Lab test prices - exasperating!

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
sawhorse
Posts: 2972
Joined: Sun Mar 01, 2015 7:05 pm

Lab test prices - exasperating!

Post by sawhorse » Tue Sep 11, 2018 4:37 pm

After getting stuck with a hefty bill for a lab blood test that insurance didn't cover, I learned my lesson. When I got a lab order, before I had my blood drawn, I called my insurance to ask whether they would cover it. Insurance said they needed the CPT codes. They said that sometimes a test can have more than one CPT code, so I couldn't just tell them the name of the test. I went to the lab in the building where my doctor's office is, handed them the lab order, and asked for the CPT codes. The lab worker said that they don't handle billing, so I would need to call the billing office. The billing office said that they can't give me the CPT codes until the tests have already been performed, as they submit the CPT codes based on the tests that the lab indicates they have completed.

I read that if you have to pay cash, it's cheaper to have the test done directly at the testing lab. Thankfully, at my insistence, my doctor provided a written lab order instead of entering it in their internal lab's system. I traveled 50 minutes to a Quest lab where I got basically the same story. They could not provide me with a cash price nor the CPT codes until after the tests had already been performed.

Because it would be exceedingly difficult for me to travel to a lab again due to mobility issues and my spouse having to take off work, I decided to risk it and have the test done and crossing my fingers that I'm not stuck with a hefty bill.

If there is an easy straightforward way to get prices on lab blood tests, could someone please tell me?

Edit: If you do get a test price, make sure you get it in writing. One time the doctor recommended a certain genetic test that I knew wasn't covered. The company said it would cost $200. The bill came, and it was $4100. Other patients had the same experience. Thankfully my doctor contacted the testing company and railed against them, and all our bills were reduced to $200. If my doctor hadn't been helpful, I and other patients would have been left paying 20x the quoted price.
Last edited by sawhorse on Tue Sep 11, 2018 6:15 pm, edited 1 time in total.

SlowMovingInvestor
Posts: 790
Joined: Sun Sep 11, 2016 11:27 am

Re: Lab test prices - exasperating!

Post by SlowMovingInvestor » Tue Sep 11, 2018 4:42 pm

If you only go to in network labs, then they typically cannot bill you extra if the test is denied. I admit that sometimes it's hard to do when doctors send samples to out of network labs.

sawhorse
Posts: 2972
Joined: Sun Mar 01, 2015 7:05 pm

Re: Lab test prices - exasperating!

Post by sawhorse » Tue Sep 11, 2018 4:46 pm

SlowMovingInvestor wrote:
Tue Sep 11, 2018 4:42 pm
If you only go to in network labs, then they typically cannot bill you extra if the test is denied. I admit that sometimes it's hard to do when doctors send samples to out of network labs.
Last time I went to an in-network lab, and almost all the tests were covered. There was, however, an expensive rarely ordered test that they didn't cover.

User avatar
nisiprius
Advisory Board
Posts: 36472
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Lab test prices - exasperating!

Post by nisiprius » Tue Sep 11, 2018 5:00 pm

sawhorse wrote:
Tue Sep 11, 2018 4:37 pm
...If there is an easy straightforward way to get prices on lab blood tests, could someone please tell me?...
After a few serious efforts to get prices in advance for medical procedures, I concluded that it's all nonsense. It's all blaming the victim. Your story does is to confirm that it's just the same for lab tests.

Suggestions that "you should have called the insurance company in advance with the codes" are nonsense. I've tried that twice--ones with an MRI, once with a surgery, and failed both times. Medicine, it appears, is interactive, and what they do next depends on what they saw last. Even with "an MRI," they don't know exactly what they will be doing until after they've done it, so they don't know the codes in advance. In the case of the surgery, I pestered and pestered and pestered and they finally gave me two codes. When I checked with the insurer, it turned out that both of the codes were actually a kind of blank check or placeholder. One was for "Surgery with anesthesia in a hospital" and the other was "office visit with surgeon!" So in this case, I had "codes," but they were codes for which there was no established price, and, furthermore, codes for which the insurer could not say whether or not they would be covered!
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

User avatar
unclescrooge
Posts: 2376
Joined: Thu Jun 07, 2012 7:00 pm

Re: Lab test prices - exasperating!

Post by unclescrooge » Tue Sep 11, 2018 5:08 pm

nisiprius wrote:
Tue Sep 11, 2018 5:00 pm
sawhorse wrote:
Tue Sep 11, 2018 4:37 pm
...If there is an easy straightforward way to get prices on lab blood tests, could someone please tell me?...
After a few serious efforts to get prices in advance for medical procedures, I concluded that it's all nonsense. It's all blaming the victim. Your story does is to confirm that it's just the same for lab tests.

Suggestions that "you should have called the insurance company in advance with the codes" are nonsense. I've tried that twice--ones with an MRI, once with a surgery, and failed both times. Medicine, it appears, is interactive, and what they do next depends on what they saw last. Even with "an MRI," they don't know exactly what they will be doing until after they've done it, so they don't know the codes in advance. In the case of the surgery, I pestered and pestered and pestered and they finally gave me two codes. When I checked with the insurer, it turned out that both of the codes were actually a kind of blank check or placeholder. One was for "Surgery with anesthesia in a hospital" and the other was "office visit with surgeon!" So in this case, I had "codes," but they were codes for which there was no established price, and, furthermore, codes for which the insurer could not say whether or not they would be covered!
So is it pointless to ask for pricing?

Do you just go ahead with the treatment/tests/procedure and hope they don't bill you an obscene amount that's not covered under insurance?

sawhorse
Posts: 2972
Joined: Sun Mar 01, 2015 7:05 pm

Re: Lab test prices - exasperating!

