I’ve written about so-called ‘chargemaster’ pricing from hospitals before, and how it typically hits the self-pay uninsured the hardest. People with high-deductible health insurance can also be victimized by ‘chargemaster’ policies, as this family found out when trying to find a facility for their daughter’s tonsillectomy. Getting real prices from a hospital can be a maddening process!
Consider the experience of David Marcovitz, a second-year med student at the time of his introduction to the world of hospital pricing, as described at the blog Costs of Care.
When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn blood. I described it to my PCP [primary care physician] through our online portal… He called me an hour later to suggest I start taking aspirin and see him the next day…
I went to see my PCP at student health the next day, and after taking a history and examining me, he decided to order a hypercoaguability panel, a set of lab tests used to diagnose a small number of inherited and acquired conditions that put one at increased risk for having blood clots. He called me when the results were in to tell me I was “heterozygous”… for a fairly common mutation called Factor V Leiden…
…things started to get interesting when I received a bill from our student health insurance company stating that I owed $2000 for the genetic test used to diagnose my Factor V Leiden. I called up the administrator… and I told them that according to the benefits guide, diagnostic blood tests were covered. They told me that the test for Factor V Leiden was a “genetic screen” which they did not cover… despite my sticker shock, the claims agent didn’t seem to share in my alarm. I realized quickly in talking to him that denying payment for this test was a very routine thing and that he had nothing further to say about it. He told me I would simply need to submit an appeal and include a letter from my PCP.
The appeal was submitted and within a few months, [I] received a new and adjusted bill from the administrator asking only that I pay the usual 10% of the cost for the test – my appeal had been a success. But what struck me was that I wasn’t asked to pay ten percent of $2000, but rather ten percent of $375. The hospital wanted $2000 from me for the test, but they only wanted $375 from the insurance company…
The blog post doesn’t directly say it, but it seems that Mr. Marcovitz had his blood tests done by a hospital. Self-pay patients should take note – unless absolutely necessary, under no circumstances should you have any diagnostic testing or screening done at a hospital!
There are numerous alternatives available in most communities, many of whom will give real prices to the uninsured and those with high-deductible health insurance. A few companies offering services nationally that I found explicitly promoting their self-pay patient pricing or discounts include First Choice Labs USA, EconoLab$, True Health Labs, and SaveOnLabs.com. Some of these companies appear to simply repackage lab tests from other companies that would otherwise charge self-pay patients the ‘full’ price.
There are also local and regional lab testing facilities that cater to self-pay patients. PeaceHealth Labs, serving Oregon, Washington, and Alaska is headquartered in Eugene, Oregon (Go Ducks!) and offers self-pay patients discounts on lab testing services, for example.
Some of these sites don’t provide clear pricing on their web site, although they do say they provide prices to patients over the phone (although often only after they’ve received a requisition request, similar to a prescription but for diagnostic testing). EconoLabS, True Health Labs, and SaveOnLabs.com all offer prices online.
Lab testing is a vital part of modern healthcare, and can be a valuable tool in helping to diagnose many conditions and illnesses. But they can also be costly, especially if patients don’t pay attention to where their tests are being done. This can even be a problem for those with ‘comprehensive’ insurance, such as Mr. Marcovitz, when their insurer decides after the test is performed that they won’t cover a certain procedure. His story turned out OK, but most self-pay patients would likely have been stuck with a $2,000 bill for a test that they should only have paid $375.
In some cases, having a lab test done by a hospital is simply unavoidable. But if at all possible, don’t have your lab test done at a hospital, go to one of the many independent lab companies that give real prices for self-pay patients.