Lab Tests: Hints to Help Lower Costs

"The most important thing any patient can do is to know your plan," Bradshaw says. "Find out which labs are in-network for your plan and ensure that your lab work is being sent there."

Bradshaw suggests logging in to your health plan's patient portal and using the "Find a Doctor" or "Find a Provider" tool to search for labs that are in-network for your plan. "Otherwise, you should be able to call your insurer and ask the representative," she says. "I always find it's helpful to be as specific as possible. Ask questions like, 'I need to have a thyroid test panel done. Can you tell if this test is covered, and which labs are in-network for me? And can you tell me how much my out-of-pocket cost should be?' This way, you're not only finding out which labs are in-network, you're also double-checking that the test itself is covered or if it needs some type of prior authorization."

She adds that when you speak to your provider during your appointment, make sure to request that your provider send your work to the in-network lab.

What Are My Options if I Don't Have Insurance?

If you are currently uninsured, Bradshaw strongly suggests finding an insurance plan. "You may qualify for Medicaid, Medicare, or a low-cost plan on the Marketplace," she says. "However, if you aren't insured or if your plan doesn't cover the tests, you can look for labs that offer in-house testing. Many will provide this information right on their website, along with the cash price. Even better, many offer discounts for students, veterans, teachers, and first responders."

Bradshaw adds that most hospitals, especially nonprofit ones, offer some type of program to help patients manage medical costs. "Charity care refers to free or discounted medical services for patients who meet certain income or hardship criteria," she says.

Can an Independent Lab Do the Work?

Lab tests are usually operated in a hospital or medical center or an independent lab. Public health offices in many communities also provide some testing, and the tests are sometimes free or available at a discounted rate.

Even if you have great health insurance, it still pays to shop around for savings on your lab work. This is especially true if you have a high deductible and are having to pay up front for most of your testing until you reach your deductible or your out-of-pocket limit, Bradshaw says.

And if you are uninsured, you can usually still save a lot of money by using a standalone lab, also known as a direct-to-consumer lab, rather than a hospital-based lab.

"Generally speaking, it will always be less expensive to have your labs done outside of a hospital setting," Bradshaw says. "Always ask to have your labs sent to a standalone provider. You're not being difficult, you're being savvy."

If a lab doesn't file insurance, you may still benefit by paying them out of pocket. "Keep in mind, of course, that these payments won't count toward your deductible. But if you aren't going to meet your deductible anyway, you may save a considerable amount of money," Bradshaw says.

Depending on the test, there may be over-the-counter test kits you buy at the store or online. These may be appealing from a cost perspective, but be sure to talk with your health care provider about whether these tests are reliable and useful for what you need.

What Will the Tests Actually Cost?

It can take some time and effort to find out what tests will cost when an insurance provider is involved, but having that information will help you make a decision. When you call your insurance company or use their online cost estimator tool, you should have the following information: CPT Code (a five-digit number that identifies the specific test procedure) and the ICD Test Code (a 10-digit number that identifies the reason for the test, such as checking for an infection based on symptoms).

You may also need to provide the name of the lab you're asking about. Insurance companies negotiate different payments for different facilities.

Bradshaw suggests doing an online search for your local labs and starting a list comparing prices. "On their website, they should provide a list of the services they offer in-house, along with how much they cost," she explains. "When I look in my area, I can get a series of tests, from a complete blood count test to a thyroid test panel, with prices ranging from $29 to $289."

Bradshaw adds that you can use an HSA (health savings account), FSA (flexible spending account), or other health expense accounts to pay for lab work.

Takeaways

Saving money on lab tests can require some homework on your part, but when you see the range in costs, you may be glad you did the research. Bradshaw recommends starting the process with your doctor, even if it's the first time you two have ever talked about health care expenses.

"Providers aren't always accustomed to talking about costs, but unfortunately they are a very important part of how patients make health care decisions," Bradshaw says. "Having an honest conversation with your provider about your concerns may change your treatment for the better, by enabling you to better adhere to the plan without a negative effect on the outcome."

If you still have concerns, Bradshaw says that getting a second opinion is your right. "Find a provider who is in-network, in the specialty you need," she recommends. "Be honest and let the second doctor know you're seeking another perspective, not necessarily rejecting the first opinion. Share your full medical history and current treatment recommendations. This should ease your mind if the recommended test is really necessary."