Finding out the cost of lab tests is a real challenge for patients

In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.

Fortunately, when I started graduate school, my father insisted that I have health insurance. As a healthy 24 year old, I didn’t see the need, but he agreed to foot the bill for a high-deductible insurance policy to cover me in the event of catastrophic illness. Except for four physician office visits subject only to a $35 co-payment, my policy offered no benefits until I spent $3,000 out of my own pocket. With my sinuses throbbing, I knew I needed to use one of those visits. Overwhelmed by the list of “in-network” providers on the insurer’s website, I picked an internist based on convenience—his practice was located in a medical complex near my home.

Arriving for my appointment, I checked in and presented my insurance card to the receptionist. “Your visit today will be $35,” said the woman behind the desk. I was relieved to hear that my coverage was working as promised. A nurse ushered me to an exam room, where the physician promptly entered, half-heartedly listened to my complaint, and confidently asserted that I did not have a sinus infection because I had no fever. I wanted to say “Really? Mind handing me a tissue so that I can show you what’s been coming out of my head?” but resisted the urge. Instead, I clarified that fever or no, I didn’t feel well, and believed my sinuses were the culprit. At this, the internist lost patience. He ordered some lab work and a sinus CT scan to rule out infection, and said that I could have everything done downstairs.

Despite my $35 office visit, I knew my insurance wouldn’t cover anything else until I met my deductible, so I needed to find out the cost of the CT scan. Doing so was much more difficult than I expected. Admissions didn’t know the cost, so they called the imaging department. Imaging had no idea, and threw it back to admissions where, after much searching, a big black binder full of prices was located in a cabinet, alongside packets of coffee creamer, some paper clips, and a couple of dried up ink pens. The sinus CT would cost roughly $900, which I could not afford. I headed instead to the lab to get my blood drawn, not knowing that I was about to make a costly mistake.

I worked as a phlebotomist during college, so I knew that lab tests were expensive, but that most insurers negotiated discounted rates that were only a fraction of the sticker price. Besides, the lab work was routine—a comprehensive metabolic panel and complete blood count—so I didn’t think to ask how much it would cost. My mistake was assuming that the lab was in-network, because the in-network internist I had just seen worked in the same building and referred me to the lab.

A month later, the bad news came in the mail. The lab was out-of-network, and I owed $478. While this wasn’t the five-figure medical bill many families face, everything is relative. For me, a graduate student living almost entirely on borrowed money, the bill changed how I bought groceries, socialized with friends, and commuted to school. For six months, I fought to scrape together enough money to make monthly payments. The experience, while costly, taught me a lot about our fragmented health care system, how little patients or providers know about the real cost of health care, and how hard it is for patients to make price-based decisions when the system isn’t designed with that in mind.

I had learned my lesson. Later, when a dermatologist put me on medication requiring monthly blood tests, I took out the yellow pages, looked up laboratories, and dialed the phone. “I’m uninsured,” I said (not far from the truth given my coverage) “and I need to have a lipid panel and a liver function test. How much will this cost?” Some labs knew, and some labs didn’t, and the answers varied widely. Needless to say, I chose the least expensive option. Making the decision was easy, getting the information on which to base the decision was—and is—the real challenge.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

On Labor Day Costs of Care, a Boston-based nonprofit, offered $1000 prizes for the best anecdotes from doctors and patients that illustrate the importance of cost-awareness in medicine. Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. To learn more about the contest and read more of our stories please visit www.CostsOfCare.org (Twitter: @CostsOfCare).

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  • imdoc

    So you are a student of health policy. I am interested in your views about lack of price transparency in health care. Why do you think prices are not advertised and list prices are stratospherically high, yet actual reimbursement from plans is a fraction?

    • http://www.healthpolicyanalysis.com Brad Wright

      There are lots of reasons, but the insurance companies are a big one. If they keep patients in the dark about actual costs, and negotiate low reimbursements for providers, they increase the amount of money they get to keep. Hooray for capitalism. Of course, it is much more complex than that, but it is 10pm on a Friday night and I have a dissertation to complete.

