It's cheaper to pay out of pocket than to go though my insurance.

I have a health condition that while it is not serious by any means, I wish to keep track of it via routine blood work.
The test is very simple and has been routine for 40 years.
If I go through my high deductible insurance policy the test will run me about $75.00 each time I request it.
However if I go to the lab and tell them I am uninsured and paying for it directly, the test is about $37.00. Same test, same blood draw, same turn around time.

I think this is an indication that the "for profit" business model of American health care does not serve the general public well.
I do believe that health care providers and professional should be fairly compensated for their years of study and having to stay current, but I just cannot reconcile the differences in cost on a basic blood test that can be done at home now.

Minerva said:

I have a health condition that while it is not serious by any means, I wish to keep track of it via routine blood work.
The test is very simple and has been routine for 40 years.
If I go through my high deductible insurance policy the test will run me about $75.00 each time I request it.
However if I go to the lab and tell them I am uninsured and paying for it directly, the test is about $37.00. Same test, same blood draw, same turn around time.

I think this is an indication that the "for profit" business model of American health care does not serve the general public well.
I do believe that health care providers and professional should be fairly compensated for their years of study and having to stay current, but I just cannot reconcile the differences in cost on a basic blood test that can be done at home now.

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Your experience is materially different than mine. Sounds like you have lousy insurance.

Yes, IMO the whole healthcare and insurance industry is a mess.

I recently went with a new insurance company. I went online to add my doctor who is "in network". I went through a 31-page list of General Practitioners and his name didn't appear. I did a search and sure enough his name came up, but there was no prompt to add him. I had no choice but to call my insurance company. The gentleman I spoke with said my doctor's name came up but he couldn't add him either electronically or manually. He had to call another department and, after 50 minutes successfully added him to my policy.

I relayed this to my doctor and he said the insurance company is basically "blocking him" and promoting other doctors ahead of him. He is a great doctor, so I'm sure this has to do with the profits the insurance company is making off other doctors.

Minerva said:

I have a health condition that while it is not serious by any means, I wish to keep track of it via routine blood work.
The test is very simple and has been routine for 40 years.
If I go through my high deductible insurance policy the test will run me about $75.00 each time I request it.
However if I go to the lab and tell them I am uninsured and paying for it directly, the test is about $37.00. Same test, same blood draw, same turn around time.

I think this is an indication that the "for profit" business model of American health care does not serve the general public well.
I do believe that health care providers and professional should be fairly compensated for their years of study and having to stay current, but I just cannot reconcile the differences in cost on a basic blood test that can be done at home now.

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I heard about this a number of years ago. I'm not entirely clear on how it works but the wiki explanation is okay.
"In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital."

Just putting this out there. I was without health insurance until early March. I had no doctor's appointments scheduled, but I typically take 3 prescription drugs that are refilled each month, so I went with GoodRX as a stop-gap. I pay $9.99 per month and the cost of the prescriptions is very cheap compared to what I used to pay under my previous insurance. We're talking $2-$4 per prescription. I now have health insurance but plan on continuing the GoodRX plan.

They told my daughter this same thing regarding her X-rays. It was cheaper without insurance, but you have to not tell them you have insurance. It's messed up. We really need a single payer, non profit option in this country.

Minerva said:

I think this is an indication that the "for profit" business model of American health care does not serve the general public well. .

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There’s a very good argument to be made that a services offered by health care providers shouldn’t have a different price for every person who walks in the door (or, in your case, the same person, but varying depending on what they know about you). Lots of perverse incentives in that for all involved.

Minerva said:

I have a health condition that while it is not serious by any means, I wish to keep track of it via routine blood work.
The test is very simple and has been routine for 40 years.
If I go through my high deductible insurance policy the test will run me about $75.00 each time I request it.
However if I go to the lab and tell them I am uninsured and paying for it directly, the test is about $37.00. Same test, same blood draw, same turn around time.

I think this is an indication that the "for profit" business model of American health care does not serve the general public well.
I do believe that health care providers and professional should be fairly compensated for their years of study and having to stay current, but I just cannot reconcile the differences in cost on a basic blood test that can be done at home now.

Click to expand...

You have to pay for blood work?
I have Crohn's disease and the drug I take to control the symptoms can cause organ dysfunction so I have blood work every two months to monitor. Me paying anything for it is just a really strange concept.

Minerva said:

I have a health condition that while it is not serious by any means, I wish to keep track of it via routine blood work.
The test is very simple and has been routine for 40 years.
If I go through my high deductible insurance policy the test will run me about $75.00 each time I request it.
However if I go to the lab and tell them I am uninsured and paying for it directly, the test is about $37.00. Same test, same blood draw, same turn around time.

I think this is an indication that the "for profit" business model of American health care does not serve the general public well.

Click to expand...

Is the lab a "for profit" business? If so, why are they only charging you $37? Why wouldn't they also charge $75, or $175?

Minerva said:

I do believe that health care providers and professional should be fairly compensated for their years of study and having to stay current, but I just cannot reconcile the differences in cost on a basic blood test that can be done at home now.

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Wouldn't it be great if medical providers had to advertise their prices? I mean ALL of them. Both for insured and uninsured patients. Then people could plan accordingly.

