Lab Testing

Lab Test ResultsDr. Geidl will typically order several different diagnostic lab tests. These lab tests allow her to provide you with very accurate and individualized information about your health, which is essential to develop the most effective plan possible for you. You have three options for how your labs are ordered:

#1 – Using Any Insurance Coverage You Have


If you have insurance that will cover laboratory testing (including Medicaid/Medicare), you can choose to use an in-network lab of your choice and use your insurance card.

CONSIDERATIONS:
▪  Your insurance company negotiates a discounted price for your lab charges, as long as you go to a lab which is “in-network” for your plan.
▪  Under many insurance plans, lab charges are subject to a deductible. If this is true for your plan, this means that your insurance company will not pay for the lab’s charges until you’ve met your yearly deductible (although you still get the benefit of the reduced price that your insurance company negotiated on your behalf).

PITFALLS:
▪  Keep in mind that insurance companies will not always approve all of the tests your doctor has ordered. When not approved, insurance companies typically indicate that, in their opinion, the test was not “medically necessary” or “experimental and investigational”.
▪  When a particular lab test is not approved by your insurance company, you then also typically do not get the negotiated “discount” price on that test from the laboratory. This can be a significant issue, as the non-discounted (retail) prices from most labs can be as high as 8-10 times more (800% – 1000%) than the discount price, and you will then be responsible for the entire cost of that test.

BOTTOM LINE:
▪  This option may be good if you do not have a large insurance deductible (or you have met your deductible for the year). Depending on your deductible, and whether or not your insurance provider approves all of the tests ordered, you may pay very little out of pocket. However, due to the above issues (and depending on which tests are ordered), sometimes it can be cheaper overall to bypass insurance and instead use negotiated “cash pricing” (described in #2 and #3 below).

#2 – Paying Cash At a Lab Of Your Choice


If you are paying out-of-pocket for your labs (e.g., you are uninsured or have a high deductible plan), you can use your orders at a lab of your choice, and pay the lab directly.

CONSIDERATIONS:
▪  We recommend informing the lab that insurance isn’t paying for these tests and asking for “cash pricing” with the lab.
▪  In order to get cash pricing, keep in mind that the lab may require for you to pay for your tests, in full, at the time you come in for the blood draw. If you are not paying for your labs at the time of draw, be sure to get a price quote in advance, and make sure you are comfortable with those charges.
▪  If you have health insurance, but are choosing to order your lab tests using this option, consider sending the receipt(s) to your insurer later, for any reimbursement allowable under your plan, or to count towards your annual deductible.

PITFALLS:
▪  Some labs in the area do not offer competitive pricing in this situation. We can give you some recommendations for a couple of labs offering competitive pricing, or you can call around to do price comparisons for your tests.
▪  If you have insurance, you could, in theory, pay more via this method than you would have if you had simply used your insurance card normally (with the lab submitting the charges to your insurance). The advantage of this option, though, is that there won’t be a “surprise” bill should your insurer decide not to approve a costly test.

BOTTOM LINE:
▪ Using this option, you should know, in advance, exactly how much you will pay. The total cost of NWMM’s basic lab testing is typically between $200 – $300 if using cash prices at a recommended lab. The lab will also charge a small fee for venipuncture (“draw fee”), which is typically around $10 – $15.

#3 – Using NWMM’s Negotiated Rates


If you are paying out-of-pocket for your labs, you can also choose to have your laboratory tests performed by either LabCorp or Pathologists’ Regional Laboratory (PRL) using Northwest Metabolic Medicine’s low negotiated rates.

CONSIDERATIONS:
▪  You will receive an itemized invoice from us, and we will collect payment from you at the time your labs are ordered.
▪  These costs are deeply discounted, and will likely be the least expensive option if insurance is not paying for your tests.
▪  If you have insurance, be aware that insurance plans often do not approve out-of-network lab charges for reimbursement or to apply towards your deductible.

PITFALLS:
▪  If you have insurance, you could, in theory, pay more via this method than you would have if you had simply used your insurance card normally (with the lab submitting the charges to your insurance). The main advantage of this option is that there won’t be a “surprise” bill should your insurer decide not to approve a costly test.

BOTTOM LINE:
▪ Using this option, you will know, in advance, exactly how much you will pay. The total cost of basic lab testing is typically between $100 – $150 (which includes the draw fee) if using this option.
 

ABOVE ALL ELSE…please keep in mind that there is NO WAY that we can know, in advance, which tests each insurance company will “approve”, and under what circumstances they will not. Insurance companies simply do not publish this kind of information, or make it possible to easily find this out in advance. We never want a patient to pay more for their lab tests than whatever would be the best option for them. Unfortunately, it is very difficult to know, with certainty, which of the above three methods will be the absolute lowest cost. This is one of the frustrations with the current insurance-based system (both the way that labs tend to charge inflated retail prices for services, and the complicated way that insurance companies operate, and all too often deny approval for lab tests that your doctor has ordered based on your individual health situation and history.)

Please be assured that we do whatever we can to keep your lab costs as low as possible, including limiting tests ordered, if appropriate, and also using any relevant lab results that were obtained recently from other physicians. If you ever have any concerns, please contact us to discuss it.