      • gzuckier

        except that after every claim, the insurance company proudly sends you an EOB (explanation of benefits) detailing very precisely what the provider would have charged you if you didn’t have insurance, what the actual negotiated charge the provider settled with the insurer for, and what part of that you have to pay. that’s keeping you in the dark in the same sense the daily newspaper keeps you in the dark about sports and weather.

        • Brad Wright

          That’s true–they also send you that information AFTER you’ve already utilized the service, not before. Which is informative in the same way as it would be if you went to McDonald’s for a Happy Meal, ate it, and then got a statement a couple of weeks later that told you that it would have been $18, but your insurance negotiated that down to $12 and paid $8 of it, so you only owe McDonald’s $4.

  • anonymous

    You should have applied for Medicaid. Then you could get all the lab tests or CTs your doctor wants, for just a $1 (or zero) copay, compliments of your government.

    • anonymous

      re: my first post…

      I misspoke. I meant to say, you could get all the lab tests or CTs YOU want, since you clearly felt the need to override your doctor’s advice.

      It happens all the time, and just reinforces my recommendation that you apply for Medicaid. In my experience, Medicaid patients frequently overuse the system, and don’t think twice about the fact that the cost of the CT their doctor just ordered for them (which may have just been a way to placate them, or a “CYA” move by the MD) would present a significant hardship to someone who actually had to pay for it.

      • http://www.healthpolicyanalysis.com Brad Wright

        You do realize that I was not categorically eligible for Medicaid, right?

  • Jeff Taylor

    So – was it a sinus infection or not? Strikes me this anecdote is full of more holes than Blackburn Lancashire. Is it a message for the free market or a single payer insurance? Is it about evidence based medicine or overtreatment?

  • JustADoc

    You could have listened to the internist for $35 and saved $478. Now I wasn’t there and didn’t examine you so I don’t know that you didn’t have acute bacterial sinusitis. But based on your description in the story you probably didn’t. But green(purple/orange/bloody/whatever ever other description you want other than purulent) snot doesn’t bacterial sinusitis make according to every recent study on the planet.
    I realize none of this is relevant to your actual point excepting of course that lots of costs could be saved if patients would just accept the wisdom of thousands of hours of education and experience. I’ve examined thousands of people with sinus complaints as has every other FP/internist/pediatrician/ENT. We sorta know what we’re talking about usually.

    • ninguem

      I’ve wondered the same as the above comments.

      What did the CT show?

      • ninguem

        Oh, I think on re-reading, it wasn’t done.

        What did the CBC show? Anylabtestnow.com, lists a CBC and chem panel for about fifty bucks each. A panel with those, plus thyroid and urine, for just over a hundred.

        Sinus infection and in particular “sinus headache” is way overdiagnosed, that’s pretty overwhelming medical opinion. When I have the exact same thing, it’s the Neti pot for me. But what do I know, I’m just a doctor.

        I leave diagnosis to ex-phlebotomist PhD candidates.

        Shop around. Find another doctor who runs a full battery of tests, with a CT head, and goes straight to antibiotics. Then you can write another blog post about doctors overtesting and overprescribing.

        Sort of a two-for-one deal. Two shots at the thousand dollar prize.

    • http://www.healthpolicyanalysis.com Brad Wright

      The $478 was for baseline new patient lab work, not to diagnose a sinus infection. I didn’t get the CT because it was too expensive.

  • http://warmsocks.wordpress.com/ WarmSocks

    I’m sorry you had to learn something like that the expensive way. Ouch!

    To add a twist, we chose a lab knowing the cost of having those particular tests done there, and discovered two months later that they’d sent the tubes of blood elsewhere. Nobody can tell me why. People at the lab we went to as well as at the lab where the work was sent are both puzzled. The order was for basic tests that could have easily been done on site. There was no reason to have sent things to the second lab, but I’m on the hook for $479 instead of $224 because the lab pulled this stunt.

