Lab test prices - exasperating!

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
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 10:13 pm

Rolyatroba wrote:
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.
I don’t disagree that tests are ordered unnecessarily. Most doctors have no financial interest in ordering unnecessary tests. If your doctor owns the lab, it should be disclosed. If you think the test is unnecessary, find a doctor that doesn’t own the lab. You have no trust in them. Unnecessary tests are often result from the litigious culture we have in the country.
"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 10:14 pm

nisiprius wrote:
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.
Nisi...I have a tremendous amount of respect for your well-researched posts, and great admiration of your seemingly unending insights (both on-topic and peripheral). So, your apparent exasperation on this is bothersome to me. Can you elucidate on why you (apparently) have thrown up your hands on this issue?

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

Re: Lab test prices - exasperating!

Post by dknightd » Wed Sep 12, 2018 10:27 pm

goodenyou wrote:
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.
This is a communication problem. The front office knows what coverage I have. The doctor should take that under consideration.

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 10:36 pm

dknightd wrote:
Wed Sep 12, 2018 10:27 pm
goodenyou wrote:
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.
This is a communication problem. The front office knows what coverage I have. The doctor should take that under consideration.
That is incorrect. They don’t have a copy of your policy and all the fine print. The administration burden to figure out your policy is out if the scope of a doctors’ office. If you can find a doctor’s office that can walk everyone through all the details of their policy, they won’t be in business very long. Unless, of course, they are doing the labs or other tests in house.
Last edited by goodenyou on Wed Sep 12, 2018 10:38 pm, edited 1 time in total.
"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 10:37 pm

goodenyou wrote:
Wed Sep 12, 2018 10:13 pm
I don’t disagree that tests are ordered unnecessarily. Most doctors have no financial interest in ordering unnecessary tests. If your doctor owns the lab, it should be disclosed. If you think the test is unnecessary, find a doctor that doesn’t own the lab. You have no trust in them. Unnecessary tests are often result from the litigious culture we have in the country.
I think the litigation risk likely has a some amount influence on the number of unnecessary tests, but that probably applies only to small practices.

Another example of my battles: I had something with flu-like symptoms, but also with some other symptoms I hadn't seen before, so I went to my big-box doc (PAMF). I had some lesions on the back of my neck, and he said I had Shingles! He then said, it also might be some kind of STD, but most likely one or the other. He then asked if I would like a to do a test for the STD, and I asked if the test was positive for the STD, would that change the treatment plan. He said no, he'd be prescribing the same medication either way. I said no STD test then. The session went on for a few more minutes and then just before finishing he took out a swab and said that he'd like to do the STD test anyway. I thought "ok there goes $50" but OK. Well, I got a bill for $350 (high-deductible plan). I was livid that the outcome of the test would not have changed the treatment plan, and I was asked to pay $350 extra anyway. Well, I fought that with the provider, and accused them of charging me for an unnecessary test, and again they didn't resist my complaint.

Some might call this a shenanigan, but I felt fleeced and have enough evidence to not feel a bit of guilt about not paying that bill.

In my own experiences, combined with the widespread coverage of unnecessary tests, it would seem to me that there is something else underneath this besides fear of litigation.

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 10:47 pm

Rolyatroba wrote:
Wed Sep 12, 2018 10:37 pm
goodenyou wrote:
Wed Sep 12, 2018 10:13 pm
I don’t disagree that tests are ordered unnecessarily. Most doctors have no financial interest in ordering unnecessary tests. If your doctor owns the lab, it should be disclosed. If you think the test is unnecessary, find a doctor that doesn’t own the lab. You have no trust in them. Unnecessary tests are often result from the litigious culture we have in the country.
I think the litigation risk likely has a some amount influence on the number of unnecessary tests, but that probably applies only to small practices.


Another example of my battles: I had something with flu-like symptoms, but also with some other symptoms I hadn't seen before, so I went to my big-box doc (PAMF). I had some lesions on the back of my neck, and he said I had Shingles! He then said, it also might be some kind of STD, but most likely one or the other. He then asked if I would like a to do a test for the STD, and I asked if the test was positive for the STD, would that change the treatment plan. He said no, he'd be prescribing the same medication either way. I said no STD test then. The session went on for a few more minutes and then just before finishing he took out a swab and said that he'd like to do the STD test anyway. I thought "ok there goes $50" but OK. Well, I got a bill for $350 (high-deductible plan). I was livid that the outcome of the test would not have changed the treatment plan, and I was asked to pay $350 extra anyway. Well, I fought that with the provider, and accused them of charging me for an unnecessary test, and again they didn't resist my complaint.

Some might call this a shenanigan, but I felt fleeced and have enough evidence to not feel a bit of guilt about not paying that bill.

In my own experiences, combined with the widespread coverage of unnecessary tests, it would seem to me that there is something else underneath this besides fear of litigation.
It is not appropriate for me to comment on specific medical conditions, but find another doctor if you think they are dishonest. What was the doctor’s profit on the test? Done in house? There are potentially a lot more reasons for the unnecessary test that was not communicated to you. The doctor was stupid to not quote you a price if they had no idea what it would cost. If it were me, I would have told you why the test was appropriate and had you pay for it before I did it. I would give you the right to decline it and would have documented that you refused. All good. Find another doctor. There are plenty. If you want a lot of tests, go to a large academic center. You will have every test imaginable.
"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 11:12 pm

goodenyou wrote:
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.
How can I get a copy of the list?

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 11:21 pm

sawhorse wrote:
Wed Sep 12, 2018 11:12 pm
goodenyou wrote:
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.
How can I get a copy of the list?
Go to the hospital outpatient laboratory. Walk in and ask. You can call an HCA facility in your area and ask. It is very simple. Have you called outpatient labs and asked? Ask, “ what do you charge for a basic metabolic panel and a CBC?” It’s $20 for the general public. You can get many more listed. $15 for a sed rate. $30 for a testosterone level etc etc.
"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 11:42 pm

goodenyou wrote:
Wed Sep 12, 2018 11:21 pm
sawhorse wrote:
Wed Sep 12, 2018 11:12 pm
goodenyou wrote:
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.
How can I get a copy of the list?
Go to the hospital outpatient laboratory. Walk in and ask. You can call an HCA facility in your area and ask. It is very simple. Have you called outpatient labs and asked? Ask, “ what do you charge for a basic metabolic panel and a CBC?” It’s $20 for the general public. You can get many more listed. $15 for a sed rate. $30 for a testosterone level etc etc.
I tried asking the lab for the cash prices and couldn't get an answer, as indicated in my original post.

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

Re: Lab test prices - exasperating!