I always find it astounding that no one can tell me before I visit a doctor example hos much that visit will cost. Imagine if you bought groceries or anything else that way.

dseag2 said:

Yes, IMO the whole healthcare and insurance industry is a mess.

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Agree. That said, Medicare is fantastic.
Don't ever let your politicians change it.

Grand Mal said:

You have to pay for blood work?
I have Crohn's disease and the drug I take to control the symptoms can cause organ dysfunction so I have blood work every two months to monitor. Me paying anything for it is just a really strange concept.

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I've got what used to be called Wegener's Granulomatosis and I have to get blood tests every six months. I also have a High-Deductible Health Plan (HDHP). But the lab I use charges less than $75. My last two blood works were $54 and $44 respectively

A HDHP is great for otherwise healthy people to cover catastrophic medical bills. It's not great if you have a chronic condition like Crohn's

It works out for me because my plan also comes with an HSA account and debit card and my company kicks in two grand a year on that. So basically they pay for the first $2000 of deductible medical bills. Then I pick up the deductible until it hits $5500. Then insurance kicks in and pays 80% until $8000 at which point it covers it all.

noonereal said:

Agree. That said, Medicare is fantastic.
Don't ever let your politicians change it.

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I hope they do change it.

Medicare is going to go broke in two years.

eman623 said:

Wouldn't it be great if medical providers had to advertise their prices? I mean ALL of them. Both for insured and uninsured patients. Then people could plan accordingly.

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They would have to have a price for that work effectively. Today they don’t. They have two dozen prices depending on what insurance you do (or don’t) have, based on the maximum they can get for any particular patient.

Greenbeard said:

They would have to have a price for that work effectively. Today they don’t. They have two dozen prices depending on what insurance you do (or don’t) have, based on the maximum they can get for any particular patient.

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Yes, having a price would be a prerequisite to advertising said price. If they do not do this now, then that has to change.

eman623 said:

I hope they do change it.

Medicare is going to go broke in two years.

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Both Social Security and Medicare could easily be made permanently solvent, and I keep suggesting how that could easily be done by changing our Federal income tax code, which would also result in a balanced Federal budget. No one appears willing to discuss the details.

Grand Mal said:

You have to pay for blood work?
I have Crohn's disease and the drug I take to control the symptoms can cause organ dysfunction so I have blood work every two months to monitor. Me paying anything for it is just a really strange concept.

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Oh you cute little naive Canadian! lol

Ginger Ale said:

Oh you cute little naive Canadian! lol

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Nearly 6'7" and about as far from cute as a 70 year old can be but yeah, our perceptions come from how we grew up.
All my life health care has been considered a right of citizenship.

noonereal said:

Agree. That said, Medicare is fantastic.
Don't ever let your politicians change it.

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Do you also have some type of Medicare Advantage.

Grand Mal said:

Nearly 6'7" and about as far from cute as a 70 year old can be but yeah, our perceptions come from how we grew up.
All my life health care has been considered a right of citizenship.

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I'm so jealous! To never know is a gift.

eman623 said:

Is the lab a "for profit" business? If so, why are they only charging you $37? Why wouldn't they also charge $75, or $175?

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Yes, it is one of several "for profit" labs in my area. I checked around and many of them offer a lower cost if you are doing a direct payment at time of service. I cannot believe the difference in price is because they have to submit paperwork to an insurance company. It is all computerized and just the matter of a few key strokes.

washunut said:

Your experience is materially different than mine. Sounds like you have lousy insurance.

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Obamacare?

When I did a search for direct pay medical lab services it found several different companies in my area. Two of them are ones that I have used many times over the years with various health insurers.

Greenbeard said:

There’s a very good argument to be made that a services offered by health care providers shouldn’t have a different price for every person who walks in the door (or, in your case, the same person, but varying depending on what they know about you). Lots of perverse incentives in that for all involved.

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The problem is that the providers contract with the insurance companies. If they don't, they are freezed out of being a provider. They negotiate the fees based on the specifics of the various plans. The insurance companies dictate monthly premiums, deductibles, and co-pays for the patient. The insurance companies decide the fees that will be charged. The insurance companies determine how much the providers will be paid for any given procedure. Does anyone else see a problem with this arrangement?

I often am asked by patients "How much does this cost?" I always answer "I don't know, because I am not familiar with the various insurance fees." I then refer them to someone in the office that can answer their questions regarding fees.

I knew one independent physician who one day was informed by his malpractice insurance carrier that his annual premium was going up - to higher than his annual income! He was devastated. Thought he would have stop practicing.

Then, a short time later, he was contacted by another insurance company offering him a job as a physician. He explained his malpractice premium issue to them. To his surprise, the insurance company replied that if he went to work for them, they would pay his annual malpractice premium as part of his compensation. This was great! He wouldn't have to give up medicine! So, he signed on.

It turned out the company he signed on with was a subsidiary of his malpractice carrier. It was all a set-up to get him to sign on as a provider for them.

Stealers Wheel said:

It turned out the company he signed on with was a subsidiary of his malpractice carrier. It was all a set-up to get him to sign on as a provider for them.

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This has to be criminal.

Minerva said:

This has to be criminal.

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Nope. It's 100% legal. "Nice medical practice you got there. Be a shame if anything were to happen to it. You smell smoke? I smell smoke. Well, have a nice day."