Lab Work / Blood tests

[Breedlove]

So I get my 6 month labs . Usually with insurance is around 65.00 my payment .

I get my bill ( my portion to pay ) 131.00 . I call the labs and ask did they bill the insurance company . Yes the total bill was 2302.00 and the insurance company negotiated it to My payment of 131.00 .

Now I was told the insurance company paid nothing but negotiated the price down ~~~~~~~~~

This seems fishy .

 

[MichaelB]

Both amounts are similar to my last lab. This “billed price” vs “negotiated insurance rate” has been doing this for over a decade, and each year it seems the difference the two rates increases.

Pity the poor souls without insurance.

 

[bingybear]

what kind of insurance? have our reached your deductible? I usually pay everything before maxing out deductibles after agreed upon rates except well care.

 

[zinger1457]

Both amounts are similar to my last lab. This “billed price” vs “negotiated insurance rate” has been doing this for over a decade, and each year it seems the difference the two rates increases.

Pity the poor souls without insurance.

I guess it depends on which lab you use. The lab I use offers cash prices that aren't much different than the insurance company negotiated rates as long you as you prepay for the test. Since I have a HDHP I use the cash option if I want to check something and it's in between my yearly checkup.

 

[Rianne]

Our HI negotiates costs down to the point that sometimes, the negotiated cost is cheaper than a co pay of $50. It was in our best interest to see online the Explanation of Benefits for every procedure to realize it was cheaper for us to go bare bones, high deductible, low premium HI. I compared 2017 to 2018 Explanation of Benefits online for various procedures, blood tests, appointment with specialists and so on. We are far better off betting on the HI company negotiating down the cost. We will save approx. $5000 this year.

 

[Texas Proud]

Where you last labs done last year?


You might have been to a point where you did not have to pay full amount.


I pay for 100% of labs until I reach deductible amount and then the insurance kicks in... but it is the lower negotiated rates so that is good.

 

[LOL!]

Our HI negotiates costs down to the point that sometimes, the negotiated cost is cheaper than a co pay of $50. It was in our best interest to see online the Explanation of Benefits for every procedure to realize it was cheaper for us to go bare bones, high deductible, low premium HI. I compared 2017 to 2018 Explanation of Benefits online for various procedures, blood tests, appointment with specialists and so on. We are far better off betting on the HI company negotiating down the cost. We will save approx. $5000 this year.

So that's after the EOBs are generated and you have had the expense? Or is that looking up estimates of procedures, specialists before scheduling the appointment and incurring the expense?

 

[MichaelB]

I guess it depends on which lab you use. The lab I use offers cash prices that aren't much different than the insurance company negotiated rates as long you as you prepay for the test. Since I have a HDHP I use the cash option if I want to check something and it's in between my yearly checkup.

The labs in my insurance plan - Quest and LabCorp - which I think are the two biggest. We have a local private lab, which has lots of branches in the area, with prices posted all around the waiting room. They look to be about 1.5 - 2 times the insurance negotiated rates of Quest and Labcorp, which makes them about 80% less than the insurance rates.

 

[Rianne]

So that's after the EOBs are generated and you have had the expense? Or is that looking up estimates of procedures, specialists before scheduling the appointment and incurring the expense?

We are fortunate our HI has good CS. Before we took the 2018 plan, I walked through, with CS, some of the EOB's from 2017. There were repeat procedures and I had a huge ER (Emergency) in November 2017 that required hospitalization. FYI, twisted small intestine.

After that, I took the massive EOB's and went through in detail all the procedures, meds, hospital costs and so on. Needless to say, the negotiated down prices were astonishing to me. With the 2018 plan, my maximum out of pocket costs are less than the premiums plus co pays from 2017.

Not sure how to better explain that.

 

[Breedlove]

It just seems too much 2300 for labs and they just mark it down to 131.00 all paid by me . All the Ins did was negotiate down .

 

[MRG]

It just seems too much 2300 for labs and they just mark it down to 131.00 all paid by me . All the Ins did was negotiate down .

Every year they find new ways to get more blood from turnips. The latest thing I've seen is the formulary is shrinking. Not just on the number of meds but also more meds require prior authorization or step therapy.

 

[marko]

My doc is a "Direct Care" PCP. Direct Care docs don't take any insurance; sort of a concierge.

I pay $7 for blood labs; no insurance or copay involved. (Of course, I pay $100 a month to him for the privilege of being my PCP) but it does illustrate the true cost vs billed cost.

 

[foxfirev5]

Mine came out to $95. I gladly paid the bill and was grateful to just move on.

 

[audreyh1]

It just seems too much 2300 for labs and they just mark it down to 131.00 all paid by me . All the Ins did was negotiate down .

Yes, that's how it works. I routinely get 10x or greater "claim" to what is negotiated down. It's crazy.