    It was a pretty short-sighted business decision on their part, because everyone in town is learning that they’ll pull shenanigans like this, and everyone who has the option of driving 30 minutes to a different lab will do it instead of risking having their bill doubled.

  • Anonymous

    Because the great majority are using third party payment, the providers have little or no incentive to offer price transparency in their services.

    Without price transparency, the free market is much less of a free market.

    • gzuckier

      not quite. the prices are very transparent, to the third party payors; because the third party payors tell the providers exactly what they are going to be paying, well in advance. you could probably find out what that amount is from your insurer, if it mattered. however that is not an option for the individual self-paying patient, who gets the short end of the stick; since it’s a take-it-or-leave-it proposition, with a touch of “if-you-have-to-ask-you-can’t-afford-it” the providers have little or no incentive to give the individual self-paying patient the info. in particular with a lab, patients can’t really bargain for a sliding scale the way they can with a sympathetic physician, or even a hospital

  • http://www.stevebalt.com SteveBMD

    For your next exercise, try to figure out the true cost of your antibiotic or prescription decongestant.

  • ninguem

    All this, for the common cold.

    Do you think a Canadian or a Brit or a Frenchman is going to be able to walk into their GP’s office and demand antibiotics for a viral illness, and get a CT sinuses, CBC with differential, comprehensive chem panel, immediately, for a brief history of nonfebrile upper respiratory symptoms?

    • http://www.healthpolicyanalysis.com Brad Wright

      If you’ll re-read, you’ll notice that there is no demand for, nor any prescription given, for antibiotics. I was more concerned that I had chronic sinusitis, because I had persistent symptoms over a period of years, with occasional “flares.” The labs were new patient lab work, and the CT was prescribed to rule out infection and/or structural abnormalities–although it was never done. What’s more surprising to me, though, is your ability to diagnose someone from a 750 word essay.

      • Vox Rusticus

        You had “persistent” symptoms or recurrent symptoms? You wrote here the former, but your history above suggests the latter.

        • ninguem

          What was described was two episodes of acute upper respiratory infection, maybe acute sinusitis. The etiology is almost certainly viral. You could have saved 100% of the cost by treating acute symptoms without blood work.

          And if the idea was chronic sinusitis (which is not what you described), then the CT would, in fact, have been indicated, should have been done.

  • Dr. J

    So, here’s the reality when it comes to sinus ‘infections’. You suffer for a week and then they go away. You say you had to suffer with only over the counter drugs the first time, well, Rx drugs are really no better, you wait out the week and then you are better.
    The job of the doctor, if you do see them is to exclude other pathology. There is no secret magic bullet that we are holding back. I really question the utility of a CT for diagnosis of acute sinusitis, the real utility of CT in this setting is if another serious diagnosis needs to me excluded. The utility of a CBC and chem panel in the diagnosis of sinusitis is that it is totally useless.

  • Med Student

    I am appalled by the physicians who think that the author, who is not an MD, should know what lab work/tests are needed for his condition. The fault lies with the doctor who ordered the tests in the first place. The author had to make the decision not to get the CT because of finances. Seriously, should he know the nuances of “persistent” vs. “recurrent”? Comments like “I leave diagnosis to ex-phlebotomist PhD candidates” are absolutely unnecessary. The author did not mention the poor diagnostic skills of physician but was talking about the unfortunate pricing system of healthcare.

    • JustADoc

      The author reported that the doctor didn’t want to order the tests:
      ‘the physician promptly entered, half-heartedly listened to my complaint, and confidently asserted that I did not have a sinus infection because I had no fever. I wanted to say “Really? Mind handing me a tissue so that I can show you what’s been coming out of my head?” but resisted the urge. Instead, I clarified that fever or no, I didn’t feel well, and believed my sinuses were the culprit. At this, the internist lost patience. He ordered some lab work and a sinus CT scan to rule out infection’

      Also note contrary to what the author is now saying in comments, all the labs were done to r/o infection, not establish baseline labs. Maybe he left that part out the first time.

