Would My Blood Test Still Cost $1,132 if the US Had a Public Health Option?

[xchrom]

http://www.commondreams.org/view/2014/03/06


Blood testing. Marc Rubin was quoted a price of $1,132 for a recent test.

I recently went for a routine blood test as part of my yearly physical and went back to the same lab I had been going to for the same test the last few years. This time however, after handing over my insurance card, I was told they were no longer an "in-network provider" for my health insurance carrier (my carrier is one of the biggest in the country). At first, I didn't care since my insurance plan allows me to see any provider, in-network or not. The difference is in the co-pay. No co-pay for the blood test with an in-network provider, a co-pay for out of network.

Given that the temperature outside was around 4F (-15.6C) with -10F (-23.3C) wind chills I was inclined to stay where I was and fork over what I thought would be a $25 or $50 co-pay. I figured that in the time it took to put on my sweater, scarf, coat, hat, gloves and warm up the car, I could stay where I was and just be done with it.

So I asked the administrator what the co-pay would be. She said she couldn't tell me since she didn't have my specific plan information, but she could tell me the cost of the blood test and the co-pay would probably be in the 20-30% range. I asked her to look it up since I had decided to stay and get it over with. Until she told me the cost of the blood test: $1,132.

Needless to say, I had no problem putting on my sweater, hat, gloves and scarf and braving the wind chills to drive to an in-network lab to pay nothing.

[Nye Bevan]

1. Very smart of the guy to ask what the copay would be before getting the test.

Pretty much anytime you go "out of network" you get completely and utterly screwed.

[Doctor_J]

4. a routine blood test should not cost $1132 regardless

The$300 copay is only part of the outrage in this story. $1132 for a blood test is ridiculous

[Doctor_J]

2. welcome to corporate healthcare

Passed by your democratic wh and congress

[Glitterati]

3. On the other hand......

I go to the doctor at least once a month, sometimes bi-weekly, and have a blood draw for thyroid tests. I pay $65.00 for the visit, including the lab work.

[Doctor_J]

5. which is what it should cost, every time for every patient

The rest of the $1100 in the op goes toward another yacht for the insurance CEO. Our system is a disgrace

[Niceguy1]

11. impossible to tell without

Knowing what the blood test was......

[Niceguy1]

16. in the real world you kinda

Need to know what something is before commenting on its cost

[Doctor_J]

17. please read words 6-14 of the quoted piece in the OP

if you are able, which seems doubtful at this point.

[LynnTTT]

21. But that is not "the cost"

The fact that you only pay $ 65 is not the point. It's the total cost of a procedure that is important. That's what drives our health costs.
A friend argued that the cost of a health insurance policy for an individual couldn't possible be $ 7700-$9,000 a year. Because she only paid $ 300 per month, according to her old paycheck stubs. I pointed out that she worked for a large national accounting company and they paid 75% or so of the premium. I swear, she never knew that!!!

[Glitterati]

22. I would have to guess you're wrong

because that's exactly my cost as a cash paying patient.

That's uninsured.

When "insurance" is kicked out of the picture, real costs come into view.

[truedelphi]

33. I have to totally disagree.

Our doctor wanted some tests done for my husband.

We called to see how much he'd be charged, and it was around $ 1,100. That is, if we went to the clinic our doctor suggested.

Instead we went home and got on the internet.

We found a lab about 90 minute drive from our house and that lab said they'd do all the tests for $ 670.

So you start to realize how made up the prices are.

You can do that with almost any procedure.

For instance, an appendectomy might cost X amount if done in one hospital, but X plus $ 6,500 if done at a different hospital. Of course in the case of an appendectomy, you often can't be transported around from hospital to hospital. You are pretty much stuck with whatever hospital whose emergency room you arrive at.

[truth2power]

9. I'm saving some print-outs and a couple of newspaper articles

from back when the ACA roll-out started, which predict some of the problems that will occur.

Just waiting for the right time.