Post by Rolyatroba » Thu Sep 13, 2018 12:22 am

goodenyou wrote:
Wed Sep 12, 2018 10:47 pm
It is not appropriate for me to comment on specific medical conditions, but find another doctor if you think they are dishonest. What was the doctor’s profit on the test? Done in house? There are potentially a lot more reasons for the unnecessary test that was not communicated to you. The doctor was stupid to not quote you a price if they had no idea what it would cost. If it were me, I would have told you why the test was appropriate and had you pay for it before I did it. I would give you the right to decline it and would have documented that you refused. All good. Find another doctor. There are plenty. If you want a lot of tests, go to a large academic center. You will have every test imaginable.
Unnecessary testing (and other unnecessary procedures) is a well researched and well understood problem in the U.S. health care system. And it is not a simple thing to fix as just changing doctors, or to question a doctor not knowing the price of a test.

And I wish more doctors were like you! In my situation, I'd have said no blanking way for that test and we wouldn't be having this conversation right now. :)

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

Re: Lab test prices - exasperating!

Post by ThereAreNoGurus » Thu Sep 13, 2018 12:57 am

VictoriaF wrote:
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
It looks like they have an annual sale in Spring: https://www.lifeextension.com/Magazine/ ... le/Page-01

There is a Life Extension magazine, published monthly, that also advertises sales. Sometimes they have specials on certain "packages." The magazine is available on their site, also. However, assuming you prefer notification of sales, I'd try contacting them and asking.

njdreamer
Posts: 1
Joined: Wed Aug 12, 2015 2:21 pm

Re: Lab test prices - exasperating!

Post by njdreamer » Thu Sep 13, 2018 9:10 am

As you would expect, pricing for lab tests is often complicated and not as simple as a list of tests with prices on a website.
Each insurance company negotiates pricing with the major lab providers (Quest, Bio-Reference, etc.) so the same test is often different based on the lab you go to.

Also it depends on the plan you have (Medicare, Medicaid, Commercial, Blues-plan, etc). The insurance companies negotiate different rates for each of those products. To complicate it further it depends on the state in which you live. Many of these contracted rates vary from state to state. Often the negotiated pricing will be based on a % of Medicare (either National Medicare pricing or state/locality). Medicare pricing varies widely from state to state. Even if you have a commercial/employer based plan, the prices are typically negotiated as a % of Medicare. A state like California has 32 separate Medicare localities and pricing varies from locality to locality.

To make it even muddier, the mega-national sized health plans will often have "all you can eat buffet style" pricing with the laboratories.
So they pay the labs a per member / per month fee and it covers (nearly) all tests provided. There's is no pricing established for individual tests. The lab gets the same per member / per month revenue if you go for bloodwork 5 times in a year or if you don't go at all.

Lynette
Posts: 1789
Joined: Sun Jul 27, 2014 9:47 am

Re: Lab test prices - exasperating!

Post by Lynette » Thu Sep 13, 2018 9:58 am

At 74, I am fortunate to be fairly healthy and my 40-year experience of living in the USA has led me to believe that many of these tests/medicines are simply to avoid lawsuits for malpractice. So doctors make the patient do all of the tests ... just in case .. I was not born in the US and came from a country where malpractice lawsuits are rare. I am fully aware of my medical history and though something new may arise, in most cases I think many of these tests are unnecessary. I may be wrong but I think that many tests for vitamins and the tests for them are simply junk. I try to eat well and exercise.

Recently I was careless and spilt a cup of boiling water on my breast. It hurt so I took a few pain killers. Then I researched it, bought some bandages that I had to tape together to make them large enough to cover the area. A few weeks later all was well.

I have a fairly high tolerance for pain and throw away many of the prescriptions I get for painkillers after a surgical procedure. Experience has taught me that many of them have worse after effects than some mild pain.

So I avoid doctors and tests wherever humanly possible.

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 » Thu Sep 13, 2018 10:29 am

Lynette wrote:
Thu Sep 13, 2018 9:58 am
At 74, I am fortunate to be fairly healthy and my 40-year experience of living in the USA has led me to believe that many of these tests/medicines are simply to avoid lawsuits for malpractice. So doctors make the patient do all of the tests ... just in case .. I was not born in the US and came from a country where malpractice lawsuits are rare. I am fully aware of my medical history and though something new may arise, in most cases I think many of these tests are unnecessary. I may be wrong but I think that many tests for vitamins and the tests for them are simply junk. I try to eat well and exercise.
Recently I was careless and spilt a cup of boiling water on my breast. It hurt so I took a few pain killers. Then I researched it, bought some bandages that I had to tape together to make them large enough to cover the area. A few weeks later all was well.
I have a fairly high tolerance for pain and throw away many of the prescriptions I get for painkillers after a surgical procedure. Experience has taught me that many of them have worse after effects than some mild pain.
So I avoid doctors and tests wherever humanly possible.
Hard for patients to know what tests may save your life OR be a waste of time and money. Worse yet, some tests can lead to unnecessary interventions that can harm you. My late father had great respect for the medical profession, BUT in his later years would only consult a doctor if he thought he would die otherwise. When my mother was alive (she died at age 49) - show would often make him see a doctor, but after she died - he rarely would consult a doctor. Worked for him - he lived to almost 90.

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 » Thu Sep 13, 2018 10:51 am

Lynette wrote:
Thu Sep 13, 2018 9:58 am
At 74, I am fortunate to be fairly healthy and my 40-year experience of living in the USA has led me to believe that many of these tests/medicines are simply to avoid lawsuits for malpractice. So doctors make the patient do all of the tests ... just in case .. I was not born in the US and came from a country where malpractice lawsuits are rare. I am fully aware of my medical history and though something new may arise, in most cases I think many of these tests are unnecessary. I may be wrong but I think that many tests for vitamins and the tests for them are simply junk. I try to eat well and exercise.

Recently I was careless and spilt a cup of boiling water on my breast. It hurt so I took a few pain killers. Then I researched it, bought some bandages that I had to tape together to make them large enough to cover the area. A few weeks later all was well.

I have a fairly high tolerance for pain and throw away many of the prescriptions I get for painkillers after a surgical procedure. Experience has taught me that many of them have worse after effects than some mild pain.

So I avoid doctors and tests wherever humanly possible.
Hi Lynette,

In many ways, my story and approach are similar to yours. However, I am taking various supplements and would like to know optimal dozes. Thus, I am considering ordering online relevant tests from independent labs and paying cash for them.

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

tioscrooge
Posts: 30
Joined: Wed May 25, 2016 10:01 pm

Re: Lab test prices - exasperating!

Post by tioscrooge » Thu Sep 13, 2018 4:31 pm

sawhorse wrote:
Wed Sep 12, 2018 11:42 pm
goodenyou wrote:
Wed Sep 12, 2018 11:21 pm
sawhorse wrote:
Wed Sep 12, 2018 11:12 pm
goodenyou wrote:
Wed Sep 12, 2018 9:35 pm
sawhorse wrote:
Wed Sep 12, 2018 8:04 pm
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.
How can I get a copy of the list?
Go to the hospital outpatient laboratory. Walk in and ask. You can call an HCA facility in your area and ask. It is very simple. Have you called outpatient labs and asked? Ask, “ what do you charge for a basic metabolic panel and a CBC?” It’s $20 for the general public. You can get many more listed. $15 for a sed rate. $30 for a testosterone level etc etc.
I tried asking the lab for the cash prices and couldn't get an answer, as indicated in my original post.
Some places offer price transparency. Everett Clinic in WA State publishes its cash prices online and onsite. See https://www.everettclinic.com/pricing/lab
You could use that as a starting point for your price comparison.