      • JustADoc

        You state that the author did not mention the poor diagnostic skills of the physician. Well, that is true. He actually mentioned the exact opposite. The physican most likely correctly diagnosed sinusitis which is usually not bacterial. The fact that there is no comment along the lines of ‘and the next week I was diagnosed with mastoiditis and had IV antibiotics for 2 weeks’ makes me think he was right.
        Now based on the story one could make comments about poor bedside manner, but not diagnostic acumen. Notice every doctor that has replied has not questioned the diagnosis of viral sinusitis. Statistics are overwhelmingly in our favor. Do notice that in my original comment I allowed the possibility that it was though.

        • Med Student

          Maybe I am just a med student, but my comment on poor diagnostic skills of the physician had to do with the fact the doctor made the choice to order the tests that he did not need. I agree (from the info provided) that he did not need all of those tests. I would not be surprised if the doctor financially benefitted from the lab tests (he did say it was in the same building). My point was that the physicians commenting were being unnecessarily rude to the author about his lack of medical knowledge when he never claimed to be a doctor.

          • JustADoc

            Did you miss the part where there was no plan to order labs or a CT initially until the patient badgered him. Could he have said ‘No, you don’t need the tests’. Sure he could and probably many times he does. But any practicing physician can tell you that sometimes you cave for a host of reasons:patient satisfaction, small doubts about slim possibilities, getting the visit to end so you can move on to the next patient who doesn’t care that you spent 10 minutes discussing why not ordering a test is best, etc. And yes, maybe the doc makes some money off of the tests or maybe not. But notice that the money-grubbing docs first inclination was to not order the tests.
            From your handle I presume you are still in school. It is easy to pontificate from there. It is more difficult to be perfect and idealistic with real patients(they don’t act all nice and textbook like in PBL).

          • ninguem

            The doctor’s diagnostic skills were just fine, by a plain English read of the story. The doc was not going to do the testing that you imply might have financially benefitted the physician. The patient pressured the physician into testing.

            Any experienced doctor can relate to that, having been there many a time. Someday it will be your turn, assuming there are still med students enering primary care.

          • Primary Care Internist

            As is the case with many many many doctors’ offices, they are often congregated in office buildings near hospitals, as do labs, radiology facilities, etc. So for example my office is in a building across the street from a medium-sized community hospital, and there are three labs within a one-block walk, including Bendiner/Schlesinger IN the building. We give patients a rx for labwork, and they go to whichever is in network with their insurer. Nothing comes back to us from any, and i don’t care at all which one my patients use.

    • ninguem

      So…….you got the lab tests. Were they abnormal? Was there a high white count, left shift? Was imaging ever actually done?

      The doc, as you described it, saw an acute upper respiratory illness. If it was longstanding, you didn’t describe it. There was one similar episode two years ago. That’s not much of a recurrent pattern.

      There is no mention of recurrent chronic symptoms. There is mention of one self-limited episode two years previously. No treatment, over in a week is a self-limited episode to anyone who has actually practiced medicine.

      What the author describes, I’ve had. Including the prior episode. I use a Neti pot, antihistamines, decongestants, nasal steroids. I’ve not felt a need to ask for laboratory studies nor imaging.

      By a plain-English read here, there was one self-limited URI, another one two years later, maybe not clear but it sure sounds like the episode was onset that very day. The person found a doctor who could accomodate a sane-day new-patient appointment. The doctor came to a conclusion I’d come to with my own patients, my family, myself in that position.

      The PATIENT demanded more intervention. It’s not the doc’s poor diagnostic skills, it’s precisely as I put it, an ex-phlebotomist making the diagnosis. That’s the story, as described, by the author, in plain English.

      The doctor felt this was another self-limited URI. I’m not the only one who brought this up, but here it is……..I read NO conclusion that “I had sinusitis all along” or I had a high white count with left shift”, or anything to make me think the doctor was wrong in the first place.

