The Free Medical Dictionary defines diagnostic test as "any test used to determine the nature or severity of a particular condition". As such, most diagnostic studies can be assigned to several broad categories: laboratory tests (e.g. complete blood count, lipid panel, urinalysis), imaging (X-ray, CT, MRI, ultrasound), cardiac tests (e.g. electrocardiogram, stress test), invasive tests (e.g. colonoscopy, breast biopsy), and organ function tests (e.g. nerve conduction studies, pulmonary function studies). Some tests may be used to screen for common conditions, such as diabetes, high cholesterol and even some types of cancer, often before patients show any signs or symptoms of the diseases in question.
It is estimated that up to 50 million Americans may not receive proper diagnostic testing for their conditions, mostly due the to the difficulties in affording the associated costs. Many of us believe that diagnostic tests are prohibitively expensive, and for a good reason: for example, a hospital-based MRI of the brain can easily be billed at four thousand dollars or more! But is this the true cost of the procedure?
Not so, according to Dr. David Belk who runs a website named "The True Cost of Healthcare". Dr. Belk convincingly demonstrates that there are gaping differences between billing and reimbursement for virtually any diagnostic test. Healthcare organizations offering these tests tend to inflate their prices artificially, knowing that actual reimbursements from governmental and private insurers will be much lower. As a result, patients that lack health insurance often end up with the worst possible deal. Clearly, this is neither fair nor sustainable in the long run.
However, since more and more people are faced with the need to pay out-of-pocket for their diagnostic tests, there has been a steady shift toward a more market-oriented approach to the diagnostic test pricing. To aid healthcare consumers in making sound financial decisions, we are offering some specific suggestions on obtaining better cash-based prices for your diagnostic tests.
As always, several disclaimers are warranted. Neither Carmel Care PLLC nor Dr. Gary Berlin receive any financial compensation from the outside entities and/or websites for including them in the list below. The resources provided here are only an aid to help you make decisions based on many different factors. We cannot endorse any of these resources or guarantee that the information presented therein is factually correct. And in regards to any individual savings or lack thereof, "your mileage may vary".
With these caveats in mind, we present our suggestions for obtaining better prices when paying out-of-pocket for your diagnostic tests:
- Healthcare Bluebook. This website states its mission as follows: "we help consumers save on healthcare expenses while helping Fair Price providers attract cost-conscious consumers". Many categories are available for pricing research, including X-ray, imaging and labs. Alternatively, tests can be looked up by name in the search box.
- Clear Health Costs. This website allows searching for tests and procedures by name within a selected distance from a user-defined zip code. Many queries will get you a list of offers from specific providers complete with prices. If there are no specific offers available in your area, the website will list the proposed Medicare reimbursement rate for the chosen test or procedure; this may be a good bargaining point when trying to negotiate your cash price with a provider.
- DealWell is a Dallas-based company that offers a marketplace for discounted medical imaging services. It has been dubbed "a Priceline of medical services". The website allows you to compare, purchase and bid on prepaid imaging deals. The company states that its certificates are non-returnable once purchased, much like the original Priceline model.
- Since Texas does not prohibit direct-to-consumer lab testing, several companies offer lab tests without a prior doctor's referral. For example, Any Lab Test Now has several branches in the DFW Metroplex where they can collect your samples. Alternatively, DirectLabs is an online service that allows you to choose and pay for your tests, and then either mails you a home testing kit or refers you to a local clinical laboratory for sample collection. A word of caution: direct-to-consumer lab providers are generally not allowed to treat or diagnose any medical conditions. If any of your tests show abnormal results, you should discuss them with your physician as soon as possible. Our house call medical practice is always ready to address the results of your tests performed at any provider or facility.
- Last but not least: Angel Mobile Health Services is a unique company that performs lab specimen collections at your own location in the DFW Metroplex. For those patients who pay out-of-pocket for their lab tests, Angel Mobile offers significantly discounted prices and provides online or telephone ordering. For the patients who have health insurance, a flat mobile lab collection fee is offered.
We hope that you will find these suggestions helpful for your health and your budget alike!