Post by sawhorse » Tue Sep 11, 2018 5:13 pm

unclescrooge wrote:
Tue Sep 11, 2018 5:08 pm
So is it pointless to ask for pricing?

Do you just go ahead with the treatment/tests/procedure and hope they don't bill you an obscene amount that's not covered under insurance?
In my experience, if it's for a simple office consultation with no tests, then you can get a price without much effort. But once you have tests, equipment, multiple medical professionals, etc then it's kind of hopeless.

I was surprised that this even happened with a doctor that doesn't take any insurance. I got an upfront price for the office visit. Something concerned her, and she ordered an EKG to be done in her office. I asked how much it would cost, and she said I needed to ask the office manager. The office manager said, "It's either $95 or $75. Let's just say $75." I was surprised she didn't consult a list or anything.

If it's in an emergency room, even if you are conscious and alert, forget about getting a price for anything. Hospital stays can be just as challenging to get prices. Most of the medical staff you see honestly don't know. The physicians might know their own price, but that's only a fraction of the total price. Plus it's not like you're in much of a position to decline.

The only thing that's easy to get prices for and verify coverage is prescriptions from a pharmacy. If you get the drug in the hospital, though, the price could be drastically different. Things like $32 for ibuprofen. Then if you ask to have someone buy the ibuprofen from the local drugstore for $4 a bottle, the hospital won't let you use that instead.

User avatar
tfb
Posts: 7936
Joined: Mon Feb 19, 2007 5:46 pm
Contact:

Re: Lab test prices - exasperating!

Post by tfb » Tue Sep 11, 2018 5:53 pm

sawhorse wrote:
Tue Sep 11, 2018 4:37 pm
If there is an easy straightforward way to get prices on lab blood tests, could someone please tell me?
I recently found some good use of a cost estimator tool provided by my insurance company. I successfully used it for an MRI and found a provider that charged 1/2 of what the doctor's affiliated facility does. Your insurance company may also have a cost estimator. Google the name of your insurance company and "cost estimator." I'm curious to see how effective it is on lab tests. If you don't mind posting the name of the test or PM me, I can see what that cost estimator tool does. It uses the name of the service as input, not CPT codes.
Harry Sit, taking a break from the forums.

chessknt
Posts: 70
Joined: Wed Jul 13, 2016 3:15 am

Re: Lab test prices - exasperating!

Post by chessknt » Tue Sep 11, 2018 6:19 pm

If finding a medical home (labs and xray and offices all housed in the same building) is an option and you have an aca insurance plan and this is a routine health visit and a routine lab then it is highly unlikely you will be charged.

Medicine costs are hard to estimate in advance for many things for various legitimate reasons, but a basic lab test is not one that falls in to that category. If you are getting genetic testing Sent to a special lab for a blood cancer that is a different story from a kidney panel--sorry they gave you the run around :(

tmcc
Posts: 138
Joined: Tue Feb 06, 2018 6:38 pm

Re: Lab test prices - exasperating!

Post by tmcc » Tue Sep 11, 2018 6:44 pm

get to a point where you're financially independent and let it go to collections for spite.

ag1
Posts: 37
Joined: Tue Apr 17, 2007 5:22 pm

Re: Lab test prices - exasperating!

Post by ag1 » Tue Sep 11, 2018 6:50 pm

It is not as easy as being financially independent. Now credit scores are used by insurance companies to price your premiums and by credit card companies/Banks to keep your accounts open.

But after receiving the bills you can negotiate them.

Ag

123
Posts: 3629
Joined: Fri Oct 12, 2012 3:55 pm

Re: Lab test prices - exasperating!

Post by 123 » Tue Sep 11, 2018 8:00 pm

If you health insurance provider has a website be sure to establish an account. Frequently they will have pricing available for different services at different locations. Individual locations are often clearly identified. When I looked up the cost of a few simple generic blood tests the prices varied dramatically. At a convenient lab at a hospital a set of tests might cost $500+ whereas at a local Quest walk-in lab they might be $75 or less. There are dramatic differences. If you have insurance or a situation that requires you pay for the service (using the insurance negoitated rates) it pays to shop around. The costs of some hospital procedures can vary tremendously.
The closest helping hand is at the end of your own arm.

MrPickles
Posts: 6
Joined: Wed Nov 21, 2007 9:08 pm

Re: Lab test prices - exasperating!

Post by MrPickles » Tue Sep 11, 2018 8:53 pm

Just type in "prepaid lab test" into your favorite search engine and you'll be directed to plenty of sites that show the cost of the test upfront.

mariezzz
Posts: 197
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Wed Sep 12, 2018 10:41 am

sawhorse wrote:
Tue Sep 11, 2018 4:46 pm
SlowMovingInvestor wrote:
Tue Sep 11, 2018 4:42 pm
If you only go to in network labs, then they typically cannot bill you extra if the test is denied. I admit that sometimes it's hard to do when doctors send samples to out of network labs.
Last time I went to an in-network lab, and almost all the tests were covered. There was, however, an expensive rarely ordered test that they didn't cover.
Having a test 'covered' is different from getting 'best coverage'. My insurance will cover out-of-network labs at 50% of the insurance company's ALLOWED amount (which includes all the labs attached to the main physician network they contract with), but if I go to Quest, my coverage is 85%. This means 85% of the amount my insurance company ALLOWS - which is many times less on average than what Quest (and all other labs) bill initially. If I go to an out-of-network lab, I am balance billed, namely, they can hold me responsible for the difference between what they billed and what my insurance company Allowed. For my insurance, Quest is "in network" and "best coverage", so they can't balance bill me.