I would stay away from hospital labs In most areas, as they will charge [outrageous] facility fees for lab work. In fact, there was a story about how small hospitals were recruited to funnel outpt labs through hospital billing just to charge facility fees. https://www.cbsnews.com/news/questionab ... -millions/

One way to find which labs in your area may give you cash prices - find out concierge practice or cash medical practice / direct medical care physicians in your area. Ask their office where they get their labs and start from there.

[business of] Medicine / health insurance in the US are so opaque that any reasonable person will be frustrated dealing with them.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 8:27 pm

dm200 wrote:
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.
My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 8:33 pm

Rolyatroba wrote:
Wed Sep 12, 2018 10:14 pm
nisiprius wrote:
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.
Nisi...I have a tremendous amount of respect for your well-researched posts, and great admiration of your seemingly unending insights (both on-topic and peripheral). So, your apparent exasperation on this is bothersome to me. Can you elucidate on why you (apparently) have thrown up your hands on this issue?
Nisi is absolutely correct. If anyone doubts it, try getting pricing up front. From everything to a vaccine, to the cost of a doctor's visit, I've hit walls. For the doctor's visit, I've asked for the rates for different lengths of visit - before my insurance comes into play (so I at least had an upper cost) - and was told it is impossible to provide.
I have been very persistent over the last 5 years or so, trying to get this information, and it's essentially impossible in most cases.
We're told to be good health consumers - to consider the costs. That's the kind of behavior that things like coinsurance & copays are supposed to encourage. But it's almost impossible to do that.

ResearchMed
Posts: 7076
Joined: Fri Dec 26, 2008 11:25 pm

Re: Lab test prices - exasperating!

Post by ResearchMed » Thu Sep 13, 2018 8:36 pm

mariezzz wrote:
Thu Sep 13, 2018 8:27 pm
dm200 wrote:
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.
My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.
What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
This signature is a placebo. You are in the control group.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 8:43 pm

goodenyou wrote:
Wed Sep 12, 2018 10:36 pm
dknightd wrote:
Wed Sep 12, 2018 10:27 pm
goodenyou wrote:
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


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.
This is a communication problem. The front office knows what coverage I have. The doctor should take that under consideration.
That is incorrect. They don’t have a copy of your policy and all the fine print. The administration burden to figure out your policy is out if the scope of a doctors’ office. If you can find a doctor’s office that can walk everyone through all the details of their policy, they won’t be in business very long. Unless, of course, they are doing the labs or other tests in house.
Even the insurance company telephone agent cannot tell you quite often. Several times, I have spent considerable amount of time, either on the phone, or securely messaging with my insurance company, and they cannot tell me whether something is covered, or at what rate.

Additionally, you may get incorrect information. I did with an insurance issue about 2 years ago. The insurance agent told me something & wrote it down verbatim, and proceeded with that information. I then got my EOB, and it did not agree with what I was told. I had to spend over 2 hours on the phone trying to resolve it, talking to 3 different people, getting elevated up the chain of command and then over to some specialist. The first 2 people frankly did not believe a word I was saying and pretty much told me that. The 3rd person was more polite. They actually were able to pull audio of the original phone call, and indeed, I was told what I claimed.

It finally got resolved, but quite frankly, the resolution cost me more (in time alone, let alone frustration) than just paying the extra cost. I persisted because I'm so tired of insurance companies getting away with murder. I complained to the state, but because the employer (the state) was self-insured, it didn't fall under the insurance commissioner.

On another issue where I securely messaged about a problem (so everything was in writing) and failed to get resolution even after 3 rounds of messages, I ended up complaining to the attorney general because the insurer is legally obligated to follow the terms of the insurance. That was the only way to get real attention to the issue high up in the insurance company - this wasn't the first time this sort of thing had happened with that insurer.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 8:47 pm

ResearchMed wrote:
Thu Sep 13, 2018 8:36 pm
mariezzz wrote:
Thu Sep 13, 2018 8:27 pm
dm200 wrote:
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.
My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.
What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.

Edited to add: I was billed $232 in Dec 2014 for a Vitamin D test by Quest (ordered by my physician), and had to pay that because the insurance company did not have a negotiated rate with Quest for tests that were deemed "medically unnecessary". I have refused all Vit D tests since because the 2 different policies I've had both consider Vit D tests unnecessary except in a few narrow cases.

This seems to be a Blue Cross policy (the 2 policies I had somehow fall under Blue Cross ultimately), but I've heard Aetna has a similar policy as well. I've also delved into the peer-reviewed literature on Vit D and I really think the insurance policy is correct, given the evidence we have. Yet doctors keep wanting to order them.
Last edited by mariezzz on Thu Sep 13, 2018 9:11 pm, edited 1 time in total.

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 » Thu Sep 13, 2018 9:03 pm

mariezzz wrote:
Thu Sep 13, 2018 8:43 pm
goodenyou wrote:
Wed Sep 12, 2018 10:36 pm
dknightd wrote:
Wed Sep 12, 2018 10:27 pm
goodenyou wrote:
Wed Sep 12, 2018 10:03 pm
dknightd wrote:
Wed Sep 12, 2018 9:57 pm


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.
This is a communication problem. The front office knows what coverage I have. The doctor should take that under consideration.
That is incorrect. They don’t have a copy of your policy and all the fine print. The administration burden to figure out your policy is out if the scope of a doctors’ office. If you can find a doctor’s office that can walk everyone through all the details of their policy, they won’t be in business very long. Unless, of course, they are doing the labs or other tests in house.
Even the insurance company telephone agent cannot tell you quite often. Several times, I have spent considerable amount of time, either on the phone, or securely messaging with my insurance company, and they cannot tell me whether something is covered, or at what rate.

Additionally, you may get incorrect information. I did with an insurance issue about 2 years ago. The insurance agent told me something & wrote it down verbatim, and proceeded with that information. I then got my EOB, and it did not agree with what I was told. I had to spend over 2 hours on the phone trying to resolve it, talking to 3 different people, getting elevated up the chain of command and then over to some specialist. The first 2 people frankly did not believe a word I was saying and pretty much told me that. The 3rd person was more polite. They actually were able to pull audio of the original phone call, and indeed, I was told what I claimed.

It finally got resolved, but quite frankly, the resolution cost me more (in time alone, let alone frustration) than just paying the extra cost. I persisted because I'm so tired of insurance companies getting away with murder. I complained to the state, but because the employer (the state) was self-insured, it didn't fall under the insurance commissioner.

