At our office we endeavor to make your healthcare experience both stellar and affordable. That being said, we would like to address a frequently posed question at our office of laboratory costs and insurance billing. Many of you have probably heard us discuss at length the fees associated with running labs through your insurance company or private paying for them directly.

Insurance Billing:

Our office does not bill insurance.  Click HERE as a reference for more information on why it is better for all of us to operate outside of that traditional model at AskDrSkip.com, LLC.

Out of Pocket Lab Cost:

Our ‘markup’ on labs is negligible compared to our insurance accepting colleagues. Lab prices are set so we are able to run ample tests affordably and cover operational costs of having the accounts, while not emptying your pockets unnecessarily or price gouging. This enables us to run expansive blood panels that get to the root of any heath issue as fast as possible (Click HERE for more information on Functional Endocrinology).

We do not want to sugar coat the potential financial implication of laboratory testing either. It can be costly. Sometimes rechecks are necessary. But when there is something chronically wrong and the body is in a state of stress and experiencing ‘dis-ease ‘ as well as the accompanying symptoms it can make for a far more expensive workup especially the more elusive and complex the problem we are handling together is.

Insurance or Out of Pocket? Which is cheaper?:

Please keep in the mind the following is just a guideline for understanding purposes only and does not reflect a specific type of insurance or coverage, because as you know, they all vary so much by carrier and plan.  We encourage you to always check with your insurance provider directly.

We can provide you a list of lab panels so you can check with your insurance for what is cheaper:  Click HERE for a general non-client specific list of labs we typically run (see bottom of the page). 

Our office can always provide you a detailed list of a testing recommended by Dr. Skip. This list can be used by you to verify and research the possibility of pre-authorization of these tests by your insurance and/or your primary care provider directly. Please understand this can cause a great deal of frustration as insurance companies can be hard to handle with all of their red tape. Our office can also give you receipts to enable you to have documentation of services provided, should you need them for taxes and your direct dealings with the insurance company and out of network providers and services.

Beware of your Deductibles:

Recently, a client of ours ran a very similar panel to what we do in my office with their local provider in Georgia. They billed her insurance company over $3,000 for a panel that is typically around $500 at my office.  The next financial impact could be a deductible. I myself have insurance which does not kick in until my deductible is met.  This means that if I allow the insurance to run the labs I will end up paying their high negotiated rate of several thousand dollars rather than my cost of several hundred.

The below illustrates and example of where the total financial impact to the client may be more expensive running it through insurance than actually paying out of pocket, so please make sure when you talk to your insurance company you take particular note of your deductibles and what percentage they will cover so you understand the financial impact.

Type

Cost of Labs

Deductible

Insurance Coverage

Out of Pocket Expense

Out of Pocket w/ Dr. Skip

$500

 N/A

N/A

$500

Insurance

$3,000

$1,000

$1,000

$1,000

Beware if Insurance deems your tests as unnecessary?

When you use insurance you agree to allow the Insurance company to decide if a lab, treatment or procedure is necessary (i.e. what they consider ‘standard of care’ or not) regardless of what the doctor wants or feels is most beneficial for your health. Weird, huh?

I don’t know about you, but having a ‘paper pushing bureaucrat’ choose my course of medical action seems totally inane. Many times there are tests and procedures that are available to you that are far safer and more useful than the ones being covered by insurance.

Bottom Line:

So, if the insurance company deems they aren’t necessary and/or only covers a portion of the labs, you are now responsible for the remaining balance. Once you submit the insurance claim, there is nothing I can do to help with the costs. In these cases, the best of the best may cover all but about $500 and in the worst, they may cover nothing, leaving you stuck with the risk of inheriting a debt of approximately $500, and hold your breath, I have seen insurance charge more than $4,000.  The challenge here is that this all hangs on what the insurance company’s negotiated rate is for that lab panel,, what kind of out of pocket deductible you have and what percentage they will cover.  Unfortunately, so often, this is not disclosed to you up front.

Lab work for your Education:

Please remember all lab work is evaluated and discussed in a purely educational fashion with no implication of diagnosis of any disease what-so-ever. Our office will not suggest the discontinuation of any medications or therapies from another practitioner. Our footer contains more information about our disclaimer polices as well as our terms and conditions and privacy. These values are discussed in a manner to optimize health with diet, exercise and natural supplementation. FDA release, blah, blah, blah…

Questions:

If you have any questions please contact the office at (972)530-4609.  We are glad to help in any way we can to ensure the quality of care is not sacrificed by either not running enough of the appropriate lab panels applicable to your health evaluation or making them so expensive only the elite may afford them.

~ Labs serve as a means to see the total picture of your physiological health. ~