I've found that Quest Diagnostic bills on average over 7 times more for labs (for someone who isn't eligible for any insurance discount, i.e., a cash payer) , compared to rates they negotiate with insurers. I had to have a large number of lab tests done over a few years (with 2 different insurers) and this was consistent across both. I carefully tracked everything in a spreadsheet and the premium for cash payer ranged from 3 times higher to 16 times higher. This was based on what the insurance company "Allowed" - before taking into account the percentage the insurance company paid (with me paying the rest).

This practice of labs charging cash payers many times more for their tests than they pay to insurance companies is one of the big medical expense scams that have not even gotten much attention, much less addressed. I have contacted my state legislators & provided them with the documentation I have from my expenses, but it's going to take a lot of people complaining for this to get addressed.

It is true that it is very difficult usually, and often impossible, to get the price up front, for medical care, which is absolutely ridiculous. I've even asked for a low & high range from my physician network, and been told they can't even provide that. With Quest, you can't even reach a person who has that information. Even if you get some number, that information is clearly marked as an estimate, and it says it's not a guarantee. This is another thing about the US medical system that needs to change. If I go to Target, I know what I'm being charged at the register - I don't expect to find out the price 2 months later. You can't make informed medical decisions without knowing the price.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 11:28 am

I might investigate why the lab tests are not covered by your insurance.

Perhaps (don't know until you investigate) these tests are not the currently advised tests - and, perhaps, they should not be ordered by your Physician.

mariezzz
Posts: 197
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Wed Sep 12, 2018 11:46 am

dm200 wrote:
Wed Sep 12, 2018 11:28 am
I might investigate why the lab tests are not covered by your insurance.

Perhaps (don't know until you investigate) these tests are not the currently advised tests - and, perhaps, they should not be ordered by your Physician.
The above is very true. Not sure what tests the OP wants to have done but here's one example:

A lot of insurance companies won't cover vitamin D tests unless you meet a narrow number of diagnoses. This is probably the correct position for the insurance companies to take, given current research. However, physicians (even ones I have considered otherwise 'good') continue to suggest & order them. I just tell the physician my insurance won't cover them, so I won't have them. Quest bills something around $200 for people without insurance, and if your insurance company doesn't consider a test medically necessary, you are effectively without insurance for that test.

I go to MDs, but I know people who go to naturopathic doctors who also suggest many tests which when I've researched them, turn out to have little value based on available research. I had a nurse practitioner for a year or so who started getting deeper & deeper into naturopathic approaches, and she seemed to have very little understanding of the (very little) scientific evidence behind the tests she was recommending. I found another provider.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 11:51 am

mariezzz wrote:
Wed Sep 12, 2018 11:46 am
dm200 wrote:
Wed Sep 12, 2018 11:28 am
I might investigate why the lab tests are not covered by your insurance.
Perhaps (don't know until you investigate) these tests are not the currently advised tests - and, perhaps, they should not be ordered by your Physician.
The above is very true. Not sure what tests the OP wants to have done but here's one example:
A lot of insurance companies won't cover vitamin D tests unless you meet a narrow number of diagnoses. This is probably the correct position for the insurance companies to take, given current research. However, physicians (even ones I have considered otherwise 'good') continue to suggest & order them. I just tell the physician my insurance won't cover them, so I won't have them. Quest bills something around $200 for people without insurance, and if your insurance company doesn't consider a test medically necessary, you are effectively without insurance for that test.
I go to MDs, but I know people who go to naturopathic doctors who also suggest many tests which when I've researched them, turn out to have little value based on available research. I had a nurse practitioner for a year or so who started getting deeper & deeper into naturopathic approaches, and she seemed to have very little understanding of the (very little) scientific evidence behind the tests she was recommending. I found another provider.
On our Medicare plan, we are fortunate that, so far at least, all blood tests are fully covered 100%.

Over the years and many different physicians and insurance, it is not uncommon for some Physicians (MD or DO) to be a bit behind the current lab test findings and recommendations.

Mitchell777
Posts: 1014
Joined: Mon May 21, 2007 6:32 am

Re: Lab test prices - exasperating!

Post by Mitchell777 » Wed Sep 12, 2018 12:04 pm

I am not yet on Medicare. I hope they cover Vit D testing as I struggle to keep it where the doc wants it. If the price is anywhere around $200 that would be a shock if not covered. I know what that test is billed to large corporate customers and it is a tiny fraction of $200. I hope my doc has some knowledge on what is covered since the practice has a good number of older people.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 12:20 pm

Mitchell777 wrote:
Wed Sep 12, 2018 12:04 pm
I am not yet on Medicare. I hope they cover Vit D testing as I struggle to keep it where the doc wants it. If the price is anywhere around $200 that would be a shock if not covered. I know what that test is billed to large corporate customers and it is a tiny fraction of $200. I hope my doc has some knowledge on what is covered since the practice has a good number of older people.
Because of medical history, I get regular Vitamin D testing. We are on a Kaiser Medicare plan.

Rolyatroba
Posts: 206
Joined: Mon Apr 22, 2013 1:14 pm

Re: Lab test prices - exasperating!

Post by Rolyatroba » Wed Sep 12, 2018 12:33 pm

I have successfully used https://requestatest.com/ on a couple of occasions, if you want to try that in the future. Not sure if it will have your test or have a relationship with a lab in your area, however.

