Let’s talk a little bit about lab work. It is the most commonly performed diagnostic procedure for obvious reasons… it is relatively quick and easy to perform, and lab work can give a lot of important information about someone’s health. We do lab work at annual preventative visits to look for things that might be awry and when someone is sick to help determine severity or cause. At my previous hospital-owned practice, I quickly realized that the lab work done during an annual physical or preventative visit was not chosen by myself (the doctor), but instead “what insurance companies would cover.” This mean that every person who came in for their physical got the same 3-4 labs because that was what insurance deemed appropriate or covered. Everyone was assumed to be the same. And everyone just accepts that insurance gets to decide.
So often, I found myself saying “well, I would really like to check X lab, but it won’t be covered by your insurance as part of your annual visit.” This was often followed by my patient asking me what the price of the lab would be if they had to pay for it. And that is the million-dollar question of healthcare. People were often shocked to learn that every insurance plan has their own determined value for diagnostics like lab work. The cost of any given lab is seemingly arbitrarily set and not at all easily accessible. The patient usually finds out via invoice 4 weeks later when their bill comes in the mail. And unlike that new pair of shoes you’ve been eyeing and waiting to go on sale, you have to commit to buying the lab before you even know the price.
As mind-blowing as that was, it got even worse (better?) when I started my direct primary care practice. By negotiating significantly discounted cash pricing with lab vendors (Labcorp, Quest), patients have complete transparency on the price of the lab work we get, can participate in informed decision making on whether they want to get certain labs through our cash pricing or use their insurance, and we are able to personalize what labs are most beneficial for each patient. One example is the NMR Lipoprofile test which is an advanced lipid screening panel showing direct particle sizes and numbers and most accurately assess cardiovascular risk. The cost of this test with your insurance is well over $100. aspireMD’s price: $18. Insurance loves to charge upwards of $200 for a vitamin D level. aspireMD’s price: $11. Even your more typical lab work is significantly discounted with cash pricing: TSH/thyroid test ($3), standard lipid panel ($5), CBC ($2), complete metabolic panel ($4).
In my new practice, I am able to order more comprehensive, personalized and actionable lab work on patients without surprise bills or unreasonable pricing. I still very much practice evidence-based medicine and do not get labs that will not change my management, but the difference is that I am able to make these decisions – not the insurance companies.