[Ms. Toad]

6. Although single payer would be far better - the ACA will cut the cost

of the blood test for an in network provider to around $113, so the coinsurance (20% for a silver plan) would be $22.

I've been tracking our billed v. actual paid costs for a couple of years. The UCR (what insurance companies pay and the hospital accepts as payment in full) runs between 5% and 25% of the billed cost - and the average is around 10% ( the $113).

So even if all you had was a silver plan and a ginormous deductible, your cost would be around $113, instead of $1132.

If you had met your annual deductible it would be around $22.

That's the difference having even an imperfect solution (insurance) makes.

ETA: Our billed expenses during that time were around $120,000 - so, while it is only one insurance company I've specifically tracked, it was a lot of bills with a lot of providers. Lab tests are the most heavily discounted for the insured (or more accurately inflated for the non-insured). And - while I didn't specifically track them with my prior insurance companies - I remember being shocked with the last two at the same kind of differential.

[Doctor_J]

8. for profit insurance bloats the cost of these essential routine services

by factors of ten to absorb profits, administration costs, and other non medical expenses

[truth2power]

10. This is what comes from turning over an essential human need to a for-profit system....

The Einsteins in our govt. don't seem to understand that.

or, wait....maybe they do.

[Ed Suspicious]

12. I think you're right... I think they well understand it.

[bvar22]

32. FDR & LBJ stipulated that Health Care was a Fundamental Human Right,

to be publicly owned and administered by the Federal Government on an Egalitarian Basis.

3rd Way (Koch Brothers funded DLC Centrist Democrats) believe that Health Care
is a Commodity to be SOLD to Americans by For Profit Corporations.

That is the difference.

[Ms. Toad]

25. There are lots of factors - not just for profit insurance.

Hospitals are mandated to provide emergency care which can't ever be paid for by patients
Government payments for care don't always cover the actual cost of care (including administration costs of the non-profit providers and the profit of the for-profit providers)
Insurance discounts provide guaranteed payment, but not necessarily profit (and sometimes a deficit) - and the insurance companies are not inclined to share the costs for two above items.

So insurance is definitely in the mix of bloating the prices - but it isn't the only factor in the equation.

[LittleGirl]

7. It's that time of year

when most people have not met their deductible too. Early in the year (when you have a calendar type of coverage) and you really need to be careful about these unexpected expenses. Our system is the worst.

[glowing]

13. These out-patient lab testing facilities cost money too!

I don't understand why it costs more for your primary Dr to draw blood at an office and send it out, rather than having the Dr sign paperwork, send it with you to the blood drawing facility, and then they proceed with the testing, and then the labs come back, and back to the Drs office... It's more effort to and money out of pockets for all of these run around items. If you don't have readily available transportation or schedules that permit running around for an extra step, it becomes a pain in the butt and something people tend to put off.

It never made sense to me that the insurance companies decided to make lab testing cheaper at an off site facility! It's not like the Drs offices can't send the blood out for analysis to the same companies or have the lab company do pick up deliveries. It seems ridiculous to me to have this system. I can't imagine if I had regular needs for lab testing. It must be a burdensome, taxing thing for the elderly and any elderly care givers (like their children who have to take time off to drive them around to their different appts).

[Doctor_J]

19. when Medicare part d rolled out, Krugman called it the

"Middleman Multiplication Act". ACA is similar

[Sgent]

28. This is usually the doctor's choice

doctor's used to be able to make a profit on doing labwork, either by doing it on site, or by sending it out and billing the patient / insurance for the lab cost at a markup.

This changed back in the 90's when Medicare and Medicaid would only pay the lab directly, then later on state laws and insurance companies did much the same.

CLIA tightened up regulations for small labs to the point that running the tests are not a viable option for many clinics.

Finally, under most situations doctors will not get paid to perform a blood draw (its included in the office visit fee...) but it still costs staff time, office space, etc. to run the lab.