BTW, if you do get a hefty bill, fight it. Show the billing dept. that you're a diligent consumer; tell them you went to every length to find out what this would cost and that you had very little choice but to do the test after not getting some kind of price quote (BTW, some states have laws about providing price quotes when asked). Then tell them that you will complain to your insurance company, the better business bureau, local news stations, etc. (Even if they don't reduce then, wait until a collection agency calls and explain the situation and that you just won't pay the entire bill. But reconsider if they keep calling! The one time I did this I never got another call or bill after that first conversation with collections.)

You will have a very good chance of the lab dramatically reducing the cost. I have done this for lab tests and MRI's on more than one occasion, and have always been successful (albeit those were all large, local provider situations--e.g., the ortho's own MRI facility).

I'm trying to think of a single industry other than health care that can get away with this practice (which might explain my success rate in getting charges reduced).

cheezit
Posts: 18
Joined: Sat Jul 14, 2018 7:28 pm

Re: Lab test prices - exasperating!

Post by cheezit » Wed Sep 12, 2018 12:41 pm

Related but different things have bitten my wife and I. Eg. when she was pregnant with our eldest, she went to an OB appointment and she and the OB went over what tests she needed to have done. She went in to Quest Diagnostics, an in-network lab, for the tests and a while later we got an enormous bill for a rejected claim. After about two months of back-and-forth and three attempts on their part to file the claim correctly, they eventually got it right, but we still ended up on the hook for $800 for a test that my wife had told the OB not to order, because the lab said it was on the list and the OB didn't recall the by-now-months-old conversation she had with my wife with enough clarity to be certain she hadn't ordered it.

It ended up not mattering, as it was preordained that we were going to go through our entire HRA balance before hitting the deductible cap anyways, but the whole experience was thoroughly lousy.

We've also had issues with a hospital claiming for months on end that our insurer never paid them, and having to act as a near-daily go-between for the hospital and the insurance company (who each kept claiming that the other didn't answer or return their calls nor reply to their faxes) until that got straightened out [by my wife eventually having a breakdown and screaming into the phone for about three minutes until the case got escalated to someone who somehow immediately found the record of payment from the insurance company to the hospital and dropped the matter].

At this point I am convinced that the entire field of medical billing is a racket designed to extract the maximum possible cash from the customer beyond the contractually agreed premium and deductible, with the side effect of being a jobs program for those that the DMV wouldn't hire because they were too bureaucratic.

User avatar
sunny_socal
Posts: 1610
Joined: Tue Mar 24, 2015 4:22 pm

Re: Lab test prices - exasperating!

Post by sunny_socal » Wed Sep 12, 2018 1:22 pm

My wife was billed $10k for a blood test & culture.
- Called insurance co, they said we're responsible for $7k
- Called clinic, they said "oops, your bill is only $150"

I'm pretty sure clinic was able to "earn" thousands somewhere in that transaction.

Approach:
1. Bill an outrageous amount for a service
2. Find out how much the victim's insurance will cover
3. Take as much as they can get

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 1:26 pm

The other issue with ending up with the wrong tests is that it then becomes a health issue.

User avatar
ThereAreNoGurus
Posts: 132
Joined: Fri Jan 24, 2014 11:41 pm

Re: Lab test prices - exasperating!

Post by ThereAreNoGurus » Wed Sep 12, 2018 1:30 pm


User avatar
susa
Posts: 440
Joined: Sat Oct 06, 2007 4:30 pm
Contact:

Re: Lab test prices - exasperating!

Post by susa » Wed Sep 12, 2018 1:49 pm

ThereAreNoGurus wrote: I used this website once:
www .lifeextension.com/Vitamins-Supplements/Blood-Tests/Blood-Tests
+1

We *always* do our entire family annual tests (ie. purchase is April during Supersale, goto Quest/Labcorp inside next 6 months) there ... last time we purchased for everyone a 7-vial (..felt a bit faint after nurse was done filling tubes..).. "comprehensive panel" and Amex was running a "spend 125 get 25 back" so we ended up paying per person about 140 due to splitting up the charges across multiple Amex cards and received a 6 page report with such details that our GP exclaimed "..had I ordered these tests it would have cost you over 1,200.00 per person !"

downshiftme
Posts: 1039
Joined: Sun Mar 11, 2007 6:11 pm

Re: Lab test prices - exasperating!

Post by downshiftme » Wed Sep 12, 2018 2:01 pm

If you only go to in network labs, then they typically cannot bill you extra if the test is denied. I admit that sometimes it's hard to do when doctors send samples to out of network labs.
I found this was not the case. An in-network lab doing an in-network test can still be handled by an non-network tech who can bill virtually any amount. I guess it was still "covered" but my portion of the bill was many times the normal cost of the test if all in-network people were involved. This is something I had no control over and no way to fix after the fact.

SlowMovingInvestor
Posts: 790
Joined: Sun Sep 11, 2016 11:27 am

Re: Lab test prices - exasperating!

Post by SlowMovingInvestor » Wed Sep 12, 2018 2:04 pm

mariezzz wrote:
Wed Sep 12, 2018 11:46 am
Quest bills something around $200 for people without insurance, and if your insurance company doesn't consider a test medically necessary, you are effectively without insurance for that test.
Is that really the case ? My impression was that if you go to an in network lab, even if your insurance company doesn't consider the test medically necessary, you are only billd the insurance rate, not the 'rack' rate.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 2:30 pm

SlowMovingInvestor wrote:
Wed Sep 12, 2018 2:04 pm
mariezzz wrote:
Wed Sep 12, 2018 11:46 am
Quest bills something around $200 for people without insurance, and if your insurance company doesn't consider a test medically necessary, you are effectively without insurance for that test.
Is that really the case ? My impression was that if you go to an in network lab, even if your insurance company doesn't consider the test medically necessary, you are only billd the insurance rate, not the 'rack' rate.
No direct experience - but that is my understanding as well.

chessknt
Posts: 70
Joined: Wed Jul 13, 2016 3:15 am

Re: Lab test prices - exasperating!