On another issue where I securely messaged about a problem (so everything was in writing) and failed to get resolution even after 3 rounds of messages, I ended up complaining to the attorney general because the insurer is legally obligated to follow the terms of the insurance. That was the only way to get real attention to the issue high up in the insurance company - this wasn't the first time this sort of thing had happened with that insurer.


I have an office full of these issues every day. I pay about 10 people sequestered in cubicals to deal with this aggravation every day. More people eating off the healthcare dollar.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 9:10 pm

delete - meant to edit earlier post

ResearchMed
Posts: 7076
Joined: Fri Dec 26, 2008 11:25 pm

Re: Lab test prices - exasperating!

Post by ResearchMed » Thu Sep 13, 2018 9:23 pm

mariezzz wrote:
Thu Sep 13, 2018 8:47 pm
ResearchMed wrote:
Thu Sep 13, 2018 8:36 pm
mariezzz wrote:
Thu Sep 13, 2018 8:27 pm
dm200 wrote:
Wed Sep 12, 2018 2:30 pm
SlowMovingInvestor wrote:
Wed Sep 12, 2018 2:04 pm


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.
My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.
What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.
I'm not doubting you. It was partly a genuine question about yet another baffling part of healthcare, but also a suggestion about an approach to try, if you hadn't already.

Have you contacted your state Insurance Commissioner's Office? It might be worth a try, and maybe you'd at least get the name of someone you could turn to in the future?
-> Would it help if there was a letter from your physician stating that the test *was* "medically necessary"?
(A reason might/might not be needed.)

As for our experiences with health insurance, we most certainly do scrutinize all charges/bills/EOB's/etc. (You might want to reconsider phrasing things so definitively quite the way you did, about what others do or don't do.)
DH has gotten a bit compulsive about this more recently, now that we/he has taken over all billing for his very elderly mother, although she has a difference coverage than we do. Her claims have taken a bit of extra effort on occasion.

And we tend to have an "above average" health care usage, so it all adds up, and a few meds require special approval.
Surprisingly, we haven't had trouble with the types of payment problems that are being discussed here.
I suspect it is at least in part due to having an excellent employer plan, and almost always using the in-network major teaching hospital/medical center.

Thus far, we have not encountered the "mysterious arrival of an out-of-network provider" (be it in the ER or OR or wherever), although we are always on the lookout. I think our state doesn't allow balance billing, so that may be why we don't see that, or else we've been lucky...?

Some of the reports here (and elsewhere) have our heads spinning (not in disbelief, but in anger/astonishment that the "system" works this way, or should I write, "doesn't work..."?).

RM
This signature is a placebo. You are in the control group.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 9:43 pm

ResearchMed wrote:
Thu Sep 13, 2018 9:23 pm
mariezzz wrote:
Thu Sep 13, 2018 8:47 pm
ResearchMed wrote:
Thu Sep 13, 2018 8:36 pm
mariezzz wrote:
Thu Sep 13, 2018 8:27 pm
dm200 wrote:
Wed Sep 12, 2018 2:30 pm


No direct experience - but that is my understanding as well.
My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.
What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.
I'm not doubting you. It was partly a genuine question about yet another baffling part of healthcare, but also a suggestion about an approach to try, if you hadn't already.

Have you contacted your state Insurance Commissioner's Office? It might be worth a try, and maybe you'd at least get the name of someone you could turn to in the future?
-> Would it help if there was a letter from your physician stating that the test *was* "medically necessary"?
(A reason might/might not be needed.)

As for our experiences with health insurance, we most certainly do scrutinize all charges/bills/EOB's/etc. (You might want to reconsider phrasing things so definitively quite the way you did, about what others do or don't do.)
DH has gotten a bit compulsive about this more recently, now that we/he has taken over all billing for his very elderly mother, although she has a difference coverage than we do. Her claims have taken a bit of extra effort on occasion.

And we tend to have an "above average" health care usage, so it all adds up, and a few meds require special approval.
Surprisingly, we haven't had trouble with the types of payment problems that are being discussed here.
I suspect it is at least in part due to having an excellent employer plan, and almost always using the in-network major teaching hospital/medical center.

Thus far, we have not encountered the "mysterious arrival of an out-of-network provider" (be it in the ER or OR or wherever), although we are always on the lookout. I think our state doesn't allow balance billing, so that may be why we don't see that, or else we've been lucky...?

Some of the reports here (and elsewhere) have our heads spinning (not in disbelief, but in anger/astonishment that the "system" works this way, or should I write, "doesn't work..."?).

RM
The phrasing ("Is that really the case ?") and line of questioning sounded quite doubtful.
SlowMovingInvestor wrote: ↑Wed Sep 12, 2018 3:04 pm
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.
Believe me, I can write an instruction book on ways to deal with this sort of thing.
See above posts - yes, I did contact insurance commissioner, but because employer was self-insured, it did not fall under the insurance commissioner's oversight. I did contact the attorney general on another issue because the insurance company is legally bound to follow the terms of the policy.

Quite honestly, I think most people would consider my insurance coverage 'excellent' - it is at least on paper. The problem is in getting the insurance company to follow the terms of the policy.

Part of the problem has to do with turnover among the customer service representatives - they don't stay long enough to really become knowledgeable. Their employer doesn't pay them enough to bring in people who will really care about providing good customer service - although some really do want to help but either have incorrect information, or it's extremely complicated, etc. The employer doesn't provide them with the training and tools they need to do a good job. Add onto that the fact that health insurance in the US is far too complicated, and there are far too many differences across far too many policies. Software tools aren't in place to help them navigate their way through complicated policies in a way that would help them get to the correct answer. And all this is true now, with the ACA, which to a degree made policies a little more uniform. In my experience, it is far better than it was.

ResearchMed
Posts: 7076
Joined: Fri Dec 26, 2008 11:25 pm

Re: Lab test prices - exasperating!

Post by ResearchMed » Thu Sep 13, 2018 9:58 pm

mariezzz wrote:
Thu Sep 13, 2018 9:43 pm
ResearchMed wrote:
Thu Sep 13, 2018 9:23 pm
mariezzz wrote:
Thu Sep 13, 2018 8:47 pm
ResearchMed wrote:
Thu Sep 13, 2018 8:36 pm
mariezzz wrote:
Thu Sep 13, 2018 8:27 pm


My direct experience is precisely what I described. My insurance company said the test was not medically necessary in my case. Since it was not medically necessary, there was no negotiated rate between Quest & the insurer. It's possible some states have laws that dictate fairer practices.
What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.
I'm not doubting you. It was partly a genuine question about yet another baffling part of healthcare, but also a suggestion about an approach to try, if you hadn't already.

Have you contacted your state Insurance Commissioner's Office? It might be worth a try, and maybe you'd at least get the name of someone you could turn to in the future?
-> Would it help if there was a letter from your physician stating that the test *was* "medically necessary"?
(A reason might/might not be needed.)

