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How much does it cost to get diagnosed with PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. Getting diagnosed with PCOS can be a lengthy and potentially expensive process, as it often requires multiple tests and doctor visits. Here is an overview of the typical costs associated with getting a PCOS diagnosis.

The Diagnostic Process for PCOS

There is no single test that definitively diagnoses PCOS. Instead, doctors look for at least two of the following three criteria:

  • Irregular or absent menstrual cycles
  • Elevated levels of male hormones like testosterone
  • Polycystic ovaries visible on an ultrasound

To evaluate these criteria, doctors may order some or all of the following tests:

  • Physical exam: Checks for signs of elevated testosterone like excess hair growth, acne, and male-pattern balding. Cost is included in doctor visit.
  • Pelvic exam: Screens for enlarged ovaries or uterine abnormalities. Cost is included in doctor visit.
  • Blood tests: Measures hormone levels like testosterone, prolactin, thyroid hormones, and insulin. Typically costs $50-200 depending on insurance.
  • Ultrasound: Visualizes ovaries to check for cysts. Costs $100-500 without insurance.

In addition to these tests, doctors will also evaluate for other health conditions like thyroid disorders, congenital adrenal hyperplasia, and tumors that can mimic PCOS symptoms. This may require additional testing.

Doctor Visits

Getting diagnosed with PCOS will require at least two doctor visits – an initial consultation and a follow-up to review test results. The specific costs depend on your insurance coverage:

  • With insurance: Specialist visit copay, typically $20-60
  • Without insurance: Up to $300 per visit

Some patients also see their regular doctor or an endocrinologist before being referred to an OB/GYN. This can add additional visits to the diagnostic process.

Total Cost of Diagnosis

The total cost to get diagnosed with PCOS can range significantly depending on what tests you need and your insurance coverage. On average, the costs breakdown as follows:

Cost Type Typical Price Range
Doctor visits $40-600
Blood tests $50-200
Ultrasound $100-500
Total $190-1300

With health insurance, total costs often fall in the $200-500 range. Without insurance, the diagnosis process can cost $1000 or more if extensive testing is necessary.

Ways to Reduce Costs

Here are some tips to keep costs down when seeking a PCOS diagnosis:

  • See an in-network provider to reduce out-of-pocket expenses
  • Ask if blood tests can be bundled into panels to cut down on individual test costs
  • See if ultrasound facilities offer discounted self-pay rates or payment plans
  • Only get tests that are necessary to make the diagnosis
  • Use a Flexible Spending Account or Health Savings Account to pay medical expenses tax-free

Health Insurance Considerations

Having health insurance can significantly offset the costs of getting diagnosed with PCOS. Here are some things to keep in mind about insurance coverage:

  • Office visit and test costs may be higher if you see an out-of-network provider
  • Contact your insurer to find in-network doctors and understand your benefits
  • Deductibles must be met before coverage kicks in
  • Co-insurance percentages apply after you meet your deductible
  • Copays are fixed fees paid per visit or service

Also check if services like blood tests and imaging are covered. For uninsured patients, ask providers about any discounts or financial assistance programs available.

The Takeaway

Getting diagnosed with PCOS can be expensive, with typical costs ranging from $190-1300 depending on insurance coverage. While necessary for treatment, patients should try to reduce unnecessary testing and make use of in-network providers and pre-tax savings accounts. With careful planning, PCOS testing and diagnosis can be financially manageable for most women.