Post by chessknt » Wed Sep 12, 2018 2:42 pm

mariezzz wrote:
Wed Sep 12, 2018 10:41 am
sawhorse wrote:
Tue Sep 11, 2018 4:46 pm
SlowMovingInvestor wrote:
Tue Sep 11, 2018 4:42 pm
If you only go to in network labs, then they typically cannot bill you extra if the test is denied. I admit that sometimes it's hard to do when doctors send samples to out of network labs.
Last time I went to an in-network lab, and almost all the tests were covered. There was, however, an expensive rarely ordered test that they didn't cover.
Having a test 'covered' is different from getting 'best coverage'. My insurance will cover out-of-network labs at 50% of the insurance company's ALLOWED amount (which includes all the labs attached to the main physician network they contract with), but if I go to Quest, my coverage is 85%. This means 85% of the amount my insurance company ALLOWS - which is many times less on average than what Quest (and all other labs) bill initially. If I go to an out-of-network lab, I am balance billed, namely, they can hold me responsible for the difference between what they billed and what my insurance company Allowed. For my insurance, Quest is "in network" and "best coverage", so they can't balance bill me.

I've found that Quest Diagnostic bills on average over 7 times more for labs (for someone who isn't eligible for any insurance discount, i.e., a cash payer) , compared to rates they negotiate with insurers. I had to have a large number of lab tests done over a few years (with 2 different insurers) and this was consistent across both. I carefully tracked everything in a spreadsheet and the premium for cash payer ranged from 3 times higher to 16 times higher. This was based on what the insurance company "Allowed" - before taking into account the percentage the insurance company paid (with me paying the rest).

This practice of labs charging cash payers many times more for their tests than they pay to insurance companies is one of the big medical expense scams that have not even gotten much attention, much less addressed. I have contacted my state legislators & provided them with the documentation I have from my expenses, but it's going to take a lot of people complaining for this to get addressed.

It is true that it is very difficult usually, and often impossible, to get the price up front, for medical care, which is absolutely ridiculous. I've even asked for a low & high range from my physician network, and been told they can't even provide that. With Quest, you can't even reach a person who has that information. Even if you get some number, that information is clearly marked as an estimate, and it says it's not a guarantee. This is another thing about the US medical system that needs to change. If I go to Target, I know what I'm being charged at the register - I don't expect to find out the price 2 months later. You can't make informed medical decisions without knowing the price.
It isn't a scam by the lab--insurers typically negotiate a specific amount or 1/10th or so of the cash price of a lab (whichever is less) , procedure, etc so any entity who contracts with them has to inflate cash prices. One could stipulate this is done to keep health insurance in business but that is beyond the cope of this forum.

chessknt
Posts: 70
Joined: Wed Jul 13, 2016 3:15 am

Re: Lab test prices - exasperating!

Post by chessknt » Wed Sep 12, 2018 2:49 pm

Rolyatroba wrote:
Wed Sep 12, 2018 12:33 pm

I'm trying to think of a single industry other than health care that can get away with this practice (which might explain my success rate in getting charges reduced).

I feel like I encounter this practice with literally every professional or contractor service I have ever used, from auto repair to legal issues to carpentry.

As I mentioned above the insurers are driving this process, not the providers or mri facility ownership or lab. They let you win because they have limited resources and margins allow for losses. You could take the same approach to get free food at every restaurant you eat in if you complain loudly enough and cause a big fuss but that doesn't mean it is a viable practice for everyone to adopt.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 2:56 pm

Sometimes (I have done this) you can reduce the need for some tests by reminding physicians/specialists of the tests you already have had (and he/she can look at those) or suggest skipping other tests when another physician normally orders them.

Rolyatroba
Posts: 206
Joined: Mon Apr 22, 2013 1:14 pm

Re: Lab test prices - exasperating!

Post by Rolyatroba » Wed Sep 12, 2018 3:12 pm

chessknt wrote:
Wed Sep 12, 2018 2:49 pm
I feel like I encounter this practice with literally every professional or contractor service I have ever used, from auto repair to legal issues to carpentry.
Well, that hasn't been my experience: auto repair shops will always give a quote for most things (perhaps internal problems that can't be diagnosed, or other--perhaps dubious--part failures, can lead to unexpected costs, but not the same problem).

Mostly the same for the carpenters I've dealt with, albeit scope creep on the buyer's part might be what you're referring to there.

And many attorney's will give you a reasonable cost range for most things. And they always tell you that you might not win.

As I mentioned above the insurers are driving this process, not the providers or mri facility ownership or lab. They let you win because they have limited resources and margins allow for losses. You could take the same approach to get free food at every restaurant you eat in if you complain loudly enough and cause a big fuss but that doesn't mean it is a viable practice for everyone to adopt.
Here is one example of why I won once (and note it probably wasn't for the reasons you mentioned). Needed an MRI...used online cost estimator at Blue Cross, was listed at $477 at nearby facility...called that facility and asked if that would be the cost...they answered yes, so I scheduled MRI...brought printout of estimate and asked again about cost, back office person came out and said correct. A few weeks later I got a bill for $2,100. Insurance company wouldn't defend me, literally saying "sometimes providers charge more than the contracted price". I paid only $477 of the bill on their online bill payment system, and explained the situation in a note field. Didn't hear from them again, not even a bill for the balance.

