“It depends” used to be my answer. Or “I don’t know.” When patients would ask what something would cost, I really couldn’t say. Not that I wasn’t allowed to tell them, but I truly didn’t know. Their insurance might pay everything for a procedure or a lab test, or it might refuse to pay any of it.
I would often order a standard set of labs. Some people would tell me it cost them $300 even when they used their insurance. Others said it cost them nothing, it was totally covered. Insurance companies call the shots and make the rules, which tend to be confusing (on purpose?).
This week a patient told me she had to pay $3000 for blood tests last year, since the insurance company refused. She’d had hair loss after “the” viral illness, and she had been referred to a dermatologist. The specialist put in 3 diagnosis codes for the labs, one of them being for hair loss. The patient herself works in the medical field, so she knew to contact the insurance company and complain. They told her that since ONE of the diagnoses was “hair loss,” payment was refused.
I had a similar situation a couple years ago. One of my patients was in for the usual recheck of “hypertension, diabetes, hyperlipidemia, etc” and mentioned her hair was thinning. I dutifully added the “hair loss” diagnosis code at the end of the note. Payment for the whole visit was refused!! When we investigated why, I was able to write an appeal to the insurance company and actually get paid for the work I did.
We all know that insurance can be frustrating for patients. But it’s equally stressful for medical providers. The rules keep changing.
That’s why I’m loving my new Direct Primary Care (DPC) practice, where I don’t bill insurance for services in my office. The monthly membership pays all office visits and communications. I am up front with any additional costs.
I’m able to draw blood “self pay” at a low price (about $35 or so for my typical blood tests) in my office. And yes, I will order tests, referrals and labs through outside facilities if you want, doing my best to keep your costs down as you use your insurance.
“Working for my patients instead of for insurance companies.”