As for our experiences with health insurance, we most certainly do scrutinize all charges/bills/EOB's/etc. (You might want to reconsider phrasing things so definitively quite the way you did, about what others do or don't do.)
DH has gotten a bit compulsive about this more recently, now that we/he has taken over all billing for his very elderly mother, although she has a difference coverage than we do. Her claims have taken a bit of extra effort on occasion.

And we tend to have an "above average" health care usage, so it all adds up, and a few meds require special approval.
Surprisingly, we haven't had trouble with the types of payment problems that are being discussed here.
I suspect it is at least in part due to having an excellent employer plan, and almost always using the in-network major teaching hospital/medical center.

Thus far, we have not encountered the "mysterious arrival of an out-of-network provider" (be it in the ER or OR or wherever), although we are always on the lookout. I think our state doesn't allow balance billing, so that may be why we don't see that, or else we've been lucky...?

Some of the reports here (and elsewhere) have our heads spinning (not in disbelief, but in anger/astonishment that the "system" works this way, or should I write, "doesn't work..."?).

RM
The phrasing ("Is that really the case ?") and line of questioning sounded quite doubtful.
SlowMovingInvestor wrote: ↑Wed Sep 12, 2018 3:04 pm
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.
Believe me, I can write an instruction book on ways to deal with this sort of thing.
See above posts - yes, I did contact insurance commissioner, but because employer was self-insured, it did not fall under the insurance commissioner's oversight. I did contact the attorney general on another issue because the insurance company is legally bound to follow the terms of the policy.

Quite honestly, I think most people would consider my insurance coverage 'excellent' - it is at least on paper. The problem is in getting the insurance company to follow the terms of the policy.

Part of the problem has to do with turnover among the customer service representatives - they don't stay long enough to really become knowledgeable. Their employer doesn't pay them enough to bring in people who will really care about providing good customer service - although some really do want to help but either have incorrect information, or it's extremely complicated, etc. The employer doesn't provide them with the training and tools they need to do a good job. Add onto that the fact that health insurance in the US is far too complicated, and there are far too many differences across far too many policies. Software tools aren't in place to help them navigate their way through complicated policies in a way that would help them get to the correct answer. And all this is true now, with the ACA, which to a degree made policies a little more uniform. In my experience, it is far better than it was.
[emphasis added]

I'm not "SlowMovingInvestor".

RM
This signature is a placebo. You are in the control group.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 10:05 pm

ResearchMed wrote:
Thu Sep 13, 2018 9:58 pm
mariezzz wrote:
Thu Sep 13, 2018 9:43 pm
ResearchMed wrote:
Thu Sep 13, 2018 9:23 pm
mariezzz wrote:
Thu Sep 13, 2018 8:47 pm
ResearchMed wrote:
Thu Sep 13, 2018 8:36 pm


What if another Patient ("X") had the same test, ordered by the same physician, had the same insurance coverage (same company, etc.), and in *this* case, that same test WAS medically necessary due to some condition of X (that you didn't happen to have)?

Why would there be a negotiated rate between insurer and Quest then, but not at other times, for someone who still/also had the same coverage?

RM
Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.
I'm not doubting you. It was partly a genuine question about yet another baffling part of healthcare, but also a suggestion about an approach to try, if you hadn't already.

Have you contacted your state Insurance Commissioner's Office? It might be worth a try, and maybe you'd at least get the name of someone you could turn to in the future?
-> Would it help if there was a letter from your physician stating that the test *was* "medically necessary"?
(A reason might/might not be needed.)

As for our experiences with health insurance, we most certainly do scrutinize all charges/bills/EOB's/etc. (You might want to reconsider phrasing things so definitively quite the way you did, about what others do or don't do.)
DH has gotten a bit compulsive about this more recently, now that we/he has taken over all billing for his very elderly mother, although she has a difference coverage than we do. Her claims have taken a bit of extra effort on occasion.

And we tend to have an "above average" health care usage, so it all adds up, and a few meds require special approval.
Surprisingly, we haven't had trouble with the types of payment problems that are being discussed here.
I suspect it is at least in part due to having an excellent employer plan, and almost always using the in-network major teaching hospital/medical center.

Thus far, we have not encountered the "mysterious arrival of an out-of-network provider" (be it in the ER or OR or wherever), although we are always on the lookout. I think our state doesn't allow balance billing, so that may be why we don't see that, or else we've been lucky...?

Some of the reports here (and elsewhere) have our heads spinning (not in disbelief, but in anger/astonishment that the "system" works this way, or should I write, "doesn't work..."?).

RM
The phrasing ("Is that really the case ?") and line of questioning sounded quite doubtful.
SlowMovingInvestor wrote: ↑Wed Sep 12, 2018 3:04 pm
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.
Believe me, I can write an instruction book on ways to deal with this sort of thing.
See above posts - yes, I did contact insurance commissioner, but because employer was self-insured, it did not fall under the insurance commissioner's oversight. I did contact the attorney general on another issue because the insurance company is legally bound to follow the terms of the policy.

Quite honestly, I think most people would consider my insurance coverage 'excellent' - it is at least on paper. The problem is in getting the insurance company to follow the terms of the policy.

Part of the problem has to do with turnover among the customer service representatives - they don't stay long enough to really become knowledgeable. Their employer doesn't pay them enough to bring in people who will really care about providing good customer service - although some really do want to help but either have incorrect information, or it's extremely complicated, etc. The employer doesn't provide them with the training and tools they need to do a good job. Add onto that the fact that health insurance in the US is far too complicated, and there are far too many differences across far too many policies. Software tools aren't in place to help them navigate their way through complicated policies in a way that would help them get to the correct answer. And all this is true now, with the ACA, which to a degree made policies a little more uniform. In my experience, it is far better than it was.
[emphasis added]

I'm not "SlowMovingInvestor".

RM
I understand that. But you continued the line of questioning. I was pretty clear in what I said initially, that prompted the line of questioning:
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.

ResearchMed
Posts: 7076
Joined: Fri Dec 26, 2008 11:25 pm

Re: Lab test prices - exasperating!

Post by ResearchMed » Thu Sep 13, 2018 10:09 pm

mariezzz wrote:
Thu Sep 13, 2018 10:05 pm
ResearchMed wrote:
Thu Sep 13, 2018 9:58 pm
mariezzz wrote:
Thu Sep 13, 2018 9:43 pm
ResearchMed wrote:
Thu Sep 13, 2018 9:23 pm
mariezzz wrote:
Thu Sep 13, 2018 8:47 pm


Presumably, yes.
If you think insurance companies act in a logical way, you either haven't dealt with them much, or haven't scrutinized the charges much. And before you ask, yes, I did try to fight it, in writing, but Quest refused to budge, and the insurance company told me since it wasn't medically necessary, there was no contract between Quest and the insurance company.

You might think the previous sentence above just simply could not be true, but you'd be wrong - and I suspect my sentence 2 above is true (you haven't scrutinized charges/EOB much, or haven't dealt with ins companies much.)