I don't take this approach at any restaurant I eat at, or any other businesses I can think of, so you might want to reconsider that rebuttal.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 3:21 pm

Here is one example of why I won once (and note it probably wasn't for the reasons you mentioned). Needed an MRI...used online cost estimator at Blue Cross, was listed at $477 at nearby facility...called that facility and asked if that would be the cost...they answered yes, so I scheduled MRI...brought printout of estimate and asked again about cost, back office person came out and said correct. A few weeks later I got a bill for $2,100. Insurance company wouldn't defend me, literally saying "sometimes providers charge more than the contracted price". I paid only $477 of the bill on their online bill payment system, and explained the situation in a note field. Didn't hear from them again, not even a bill for the balance.
Feel fortunate that on our Medicare plans, we currently are charged $150 for MRIs and CT scans. :happy

chessknt
Posts: 70
Joined: Wed Jul 13, 2016 3:15 am

Re: Lab test prices - exasperating!

Post by chessknt » Wed Sep 12, 2018 3:25 pm

Rolyatroba wrote:
Wed Sep 12, 2018 3:12 pm
chessknt wrote:
Wed Sep 12, 2018 2:49 pm
I feel like I encounter this practice with literally every professional or contractor service I have ever used, from auto repair to legal issues to carpentry.
Well, that hasn't been my experience: auto repair shops will always give a quote for most things (perhaps internal problems that can't be diagnosed, or other--perhaps dubious--part failures, can lead to unexpected costs, but not the same problem).

Mostly the same for the carpenters I've dealt with, albeit scope creep on the buyer's part might be what you're referring to there.

And many attorney's will give you a reasonable cost range for most things. And they always tell you that you might not win.

As I mentioned above the insurers are driving this process, not the providers or mri facility ownership or lab. They let you win because they have limited resources and margins allow for losses. You could take the same approach to get free food at every restaurant you eat in if you complain loudly enough and cause a big fuss but that doesn't mean it is a viable practice for everyone to adopt.
Here is one example of why I won once (and note it probably wasn't for the reasons you mentioned). Needed an MRI...used online cost estimator at Blue Cross, was listed at $477 at nearby facility...called that facility and asked if that would be the cost...they answered yes, so I scheduled MRI...brought printout of estimate and asked again about cost, back office person came out and said correct. A few weeks later I got a bill for $2,100. Insurance company wouldn't defend me, literally saying "sometimes providers charge more than the contracted price". I paid only $477 of the bill on their online bill payment system, and explained the situation in a note field. Didn't hear from them again, not even a bill for the balance.

I don't take this approach at any restaurant I eat at, or any other businesses I can think of, so you might want to reconsider that rebuttal.
That was a cost estimate to you based on your insurance benefit. Key word is estimate: noone can predict what your insurance will ultimately pay based on their seemingly endless algorithms to reduce payments. Came out higher for you based on final payment from insurance and you refused to pay and clearly demonstrated that you were not going to do so. Instead of fighting it they just write it off and move on. Maybe they were trying to overcharge you but the majority of the time the health insurance entity plays games driving overhead in to the stratosphere. They literally have people whose full time job is to call health insurance companies to wait on hold half the time and argue with them the other half of the time. Nobody has time for the uncommon patient who won't pay his bill because of insurance shenanigans he doesn't understand and erroneously attributes to them, especially if it looks like he is going to go on a crusade to try and damage the reputation of the facility or practitioner.

The same thing can happen with dentists but usually they force you to deal with the problem based on all the paperwork you sign on your first visit.

sport
Posts: 7179
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: Lab test prices - exasperating!

Post by sport » Wed Sep 12, 2018 3:28 pm

Mitchell777 wrote:
Wed Sep 12, 2018 12:04 pm
I am not yet on Medicare. I hope they cover Vit D testing as I struggle to keep it where the doc wants it. If the price is anywhere around $200 that would be a shock if not covered. I know what that test is billed to large corporate customers and it is a tiny fraction of $200. I hope my doc has some knowledge on what is covered since the practice has a good number of older people.
My Dr. ordered a Vit D test for me. When I went to the lab, they told me it would not be covered by my Medicare insurance, it would cost $93, and I had to sign a paper saying I agreed to pay if insurance did not. I decided that it was worth $93 for me to get the test, so I signed. It turned out that the insurance reduced the charge to about $50 and then paid it. My cost was -0-.

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 3:29 pm

The same thing can happen with dentists but usually they force you to deal with the problem based on all the paperwork you sign on your first visit.
Of course, I would not want any dentist working on me where that dentist was unhappy with me and/or my declining to pay my bill(s).

Rolyatroba
Posts: 206
Joined: Mon Apr 22, 2013 1:14 pm

Re: Lab test prices - exasperating!

Post by Rolyatroba » Wed Sep 12, 2018 3:56 pm

chessknt wrote:
Wed Sep 12, 2018 3:25 pm
That was a cost estimate to you based on your insurance benefit. Key word is estimate: noone can predict what your insurance will ultimately pay based on their seemingly endless algorithms to reduce payments. Came out higher for you based on final payment from insurance and you refused to pay and clearly demonstrated that you were not going to do so. Instead of fighting it they just write it off and move on. Maybe they were trying to overcharge you but the majority of the time the health insurance entity plays games driving overhead in to the stratosphere. They literally have people whose full time job is to call health insurance companies to wait on hold half the time and argue with them the other half of the time. Nobody has time for the uncommon patient who won't pay his bill because of insurance shenanigans he doesn't understand and erroneously attributes to them, especially if it looks like he is going to go on a crusade to try and damage the reputation of the facility or practitioner.
That argument (and thus all the woo woo that follows) doesn't take into account my specific action of asking the provider if the $477 cost is what I should expect. I had an oral contract for that specific test on that day, and would have been happy to explain to a judge--complete with all the corroborating evidence I had--that the provider did not perform their side of that contract (i.e., raising the price from what I reasonably understood it would be).