      I didn’t write the story. I’m just reading it. The high medical costs encountered were a direct result of the patient demanding unnecessary interventions.

      I’m not the only practicing, fully-trained, experienced physician, who has seen this same story, saying the same thing in this thread.

  • tpetrusick

    CBC $6
    Comprehensive panel $25?
    I know the cbc number is correct because we contin the convenience of in-house cbc and insurers will not pay us more than they pay commercial labs. Hosp health fairs at the malls of america will do fairly comprehensive lab work for low prices and they do not lose money so cost of test is low. So press on with shopping.

    I am sympathetic to Brad and appologize for the crass responses he has recieved . History and duration of symp is the best way to diagnose sinusitis. CT is only of use in a complicated hospital pt. With a URI CT shows sinusitis this has got to be one of the biggest wastes of health care dollars ongoing. First line treatment of symp sinusitis should be over the counter decongestants the good stuff that you have to sign for pseudophedrine and a few days of otc oxymetrazoline. If no improvement then you are two steps ahead of your MD.

    Do not over pay the lab.
    If you paid the entire bill you were ripped off.

  • JPB

    This brings up something that I have thought a lot about. When are we going to start demanding justification from the medical industry for these outrageous fees? But no one wants to talk about that, we are just supposed to accept that this is the way things are!

  • http://www.stevebalt.com SteveBMD

    If Brad — or anyone else, for that matter — really wants a CT scan, lab test, or medication that a doctor believes is unnecessary, then he should be permitted to get it (after all, it’s the free market), but it should not count against his deductible. (Yes, I know the doctor reluctantly ordered the labs & CT in this case, possibly to placate Brad, but that’s another issue.)

    Brad’s fundamental argument is that the costs of these services are anything but transparent. And I wholeheartedly believe that if we had a better idea of what our treatment costs actually are — and we were held responsible for frivolous expenses — then our health care cost crisis would improve dramatically.

    • ninguem

      Actually, you can get lab tests without a physician order. That’s been true a long time. The doc’s order is needed for INSURANCE PAYMENT. Same with a lot of imaging.

      Many a time I’ve had patients come to me, from various naturopaths and chiros and other nonphysician alternative practitioners. They have some list of testing and imaging already ordered by that practitioner. They just want me to cosign the order so they get it paid for by insurance.

      Which reminds me. Depending on the high-deductible insurance. My HSA-affiliated HDHP is a major insurance company nationally, and most places will be participating.

      If I get one of those “rack-rate” unrealistically high bills like this one, the fee is still repriced to the insurance participating rate. No way to know if that was the case with this one, five, six years ago.

  • http://warmsocks.wordpress.com/ WarmSocks

    Brad, I missed your mention of specific tests before. Costs vary geographically. My insurance allows $40.05 for CMP and $10.39 for CBC, plus $2.85 for the draw fee. Going out-of-network, you don’t get the insurance discount, though.

    If you are stuck with cash pay prices, at my lab that would be $43.53 + $40.27 + $20. The place you went is significantly overpriced, whether or not they accept your insurance.

  • DrTomStLouis

    Sorry you got stuck with a bill for the lab work that was pretty excessive.

    You should never take insurance advice from your doctor. We know how WE get paid by them, but it’s a private contract between you and your insurer. There are hundreds of different insurance contracts in each insurance plan — YOUR particular version of insurance from the name on the card you carry might require certain labs for the cost to be the lowest for you, but how would we know this?

    The doctors here have taken offense at a number of things from your article — and I think rightly. You imply the physician wasn’t listening to you, but the only evidence you prove supports the physician, not your self-diagnosis. He was available to you on the same day you called, was prompt, and gave you appropriate advice. When you challenged him on his advice and you indicated you weren’t willing to take his word for it, he ordered back up testing. I have the same patient (?) conversations multiple times per day with patients who need only supportive care for their ‘sinus infections’. I guess I am cheaper than he is and wouldn’t order a sinus CT just to shut you up (which is what it sounds like was going on here), but as you have pointed out, none of the rest of us were there.