End result, its easiest and cheapest for doctors to send the patient to a 3rd party lab and not have to deal with all the headaches. They will still do "waived" testing (urine dipstick, generally swabs, some simple automated stuff) which they can get paid for but no longer collect or test samples themselves.

[Thespian2]

15. Medical Tests

I went to a neurologist while visiting in Florida. He set up an appointment for an MRI to examine my spine and sciatic nerve. At the lab, I presented the clerk with my North Carolina State Retiree insurance information. I live in Canada and no longer have Medicare Part B. The clerk called the next day to inform me that the MRI, after the insurance payment, would cost me almost $1000.00. I cancelled the appointment. At home in Canada, the test will cost me $0.00.

[Doctor_J]

18. our president declared "big insurance deserves to make a profit"

So you're probably a racist for not understanding our system.

[jsr]

23. "I have no interest in putting insurance companies out of business.

They provide a legitimate service, and employ a lot of our friends and neighbors."

[bvar22]

29. "provide a legitimate service"????

What "legitimate service" would that be?
The Federal Government can read a bill and print a check with almost no overhead (3%).
(SEE: Medicare)

The For Profit Health Insurance Industry :

*manufactures NOTHING

*Produces NO useful Product

*Provides NO essential or useful service

*Produces NO Value Added Wealth

It needs to go the way of the Buggy Whip Industry,
not receive $100 Billion per year in Taxpayer Funded Subsidies.

It is sad that those workers will have to find another job,
just like the Millions of other Americans who have had to find another job
when our politicians sent our old jobs overseas.

[jsr]

30. Their #1 job:

[truedelphi]

34. It appears that some here at DU refuse to realize how much those

Big Insurers are paying for those Denial Stamps.

Gotta be real big bucks spent on those! (Plus the cost of all the ink has to be astronomical!)

[Bluenorthwest]

20. I voted for a guy once who claimed he'd insist upon a pubic option to help control costs

but then he did not insist, nor even mention it and in fact claimed he'd never run on such a promise. But he did.

[bvar22]

31. Back in those days, the Public Option was essential.

The Public Option was necessary to keep them honest and open the door to Single Payer.

I remember when he ridiculed Hillary during the debates for HER Health Care Plan,
which was Mandates with NO Public Option.
Ridiculed her on national TV.

I'll bet Hillary is pissed that Obama passed HER Health Care Plan after he was elected.


One of the reasons I supported Obama was that beating he gave to Hillary over her ridiculous Health Care Plan.
A Mandate to BUY Health Insurance from For Profit Corporations?
with NO Public Option to "keep them honest"?
In America?
Absurd!
.
.
.
The only thing more amazing than Obama's transformation
was the overnight transformation of his acolytes on DU.
Overnight from:
YAY Public Option
to
Its not that important. We didn't really need it anyway.


That was enough to give a normal person Whiplash.


You will know them by their WORKS,
not their promises or excuses.

[truedelphi]

35. Apparently he was saving that money saved by not having a

Public Option for that war he asked us to support last summer, that is, a war on Syria that only 17% of all Americans ended up saying they wanted.

I know my household would have rather had the Public Option.

[cbdo2007]

24. This is a dumb argument and is the reason the ACA exists.

I'm so glad the internets can give all the complainers of the world a forum *eyeroll*

[truedelphi]

38. I don't believe most of the people replying to the OP follow yr logic.

It makes little if any sense that people need to shop around, and/or that they need to find out if the doctor they are seeing, that is one of their Big Insurers' Covered Doctors, might not be using a lab that is part of the network.

There was a huge discussion on Daily Kos about how sometimes you don't even know, right? You think that since you are indeed seeing a doctor that is covered by your insurance, so you make assumptions - you don't even consider whether the lab he or she is sending the lab work to might be out of network. And then should it turn out that the doctor has sent the work on to an out of network lab, you are screwed, because you will find that you are responsible for the costs of the tests, as the Big Insurer doesn't have to pay them. The ACA has kept us trapped inside the maze.