BTW, you might want to know more facts about a situation or more about who you are talking to, before accusing he/she of not understanding something and/or engaging in shenanigans.

User avatar
goodenyou
Posts: 1320
Joined: Sun Jan 31, 2010 11:57 pm
Location: Skating to Where the Puck is Going to Be..or on the golf course

Re: Lab test prices - exasperating!

Post by goodenyou » Wed Sep 12, 2018 4:05 pm

If I pay cash for labs, I know the price. If I run it through insurance, the lab inflates the price and then I have to pay the inflated price since it goes towards my deductible. I learned the hard way. I was charged a ridiculous amount because it was run through my insurance. I just got labs recently and paid cash. I won’t use my insurance for the first dollar up to the yearly deductible for labs. The insurance company only cares about their dollar. Cash is king and medical facilities would take it over the insurance hassles anytime. You don’t want to be caught in the dark hole of insurance claims. It is awful for the patient and the provider. If you can avoid it, try your level best to avoid it.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

User avatar
dm200
Posts: 17739
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Lab test prices - exasperating!

Post by dm200 » Wed Sep 12, 2018 4:49 pm

One (of many) things I like about our provider is that almost all test results are available to me online - and going back many years.

sport
Posts: 7179
Joined: Tue Feb 27, 2007 3:26 pm
Location: Cleveland, OH

Re: Lab test prices - exasperating!

Post by sport » Wed Sep 12, 2018 4:50 pm

goodenyou wrote:
Wed Sep 12, 2018 4:05 pm
If I pay cash for labs, I know the price. If I run it through insurance, the lab inflates the price and then I have to pay the inflated price since it goes towards my deductible. I learned the hard way. I was charged a ridiculous amount because it was run through my insurance. I just got labs recently and paid cash. I won’t use my insurance for the first dollar up to the yearly deductible for labs. The insurance company only cares about their dollar. Cash is king and medical facilities would take it over the insurance hassles anytime. You don’t want to be caught in the dark hole of insurance claims. It is awful for the patient and the provider. If you can avoid it, try your level best to avoid it.
When the inflated price is run through insurance, doesn't the insurance company reduce the price to the contracted insurance price? They should if you go to an "in network" provider. If you go "outside of network", then you get to pay the full invoice.

User avatar
goodenyou
Posts: 1320
Joined: Sun Jan 31, 2010 11:57 pm
Location: Skating to Where the Puck is Going to Be..or on the golf course

Re: Lab test prices - exasperating!

Post by goodenyou » Wed Sep 12, 2018 6:12 pm

sport wrote:
Wed Sep 12, 2018 4:50 pm
goodenyou wrote:
Wed Sep 12, 2018 4:05 pm
If I pay cash for labs, I know the price. If I run it through insurance, the lab inflates the price and then I have to pay the inflated price since it goes towards my deductible. I learned the hard way. I was charged a ridiculous amount because it was run through my insurance. I just got labs recently and paid cash. I won’t use my insurance for the first dollar up to the yearly deductible for labs. The insurance company only cares about their dollar. Cash is king and medical facilities would take it over the insurance hassles anytime. You don’t want to be caught in the dark hole of insurance claims. It is awful for the patient and the provider. If you can avoid it, try your level best to avoid it.
When the inflated price is run through insurance, doesn't the insurance company reduce the price to the contracted insurance price? They should if you go to an "in network" provider. If you go "outside of network", then you get to pay the full invoice.
Ideally, but it doesn't always work that way. I can get an "executive" metabolic panel for $20 at my hospital. If I run it through insurance, it is a lot more. The cash price is lower than the negotiated reduced fee that the insurance company (I) would pay. If it is a very expensive lab test, you may want to use insurance. Cash prices are usually lower that the network price, because the provider doesn't have to pay people to chase the money and, just like patients. they have uncertainty as to how much they will be paid.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

sawhorse
Posts: 2972
Joined: Sun Mar 01, 2015 7:05 pm

Re: Lab test prices - exasperating!

Post by sawhorse » Wed Sep 12, 2018 8:04 pm

goodenyou wrote:
Wed Sep 12, 2018 4:05 pm
If I pay cash for labs, I know the price. If I run it through insurance, the lab inflates the price and then I have to pay the inflated price since it goes towards my deductible.
How do you find out the cash price ahead of time? And how do you know whether to run it through insurance?
Last edited by sawhorse on Wed Sep 12, 2018 8:26 pm, edited 1 time in total.

User avatar
nisiprius
Advisory Board
Posts: 36472
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Lab test prices - exasperating!

Post by nisiprius » Wed Sep 12, 2018 8:21 pm

unclescrooge wrote:
Tue Sep 11, 2018 5:08 pm
So is it pointless to ask for pricing?
In my experience, as nearly as I can tell... yes.
Do you just go ahead with the treatment/tests/procedure and hope they don't bill you an obscene amount that's not covered under insurance?
Why, yes. That is what I do. Because I haven't figured out what else to do.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

sawhorse
Posts: 2972
Joined: Sun Mar 01, 2015 7:05 pm

Re: Lab test prices - exasperating!