    What *IS* important for all you non-physicians who happen to be reading this to realize is that the doctors have NO skin in the game. We don’t get a kickback from ordering tests, prescribing certain medicines, ordering radiologic tests (unless it’s done within the office itself, I guess). And as we don’t control the labs, we cannot typically provide guidance for what the charge for something is.

    • gzuckier

      indeed. and thus the jaundiced eye given to MDs who have their own in house labs, MRI machines, etc. by those who suspect over-referral.

  • imdoc

    The vignette generated a lot of discussion about clinical elements of care. I gathered that the main point from the story the author is giving is an account of the difficulty of pricing discovery. I think that is an important issue to discuss as it is really pivotal to much of the mess we are in and contributes to the plight of uninsured and underinsured. Comments?

  • Brad Wright

    A few things that appear to be confusing because they are omitted from the story in order to meet the 750 word limit.

    1. I had nagging sinus symptoms pretty much the entire time between the two acute episodes, by which I mean persistent, foul-smelling mucus, post-nasal drip and the like. Given my crappy insurance, I just dealt with it until an acute episode made me decide to go to the doctor.

    2. I was not seen the same day I called for an appointment. It was the following week.

    3. I thoroughly explained my history to the physician and I believe THAT is why he ordered the sinus CT. He also prescribed Flonase as I recall.

    4. There seems to be a great deal of condescension from some reading my story because they think I am upset with the doctor, or I inaccurately self-diagnosed and pressured him into action. Neither is true. Did I think that I might have chronic sinusitis–along with an acute episode at the time?–absolutely. But that’s why I went to the doctor. To have him decide. And that’s precisely what he did. He said “no fever = no acute sinusitis” but given the history I provided him, he saw fit to order the CT. Did he do it impatiently without taking the time to listen to my history carefully? I think so, yes. It was a “You don’t have A, but it sounds like you may have B, and there’s a test to check for that, so go get it done and get out of my office” type of situation. I wasn’t seeking antibiotics, I was seeking answers. Of course, none of you were there, and I only had 750 words to convey things, so maybe that’s less than clear.

    5. Not all primary care physicians practice medicine that way. I know this from the experience of having had other docs care for me in a much more respectful, thorough manner.

    6. The fact that I was a phlebotomist part-time during college was not provided as a credential for the accuracy of my medical knowledge–it was to show that I was more familiar than most with the cost of lab tests, and knew that the tests that had been ordered were routine.

    7. ALL OF THIS is beside the point. The essay was not about patients seeking unnecessary treatment or physicians over-ordering tests, it was about the lack of price transparency in health care. It was the fact that once the CT had been ordered, necessary or not, it was nearly impossible for me to find out how much it was going to cost. It was the fact that once the labs had been ordered, I made some assumptions that I shouldn’t have about the costs. Yes, I should have shopped around. By the end of the essay, I demonstrate that I learned that lesson. What should be alarming to readers is that I have a significantly better understanding of the health care system than the average American, and I still made these mistakes. From that, I conclude that there is not much hope for the rest of the country unless something is done to make health care prices more transparent.

    • AA

      As someone who is not in the medical profession, I am also amazed at the condescension of some of the physicians who responded.

      How many times are patients blown off who don’t question their doctors only to be found to have something very serious? In some cases, the penalty of being blown off is death.

      Obviously, Mr. Wright wasn’t in danger of dying. But to act like the doctor was right when you weren’t there and in light of all the medical errors that continue to take place in your profession, I found your responses mind boggling.

      Anyway, as one who fears being in the same situation due to my weak health insurance plan, I thank you profusely for posting about your situation.

    • ninguem

      Your story is now obsolete. In 2005, it was difficult to price these things. You CAN price the procedures quite easily. To the extent that this is true these days, it is because we have consumer-directed healthcare, and patients are now motivated to find the true cost of procedures, and the various providers of medical services are motivated to provide the price.

