic Oral Evaluation – Establish Patient |
| 85018 | $21.04 | Blood Count, Hemoglobin |
| 90715 | $104.17 | TDAP 7 Years and Older |
| 99392 | $211.34 | Preventive Checkup, est, 1-4 yrs |
What is a Good Faith Estimate, or GFE?
Beginning on Jan. 1, 2022, all community health centers and most other health care providers must give all uninsured or self-pay patients an estimate of the cost of their care prior to their appointment. This mandate comes from the federal No Surprises Act, which was passed in December 2020. These cost estimates, also called Good Faith Estimates (GFEs), summarize a patient’s total out-of-pocket expenses for the care they will receive at the specified appointment. GFEs must be provided to qualifying patients who schedule an appointment at least three business days in advance or to any patient specifically requesting a GFE.
Are GFEs optional?
Patients cannot opt out of these estimates, and Clinica must provide them.
Which patients must be provided a GFE?
All uninsured and self-pay patients must be provided a GFE for their visit as long as they:
- Schedule an appointment for that service at least three business days in advance.
- Request a GFE (or otherwise ask about the costs of the service) even without scheduling an appointment.
- Have insurance but it does not cover the service they are seeking (e.g., they only have medical coverage but are inquiring about a dental service).
- Have a short-term, limited-duration plan.
- Are underinsured and indicate that they do not plan to submit a claim to their insurer but will pay for the service entirely out-of-pocket.
What information is included in the GFE?
A GFE must provide the following information:
- The primary service being provided to the patient during the visit or “period of care.”
- The items and/or services that are “reasonably expected” to be provided “in conjunction with the primary service” for which Clinica, or an outside provider, has a separate charge. For example, if a patient schedules an appointment for suspected strep throat, the GFE would include an office visit, a lab test (if there is a separate charge for that) and a generic medication.
- The exact charge for the service(s) the patient will be receiving related to the appointment.
The services listed on the GFE will be based on the information available at the time it is requested or generated. The GFE is not required to cover unanticipated care that is not reasonably expected or results from unforeseen events.
What is the “period of care” for a GFE?
In most cases, the “period of care” is a single day. However, if a patient receives a single service that requires returning to the clinic to receive full service (e.g., the two-dose HPV vaccine), then the period of care should encompass both dates. Also, if the patient will have lab work done on a different day and those services are scheduled by Clinica, then the period of care must include both dates.
What if the cost of an item or service is incorrect on my GFE?
Patients whose charges are more than $400 above the cost estimate can pursue a dispute resolution process to get their charges reduced. To pursue a dispute resolution, contact our Billing Department at (303)827-7102.
Will Clinica staff be required to ask me if I am uninsured or self-pay to determine if I should receive a GFE?
Yes. The new federal law requires that health care providers, or a member of their team, ask every person who schedules an appointment (or asks about the cost of their care) if they are:
- uninsured for that service
- are self-pay (they do not plan to submit a claim or their insurance doesn’t cover the service)
How will I receive my GFEs?
You will receive GFEs through the patient portal or by standard mail (US Postal System). All GFEs will be stored in the patient’s chart for six years for future reference.
Can I ask for a GFE during an appointment?
If you ask ask for a cost estimate at the time of service, you will be directed to Clinica’s Billing Department at (303)827-7102.
What if I have questions about my GFE?
If you have additional questions after receiving their GFE, you can contact the Billing Department at (303)827-7102.
Must costs for dental and vision services (e.g., dentures, glasses frames, lenses, etc.) be included in the GFE?
Yes. GFE rules apply to “items or services such as those related to dental health, vision, substance use disorders and mental health.”
Ready to Become a Clinica Patient?
Registering is easy. Click the button below and fill out the brief form to start the process. We will email you when your chart has been created (usually within two weeks) so you can complete the registration process on-line.