I will also mention I'm in a state where we have fairly good consumer protections. I shudder to think of what it's like in many states.
I'm not doubting you. It was partly a genuine question about yet another baffling part of healthcare, but also a suggestion about an approach to try, if you hadn't already.

Have you contacted your state Insurance Commissioner's Office? It might be worth a try, and maybe you'd at least get the name of someone you could turn to in the future?
-> Would it help if there was a letter from your physician stating that the test *was* "medically necessary"?
(A reason might/might not be needed.)

As for our experiences with health insurance, we most certainly do scrutinize all charges/bills/EOB's/etc. (You might want to reconsider phrasing things so definitively quite the way you did, about what others do or don't do.)
DH has gotten a bit compulsive about this more recently, now that we/he has taken over all billing for his very elderly mother, although she has a difference coverage than we do. Her claims have taken a bit of extra effort on occasion.

And we tend to have an "above average" health care usage, so it all adds up, and a few meds require special approval.
Surprisingly, we haven't had trouble with the types of payment problems that are being discussed here.
I suspect it is at least in part due to having an excellent employer plan, and almost always using the in-network major teaching hospital/medical center.

Thus far, we have not encountered the "mysterious arrival of an out-of-network provider" (be it in the ER or OR or wherever), although we are always on the lookout. I think our state doesn't allow balance billing, so that may be why we don't see that, or else we've been lucky...?

Some of the reports here (and elsewhere) have our heads spinning (not in disbelief, but in anger/astonishment that the "system" works this way, or should I write, "doesn't work..."?).

RM
The phrasing ("Is that really the case ?") and line of questioning sounded quite doubtful.
SlowMovingInvestor wrote: ↑Wed Sep 12, 2018 3:04 pm
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.
Believe me, I can write an instruction book on ways to deal with this sort of thing.
See above posts - yes, I did contact insurance commissioner, but because employer was self-insured, it did not fall under the insurance commissioner's oversight. I did contact the attorney general on another issue because the insurance company is legally bound to follow the terms of the policy.

Quite honestly, I think most people would consider my insurance coverage 'excellent' - it is at least on paper. The problem is in getting the insurance company to follow the terms of the policy.

Part of the problem has to do with turnover among the customer service representatives - they don't stay long enough to really become knowledgeable. Their employer doesn't pay them enough to bring in people who will really care about providing good customer service - although some really do want to help but either have incorrect information, or it's extremely complicated, etc. The employer doesn't provide them with the training and tools they need to do a good job. Add onto that the fact that health insurance in the US is far too complicated, and there are far too many differences across far too many policies. Software tools aren't in place to help them navigate their way through complicated policies in a way that would help them get to the correct answer. And all this is true now, with the ACA, which to a degree made policies a little more uniform. In my experience, it is far better than it was.
[emphasis added]

I'm not "SlowMovingInvestor".

RM
I understand that. But you continued the line of questioning.
:confused

RM
This signature is a placebo. You are in the control group.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 10:13 pm

tioscrooge wrote:
Thu Sep 13, 2018 4:31 pm
Some places offer price transparency. Everett Clinic in WA State publishes its cash prices online and onsite. See https://www.everettclinic.com/pricing/lab
You could use that as a starting point for your price comparison.

I would stay away from hospital labs In most areas, as they will charge [outrageous] facility fees for lab work. In fact, there was a story about how small hospitals were recruited to funnel outpt labs through hospital billing just to charge facility fees. https://www.cbsnews.com/news/questionab ... -millions/

One way to find which labs in your area may give you cash prices - find out concierge practice or cash medical practice / direct medical care physicians in your area. Ask their office where they get their labs and start from there.

[business of] Medicine / health insurance in the US are so opaque that any reasonable person will be frustrated dealing with them.
Just to give people some idea of the difference between paying cash (no insurance) vs. what an insurance company contracts for, below are some general tests people have quite often, together with the price Quest billed me in 2015, and the amount the insurance company allowed. Of the allowed amount, I paid 15%, and the insurance company paid 85%. I could provide plenty more examples, but this is enough to give you the general picture. I had a few years when I had many different lab tests run and on average, Quest's 'cash' price was 7.7x the amount the insurance company allowed under contract (range: 3-16 times)
HbA1c (screening test for diabetes): initially billed $74, insurance allowed $10 (in other words, Quest was paid only $10 for this test in total)
Lipid panel: initially billed 133, insurance allowed $13
CBC, CMP, TSH: initially billed 233, insurance allowed 65
Potassium blood test: initially billed 35, Insurance allowed $4
I agree with staying away from hospitals. I saw an opthamologist in a hospital complex once. The visit itself was billed as I expected; dr. was in-network. But I was sent 2 rooms down for some eye test, and that incurred a facility fee, plus lower percentage coverage because the hospital facility itself was out of network. This despite my asking up front when I made the appointment whether they were in network, and being assured they were. The doctor was, but the room the dr. had pts do certain tests in, was not. It didn't occur to them that there was this difference. I honestly don't blame them - insurance policies (and their networks) get far too complex. But I ended up spending more money than I expected, and had I known, I might have made a different decision about where I got care.
Edited to correct one detail in test list.
Last edited by mariezzz on Thu Sep 13, 2018 10:40 pm, edited 1 time in total.

mariezzz
Posts: 199
Joined: Mon Oct 02, 2017 11:02 pm

Re: Lab test prices - exasperating!

Post by mariezzz » Thu Sep 13, 2018 10:27 pm

Adding to above:
On top of this, the amount billed was quite high for this test (compared to later bills I got elsewhere) - hospital fees tend to be on the high side overall.

User avatar
ram
Posts: 1052
Joined: Tue Jan 01, 2008 10:47 pm
Location: Midwest

Re: Lab test prices - exasperating!

Post by ram » Thu Sep 13, 2018 11:03 pm

It is my belief that neither health care consumers nor health care providers are happy with the current state of health care billing in our country.

These are some of my experiences:

I have received funding for medical research on multiple occasions (mostly from the federal government). Each study always included blood tests on patients (at no cost to them). I have always asked for quotes on blood tests from the lab before hand. These have been promptly provided. These have been typically far less than what all of us are used to seeing. For example:
Test X $5.20
Test Y $13.52 etc
The quoted prices have always been honored. I have typically provided proof of funding at the time of asking for the price quotes. The lab has received its payment promptly and reliably.

I have previously worked in another country where it is conventional to provide estimated charges for many blood tests/ imaging studies/ procedures with a fair amount of accuracy.
For Example:
MRI Head: $200
Typically 50% of the amount is demanded by the facility before the patient is put in the MRI machine and 50% before the result is provided. The facility will provide the report to the patient only when the balance 50% is paid. If the patient wants the report to be sent directly to his physician then you are asked to pay 100% of the charge in advance. It is perfectly legal under the laws of the country for the healthcare facility to withhold the results of the MRI if payment is not made.