One of the only people I see here who is claiming all is well inside this crazy system is a person who admitted her household was covering a $ 50,000 a year insurance bill before the ACA, and it has helped her family, as now they pay only $ 36,000 a year. Good for her. I am glad someone is benefiting.

But for those of us who don't even make $ 36,000 a year, we really feel the pain of high deductibles, the huge co pays and the total sense of not having control over our lives at a time when we need that control the most. (Will Pitt's OP of the last day or so makes an excellent demonstration of the frustrations that are occurring.)

[cbdo2007]

41. **Bookmarking to respond in 5 years

Sorry it didn't happen for you overnight like you were expecting, but let's see the changes that come about in 5 years time. Thanks!

[JayhawkSD]

26. Some good points have been made and one overlooked.

Overlooked in the original post was, "I was told they were no longer an 'in-network provider' for my health insurance carrier," which is a very significant point. As insurance companies change their payment terms and/or methods, medical providers drop out of those companies' networks, and the impact on consumers can be dramatic. In evaluating the coverage provided on the "health care exchanges" (which are actually health insurance exchanges) we are always told the amounts of the premiums, sometimes told the copays and deductibles, but we never hear anything about the networks of providers, and that factor is of vital importance.

Insurance has huge impact on doctors. Of the four doctors I go to (primary, neurologist, pulmanologist and cardiologist), in the last two years one has left the medical practice, one has moved to a smaller town, and one has quit the network of my insurance carrier (United Health care, which I've had for almost twenty years). Insurance issues played a role in all three cases, and changing three out of four doctors when you are 70 years old, have had multiple strokes, emphysema, two heart attacks and Parkinson's Disease is not a lot of fun.

Ms Toad makes a good point with the difference between the nominal billed price and the discounted price paid by insurance companies. Even "out of network" providers receive a discount from that initial price, but a smaller discount than "in network" providers. Supposedly a cash patient would pay the full price, but negotiation will always bring it down. All of this would be horrendously illegal in any industry other than health care, which has exemptions to make it legal.

Dr. J also makes a point that for profit insurance inflates the cost of health care, but that is actually a lesser impact than is generally made. The increases in costs come from providers rather than from insurance, since insurance markups have remained relatively steady over the years and are now fixed by the ACA at 25% of the amount billed by the provider. I personally find that utterly appalling, but supporters of the ACA think it's some kind of victory.

truth2power points out the bottom line of the problem when he says that it is the "for profit" basis of something that people buy as a basic need, although in reality even doing it on a for profit basis would be fine if it were done on a "regulated for profit" basis. Electricity is provided on a for profit basis, but there are regulations on how it can be priced. Health care is not only unregulated, but it is exempted for all kinds of anti-trust and other pricing regulations that normal business is subject to.

[truedelphi]

37. A lot of providers, especially specialists, are really hiking up rates.

Last edited Fri Mar 7, 2014, 04:33 AM - Edit history (1)

About a month ago, an article was making the rounds on FB about how a woman who had a small mole removed by her dermatologist ended up being presented with a $ 22,000 bill.

She had no idea it was going to cost that much. I mean, I have had friends who had major face lifts who only spent $ 16,000.

Full article is at link below. And on edit - not only would any human having this simpler form of skin cancer not get a bill at all if they were in Great Britain - they would be given a topical ointment that would simply crust the crap off their face, and they wouldn't need surgery, Moh or not, nor an anesthesiologist!

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?_r=0

[gopiscrap]

27. three words: UNIVERSAL SINGLE PAYER!!!

[Pretzel_Warrior]

36. Yes.

Hospitals and clinics already have different prices negotiated by different payers. If you don't qualify for a public option (have employer based health insurance) you'd likely pay the same or more as you do now.

[Skinner]

39. From the article: "my blood test in the end cost me nothing"

Another Obamacare horror story. This poor guy had to put on a scarf to save $1,132.

[sibelian]

40. Move to Scotland.

It's FREE.