As a physician who continues to directly treat patients, I’m often asked, “how much will these tests cost me.” Unfortunately, the answer is often that I have no idea.
As a physician I, of course, feel the responsibility of being able to provide that information so the cost of tests can be weighed against their potential value. The thing is, I often do not know not out of lack of effort or desire--it’s just nearly impossible to know!
There are thousands of different laboratory tests, each with different prices and reimbursement. Making it even more complicated, there are dozens of different insurance companies, each having their own negotiations on prices, protocols on which tests they will help reimburse, and even what portion of the bill they will reimburse. In many instances the reimbursement for the same test from the same insurance will even vary… based on the indication, physician authorization, or even what lab is performing the test.
Even as an occasional patient myself, I have resigned that I will almost never know the pricing ahead of time, and will only discover the price when I receive the bill.
While such resignation is common among physicians and patients, that does not make the status quo right. Let’s talk about the regular world for a moment: In nearly every consumer transaction we weigh the cost versus the value. For some reason, when it comes to something as important as our health, we rarely have that opportunity.
The Affordable Care Act did not increase transparency, nor did it increase coverage for most testing. In fact, among testing the only guaranteed free screening tests offered are cholesterol and blood sugar -- and that’s only for certain age or risk groups. Too often we only discover the bills or what an insurance company is willing to pay (or not willing to pay) by being surprised by a major bill in the thousands. Surprise-events such as this are only increasing as insurance companies are progressively switching to having higher deductibles, lesser reimbursement, and, in general, a higher portion of care borne by the patient.
Fortunately, companies such as EverlyWell are overcoming this trend by working with consumers directly. With transparent pricing -- typically lower than out-of-pocket patient costs -- there is no longer a question of what the costs may or may not be. In addition, EverlyWell only offers tests that can be performed at home, obviating the need to give up time to go into a lab. Not only does that save the consumer time, but because a laboratory technician and facility are not needed to obtain test samples, costs are lower as well. By not requiring an in-person physician visit for the tests to be ordered or reviewed, time and costs are further saved.
While laboratory testing insurance coverage is unpredictable and decreasing (leading to high and occasional extraordinary costs), you can now access the testing that you need at a clear and reasonable cost. So instead of the unknown or big bills, you can focus on your health!