Based on these experiences I have come to the conclusion that a facility is typically willing to provide fixed pricing/ reliable estimates only when full payment in a timely manner is certain. This makes intrinsic sense to me.

Perhaps working to establish such a system may be desirable.
Ram

Lynette
Posts: 1789
Joined: Sun Jul 27, 2014 9:47 am

Re: Lab test prices - exasperating!

Post by Lynette » Fri Sep 14, 2018 5:59 am

Hi Victoria and DM200,

I mentioned that I know my own health based on being virtually forced to take wellness tests each year for nearly 20 years. We got a discount on our copays if we went to them each year. With boring regularity the results were the same. The mammogram was boringly the same - no history of breast cancer in my family so I happily skip this. I do think the colonoscopy is worthwhile as I had two grandparents die of colon cancer etc. etc. I am highly skeptical of supplements and vitamins as I think one should be able to get these by eating well. This is just my opinion.

I had so many problems with Medicare billing when I went for my first wellness test last year. Everyone got billing codes wrong. I had no billing problems when I used my employer's HMO. So for a few years I'm going to avoid any tests! I've lost weight and gained muscles by heavy manual labor in my gardening this year. I have to go and move the hoses now - been leveling the yard caused by sinking of drains - etc. etc. Its far more fun learning and experimenting with with new plants than fighting billing codes.

To each his own - I'm avoiding doctors, tests and billing problems .. for now.

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

Re: Lab test prices - exasperating!

Post by susa » Fri Sep 14, 2018 9:13 am

VictoriaF wrote: When do they normally run sales?
in the original message.. wrote: ...purchase is April during Supersale...

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 » Fri Sep 14, 2018 9:39 am

Lynette wrote:
Fri Sep 14, 2018 5:59 am
Hi Victoria and DM200,

...I am highly skeptical of supplements and vitamins as I think one should be able to get these by eating well. This is just my opinion.

...To each his own - I'm avoiding doctors, tests and billing problems .. for now.
Lynette,

My attitude towards supplements, herbs, and spices is similar to my attitude to food: some of them are helpful, some of them are harmful, and many of them are hyped. In lieu of running my own lab, I have to choose whom to trust, and I chose to trust biohackers and doctors who are not selling supplements.

I agree that to each his own.

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

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 » Fri Sep 14, 2018 10:02 am

ram wrote:
Thu Sep 13, 2018 11:03 pm
It is my belief that neither health care consumers nor health care providers are happy with the current state of health care billing in our country.

These are some of my experiences:

I have received funding for medical research on multiple occasions (mostly from the federal government). Each study always included blood tests on patients (at no cost to them). I have always asked for quotes on blood tests from the lab before hand. These have been promptly provided. These have been typically far less than what all of us are used to seeing. For example:
Test X $5.20
Test Y $13.52 etc
The quoted prices have always been honored. I have typically provided proof of funding at the time of asking for the price quotes. The lab has received its payment promptly and reliably.

I have previously worked in another country where it is conventional to provide estimated charges for many blood tests/ imaging studies/ procedures with a fair amount of accuracy.
For Example:
MRI Head: $200
Typically 50% of the amount is demanded by the facility before the patient is put in the MRI machine and 50% before the result is provided. The facility will provide the report to the patient only when the balance 50% is paid. If the patient wants the report to be sent directly to his physician then you are asked to pay 100% of the charge in advance. It is perfectly legal under the laws of the country for the healthcare facility to withhold the results of the MRI if payment is not made.

Based on these experiences I have come to the conclusion that a facility is typically willing to provide fixed pricing/ reliable estimates only when full payment in a timely manner is certain. This makes intrinsic sense to me.

Perhaps working to establish such a system may be desirable.
Changes to the healthcare delivery system requires not just procedural changes but cultural changes. It is multifaceted from legal aspects to the culture of consumerism. In this country, if you withhold vital medical information for payment reasons, you run the risk of annihilation by Slip-and-Fall lawyers.
"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 » Fri Sep 14, 2018 11:58 am

Rolyatroba wrote:
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.
My opinion as well. It is not just the initial costs of unnecessary tests - but more expensive followup tests when some test shows an "abnormality".

User avatar
Hayden
Posts: 1141
Joined: Tue Apr 16, 2013 5:13 pm

Re: Lab test prices - exasperating!

Post by Hayden » Fri Sep 14, 2018 1:22 pm

My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?

ResearchMed
Posts: 7076
Joined: Fri Dec 26, 2008 11:25 pm

Re: Lab test prices - exasperating!

Post by ResearchMed » Fri Sep 14, 2018 2:00 pm

Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
Double check in case your "system" allow a [ridiculous] "post-pre-authorization", which is requesting the pre-authorization after the fact.

Yes really. :oops:

Our insurance sometimes allows this if someone "goofs".

Go figure, etc....

RM
This signature is a placebo. You are in the control group.

Lynette
Posts: 1789
Joined: Sun Jul 27, 2014 9:47 am

Re: Lab test prices - exasperating!

Post by Lynette » Fri Sep 14, 2018 3:44 pm

VictoriaF wrote:
Fri Sep 14, 2018 9:39 am
Lynette wrote:
Fri Sep 14, 2018 5:59 am
Hi Victoria and DM200,

...I am highly skeptical of supplements and vitamins as I think one should be able to get these by eating well. This is just my opinion.

...To each his own - I'm avoiding doctors, tests and billing problems .. for now.
Lynette,

My attitude towards supplements, herbs, and spices is similar to my attitude to food: some of them are helpful, some of them are harmful, and many of them are hyped. In lieu of running my own lab, I have to choose whom to trust, and I chose to trust biohackers and doctors who are not selling supplements.

I agree that to each his own.

Victoria
I suppose it is fine if you take those precautions. My doctor only recommends calcium with Vitamin D. I take it but am not certain it does any good. I don't feel I have the need for anything else.

User avatar
HueyLD
Posts: 5963
Joined: Mon Jan 14, 2008 10:30 am

Re: Lab test prices - exasperating!

Post by HueyLD » Fri Sep 14, 2018 4:03 pm

Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
My insurance (the most widely accepted insurance in my area) has three pages of pre-certification requirement for certain admissions, procedures and tests. And unfortunately it is the insured's responsibility to obtain such authorization if (s)he wants to be paid. I wonder how many patients are aware of this rule.

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

Re: Lab test prices - exasperating!

Post by sawhorse » Fri Sep 14, 2018 4:54 pm

Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
Unfortunately yes. It's totally unrealistic for many tests because the doctor leaves the room, and in comes a phlebotomist to draw your blood. If they had to wait for you to check your insurance, especially if you're having loads of tests done, you'd be there for hours.