      Also, depending on your insurance, the procedure would be priced to the insurance network rate, even if you are paying 100% out of pocket.

      That’s how my HDHP and HSA work.

      • Brad Wright

        Read the entry again. You see that I knew even then that I needed to be looking for prices–they weren’t easy to find then, and they still aren’t. Get on the phone and try it. Sometimes you get an answer, sometimes you don’t–and most patients have no way to understand the variation in prices they are quoted. Shopping for health care isn’t like shopping for most goods and services. That’s why health economics is a separate field of study. I also noted that my poor assumption was assuming (for a variety of reasons) that I was going to an in-network lab. I know how insurance contracting works, as I write in the post.

  • ninguem

    Sorry. Disagree categorically.

    “Get on the phone and try it.”

    I do. Every day. I can, and do, check price for services for myself and for patients. We get price for advanced imaging, lab work etc., all the time. Our own prices, patients always ask. We have a fee schedule, and we tell the patients what our services cost in our office.

    It’s still not easy, but it’s far easier than it was in 2005. Of course I want more price transparency, everyone does.

  • ninguem

    “Get on the phone and try it.”

    Does online count?

    Just one example:
    anylabtestnow.com
    105 W. NC Hwy. 54 Suite 245
    Durham, NC 27713
    Phone: (919) 321-4355

    You can walk right in, get the price quoted in advance. Actually, their fee schedule is posted online. Heck, you don’t even need a doctor’s order for the lab work.

    Here’s another one:
    http://www.prepaidlab.com/
    I put in a Chapel Hill zip code and found facilities in your area. You should be able to use those prices as a benchmark if you choose another lab. Two sources, in your area, where you can either get the test, or get a price list online to use when shopping elsewhere.

    That took me all of a minute.

    For Chicago, Leslie’s list, frequently mentioned here, has done more good for price transparency than all the healthcare policy wonks at Northwestern put together. Which, looking at her findings, Northwestern is not the place you want to go for a CT, cost is about tenfold more than the lowest-cost facility.
    http://www.leslieslist.org
    I’ll use CT brain as a benchmark.

    I have similar facilities in my area, they have given me their cash-pay imaging fee schedule. It’s not hidden in any closet. I reference it for my patients every day.

    I stand by what I said. This was not available in 2005, or more accurate to say it was more difficult. It is much easier now, I can find the prices online and I don’t live in your area. It should be even easier than it is now.

    To the extent that we have more transparency now, IMHO, it’s directly related to the consumer-directed healthcare, the HDHP and HSA’s motivating people to shop price.

  • ninguem

    Price shopping for CT sinuses took about five minutes for your area.

    http://www.newchoicehealth.com/Directory/CityProcedure/North%20Carolina/Durham/4/CT%20Maxillofacial%20%28Sinus%29

    I’m assuming Chapel Hill. I searched Durham, and Chapel Hill facilities show in the search.

    There’s a feature there, for a quote sent directly to you.

  • Jeff Taylor

    ‘Northwestern is not the place you want to go for a CT, cost is about tenfold more than the lowest-cost facility.
    http://www.leslieslist.org
    I’ll use CT brain as a benchmark.’

    Ok – I looked at this. Are you comparing like with like? Does the lowest cost scan include a board certified radiologist’s report? Are the low cost facilities audited to a high standard? Are radiologists of the same grade as Northwestern?

  • Robert Berry

    At my practice, the CMP and CBC would have totaled $45. The price is up front on the charge sheet.

  • imdoc

    Brad, I am quite serious when I say spending a few weeks working with a medical billing clerk in an office is worth at least a semester at the university. You will really learn what is going on and be better equipped to be an authority on health care policy.

  • Brad Wright

    I’d just like to thank everyone for all of the unsolicited advice, diagnoses, and much needed enlightenment. Duly noted.

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