Labs. We all need labs sometimes. Many of us get labs on a yearly basis, some of us need to check labs regularly throughout the year. Like many services in healthcare, it can be difficult to know how much something is going to end up costing us up front, and this is so frustrating!
Did you know that labs have different prices depending on how the lab is billed? A Complete Blood Count (CBC) can cost as much as $40 or as little as $5? This is because all these prices are negotiated between the various entities, but generally excluding you, the most important part of the equation. When you get labs drawn and have them bill your insurance, you may not be certain that these labs will be covered or not. The coverage depends on the specifics of your plan, whether you’ve met or deductible, or it is because the insurance company did not approve of the diagnosis code the provider put (even though it is a perfectly adequate code). They can and do change their minds about what is covered and what is not. Insurance is not about your health.
However, the cash price my patients pay at Pathology Laboratories is $5. For every lab you can know what you are paying for every lab up front, and it is generally WAY cheaper than it would be if your insurance rejects coverage for the lab.
For this reason, I don’t encourage my patients to use insurance for routine labs because if the insurance (including Medicare/Medicaid) that code isn't one they believe requires that lab (or for some other reason), the patient is stuck with the insurance's inflated lab pricing. There may be some expensive labs for specific problems, or if you are routinely getting labs to follow your thyroid hormone adjustments, then this might work out with the insurance. But for routine, or infrequent labs, you are likely better off paying cash.
Some people will bill insurance to try to get that to count against your deductible, even if they end up paying way more in the end. This is your choice, of course. But I’d rather keep the money and use it for something else rather than let the insurance companies invest in unscrupulous activities.
Labs are just one example of the kind of insurance cost bloat that goes on. Nearly everything you pay for in health care involves inflated prices that have been negotiated. Always ask for the cash price and it may even be cheaper if you pay the entire amount up front. You do have rights to demand a cash price through the HITECH Act. HITECH requires that any HIPAA covered entity offer a cash price to patients desiring to keep their protected health information private from their "health plan." This election is available to Medicare patients, though the Medicare limiting rates still apply when the patient pays the practice out of pocket in full. The physician is free to offer a rate less than the Medicare amount to any patient including Medicare patients. This applies to pharmacies, hospitals, specialists, etc. You have to advocate for yourself every step of the way as this is not automatically applied, but it can be worth it. The hospitals may claim ignorance, but that is not a reason not to follow the law.
I hope that this kind of information is helpful to you. If there is a topic or question you would like to see discussed, please contact me here. If you would like to recieve information like this directly to your email inbox, please sign up here.
Take care, everyone!
Dr. Katherine
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