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 » Fri Sep 14, 2018 7:46 pm

sawhorse wrote:
Fri Sep 14, 2018 4:54 pm
Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
Unfortunately yes. It's totally unrealistic for many tests because the doctor leaves the room, and in comes a phlebotomist to draw your blood. If they had to wait for you to check your insurance, especially if you're having loads of tests done, you'd be there for hours.
If the doctor is running a lab, she should have the patient come back another day and call insurance to get preauthorization. The patient should have the option to get it done at that time or take more time and come back. That is why I write the order, and tell the patient to go find a lab. It is incumbent on the patient to navigate their insurance benefits for tests and radiology services outside the office. They can decide if they want the tests or not. For surgeries and procedures we precertify benefits and we still get stiffed by the insurance companies. I can't even imagine the headache in dealing with patients that you run up charges without their consent. It is a stupid business policy and you would be eating the costs after the fact.
"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 » Fri Sep 14, 2018 8:03 pm

goodenyou wrote:
Fri Sep 14, 2018 7:46 pm
sawhorse wrote:
Fri Sep 14, 2018 4:54 pm
Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
Unfortunately yes. It's totally unrealistic for many tests because the doctor leaves the room, and in comes a phlebotomist to draw your blood. If they had to wait for you to check your insurance, especially if you're having loads of tests done, you'd be there for hours.
If the doctor is running a lab, she should have the patient come back another day and call insurance to get preauthorization. The patient should have the option to get it done at that time or take more time and come back. That is why I write the order, and tell the patient to go find a lab. It is incumbent on the patient to navigate their insurance benefits for tests and radiology services outside the office. They can decide if they want the tests or not. For surgeries and procedures we precertify benefits and we still get stiffed by the insurance companies. I can't even imagine the headache in dealing with patients that you run up charges without their consent. It is a stupid business policy and you would be eating the costs after the fact.
It's often very difficult to return the next day. I sometimes have to get driven by someone else for 2.5 hours and have mobility and pain problems that make it difficult for me to travel. How am I supposed to return the next day? Even more so if I've flown thousands of miles to see a specialist and am flying out that night.

I suppose I could do it at a closer lab which would again be a burden because it's hard to even get out of my bed. I'd have to arrange for a medical aide service to help me to the lab.

I spent 2 hours on the phone today getting pre authorization for physical therapy. I can't do that for every medical expense. A few years ago my neurological problens affected my speech so even that was impossible.

It's really really hard to be on top of all the insurance stuff when you're dealing with overwhelming fatigue, pain, mobility problems, speech problems, and/or cognitive problems. For many people in bad health, everyday existence is difficult.

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

Re: Lab test prices - exasperating!

Post by dknightd » Fri Sep 14, 2018 8:30 pm

I guess I'm lucky. I'm a member of an HMO. If a doctor refers me to further tests, I usually do not get charged. And if I do it is a minimal amount. I've had to use emergency services once in a while (usually out of my service area). And my copay was the $100 they said it would cost.
On the other hand, I can't contribute to an HSA.
It is a crap shoot. Pay more now for predictable expenses, or, take your chances.
On balance I might be ahead with a high deductible plan. For now I'm OK paying extra for a good plan. YMMV
I might want to move outside my current HMO area one day. It will be interesting to see what options are available. Probably blue cross of some kind. It would suck if we had to stay here just for health insurance.
I still think getting unexpected lab expenses is in part due to user error. First thing I ask when I walk into a lab is will this be covered.

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

Re: Lab test prices - exasperating!

Post by sawhorse » Fri Sep 14, 2018 8:36 pm

dknightd wrote:
Fri Sep 14, 2018 8:30 pm
I still think getting unexpected lab expenses is in part due to user error. First thing I ask when I walk into a lab is will this be covered.
How would they know?

Turbo29
Posts: 124
Joined: Tue May 01, 2018 7:12 am

Re: Lab test prices - exasperating!

Post by Turbo29 » Fri Sep 14, 2018 9:13 pm

sawhorse wrote:
Fri Sep 14, 2018 4:54 pm
Hayden wrote:
Fri Sep 14, 2018 1:22 pm
My Dr ordered a medically necessary test, to be conducted at his facility. When I received the EOB, the charge was denied because pre-authorization had not been obtained.

So when my Dr orders a test, I'm supposed to call the insurance company to check before I have the test?
Unfortunately yes. It's totally unrealistic for many tests because the doctor leaves the room, and in comes a phlebotomist to draw your blood. If they had to wait for you to check your insurance, especially if you're having loads of tests done, you'd be there for hours.
Interestingly the last time I had blood drawn at my doctor's office the phlebotomist looked at her computer and said the total would be no more than $30.57. This was without me asking.

Right now, I have the bill in front of me (I have an hdhp) and I owe LabCorp, $30.57.

So some doctor's offices can do it.

Edit: Just to clarify this total was for several tests with a total charge of $349. The bill after the negotiated discount was $30.57 so the phlebotomist in the doctor's lab was able to give me a figure for the charge after the negotiated discount.
Last edited by Turbo29 on Fri Sep 14, 2018 9:26 pm, edited 1 time in total.

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

Re: Lab test prices - exasperating!

Post by dknightd » Fri Sep 14, 2018 9:22 pm

sawhorse wrote:
Fri Sep 14, 2018 8:36 pm
dknightd wrote:
Fri Sep 14, 2018 8:30 pm
I still think getting unexpected lab expenses is in part due to user error. First thing I ask when I walk into a lab is will this be covered.
How would they know?
If they did not know, I'd probably walk out and ask them to call me when they did know. How could they not know?

Edit: I mean really; if you are providing a service you should know what your customer is going to have to pay. Would you buy a service without knowing about what it would cost?

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

Re: Lab test prices - exasperating!

Post by sawhorse » Fri Sep 14, 2018 10:10 pm

dknightd wrote:
Fri Sep 14, 2018 9:22 pm
sawhorse wrote:
Fri Sep 14, 2018 8:36 pm
dknightd wrote:
Fri Sep 14, 2018 8:30 pm
I still think getting unexpected lab expenses is in part due to user error. First thing I ask when I walk into a lab is will this be covered.
How would they know?
If they did not know, I'd probably walk out and ask them to call me when they did know. How could they not know?

Edit: I mean really; if you are providing a service you should know what your customer is going to have to pay. Would you buy a service without knowing about what it would cost?
This is precisely the problem that inspired the thread in the first place. I couldn't get an answer about coverage and costs. And I far from alone.

Have you read through the thread?

helloeveryone
Posts: 101
Joined: Sun Sep 04, 2016 5:16 pm

Re: Lab test prices - exasperating!

Post by helloeveryone » Fri Sep 14, 2018 10:34 pm

this website seems promising to get a rough estimate of cost for imaging or procedures. gives you in network versus out of network.
you can search with a code or just the name of the procedure if you know it.
still not the easiest to navigate though because there are no many codes and variations.

https://www.fairhealthconsumer.org

toofache32
Posts: 1288
Joined: Sun Mar 04, 2012 6:30 pm

Re: Lab test prices - exasperating!

Post by toofache32 » Fri Sep 14, 2018 10:44 pm

The common theme with all these threads is insurance companies. Period.

Post Reply