Post by sawhorse » Wed Sep 12, 2018 8:31 pm

123 wrote:
Tue Sep 11, 2018 8:00 pm
If you health insurance provider has a website be sure to establish an account. Frequently they will have pricing available for different services at different locations. Individual locations are often clearly identified. When I looked up the cost of a few simple generic blood tests the prices varied dramatically. At a convenient lab at a hospital a set of tests might cost $500+ whereas at a local Quest walk-in lab they might be $75 or less. There are dramatic differences. If you have insurance or a situation that requires you pay for the service (using the insurance negoitated rates) it pays to shop around. The costs of some hospital procedures can vary tremendously.
In your experience, if a lab is less expensive for one test, is it generally less expensive for all tests? I sometimes have to get over a dozen vials collected. My record is 28 vials. So that's a lot of tests. If different labs are cheaper for different tests, that would mean I'd have to go to several different labs to get all the tests, something that is very difficult in my current state of health.

User avatar
VictoriaF
Posts: 18525
Joined: Tue Feb 27, 2007 7:27 am
Location: Black Swan Lake

Re: Lab test prices - exasperating!

Post by VictoriaF » Wed Sep 12, 2018 9:08 pm

susa wrote:
Wed Sep 12, 2018 1:49 pm
ThereAreNoGurus wrote: I used this website once:
www .lifeextension.com/Vitamins-Supplements/Blood-Tests/Blood-Tests
+1

We *always* do our entire family annual tests (ie. purchase is April during Supersale, goto Quest/Labcorp inside next 6 months) there ... last time we purchased for everyone a 7-vial (..felt a bit faint after nurse was done filling tubes..).. "comprehensive panel" and Amex was running a "spend 125 get 25 back" so we ended up paying per person about 140 due to splitting up the charges across multiple Amex cards and received a 6 page report with such details that our GP exclaimed "..had I ordered these tests it would have cost you over 1,200.00 per person !"
Thank you for the recommendation.

I have just reviewed the LifeExtension web site and became curious about several tests. When do they normally run sales? How to find out that they are running a sale?

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

dknightd
Posts: 717
Joined: Wed Mar 07, 2018 11:57 am

Re: Lab test prices - exasperating!

Post by dknightd » Wed Sep 12, 2018 9:35 pm

If my doctor suggested a lab test that was not covered I'd complain and probably have to change doctor.
When you walk in the door, they want to confirm your health insurance. So they know what is covered. At least most of the time

User avatar
goodenyou
Posts: 1320
Joined: Sun Jan 31, 2010 11:57 pm
Location: Skating to Where the Puck is Going to Be..or on the golf course

Re: Lab test prices - exasperating!

Post by goodenyou » Wed Sep 12, 2018 9:35 pm

sawhorse wrote:
Wed Sep 12, 2018 8:04 pm
goodenyou wrote:
Wed Sep 12, 2018 4:05 pm
If I pay cash for labs, I know the price. If I run it through insurance, the lab inflates the price and then I have to pay the inflated price since it goes towards my deductible.
How do you find out the cash price ahead of time? And how do you know whether to run it through insurance?
My hospital has a list like a Chinese menu. You can pick many combinations and a few appetizers. If it’s not listed, I ask the cost. The list is for the general public. I have some friends in the business and some knowledge of the system.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

User avatar
goodenyou
Posts: 1320
Joined: Sun Jan 31, 2010 11:57 pm
Location: Skating to Where the Puck is Going to Be..or on the golf course

Re: Lab test prices - exasperating!

Post by goodenyou » Wed Sep 12, 2018 9:52 pm

dknightd wrote:
Wed Sep 12, 2018 9:35 pm
If my doctor suggested a lab test that was not covered I'd complain and probably have to change doctor.
When you walk in the door, they want to confirm your health insurance. So they know what is covered. At least most of the time
Who knows what’s covered?
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

dknightd
Posts: 717
Joined: Wed Mar 07, 2018 11:57 am

Re: Lab test prices - exasperating!

Post by dknightd » Wed Sep 12, 2018 9:57 pm

goodenyou wrote:
Wed Sep 12, 2018 9:52 pm
dknightd wrote:
Wed Sep 12, 2018 9:35 pm
If my doctor suggested a lab test that was not covered I'd complain and probably have to change doctor.
When you walk in the door, they want to confirm your health insurance. So they know what is covered. At least most of the time
Who knows what’s covered?
I assume the insurance company knows. The doctor's office probably also knows

User avatar
goodenyou
Posts: 1320
Joined: Sun Jan 31, 2010 11:57 pm
Location: Skating to Where the Puck is Going to Be..or on the golf course

Re: Lab test prices - exasperating!

Post by goodenyou » Wed Sep 12, 2018 10:03 pm

dknightd wrote:
Wed Sep 12, 2018 9:57 pm
goodenyou wrote:
Wed Sep 12, 2018 9:52 pm
dknightd wrote:
Wed Sep 12, 2018 9:35 pm
If my doctor suggested a lab test that was not covered I'd complain and probably have to change doctor.
When you walk in the door, they want to confirm your health insurance. So they know what is covered. At least most of the time
Who knows what’s covered?
I assume the insurance company knows. The doctor's office probably also knows
Of course the insurance company knows. They sold the policy. The doctor has no earthly clue what is in your insurance policy. How would they know? They only know that they participate as a medical provider. There are hundreds of policies over thousands of patients with different benefits. Doctors don’t pick lab tests based on what is covered. I would hope it is based on what is medically necessary.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

Rolyatroba
Posts: 206
Joined: Mon Apr 22, 2013 1:14 pm

Re: Lab test prices - exasperating!

Post by Rolyatroba » Wed Sep 12, 2018 10:07 pm

goodenyou wrote:
Wed Sep 12, 2018 10:03 pm
Doctors don’t pick lab tests based on what is covered. I would hope it is based on what is medically necessary.
I'd suggest that is a naive hope. Unnecessary tests are widely considered to be a significant part of the problem of our high-cost health care system.

Post Reply