Blood Tests Form the Core of the Quantitative Medicine Measurements. Several Tests Are Needed That Are Frequently Not Covered by Insurance. Here Is How to Deal with That.

The following sage advice is for Americans only, as no other country allows their blood test centers to prey on patients.

In the book, Quantitative Medicine, are found lists of blood tests, with some being needed only once, while others should be measured quarterly. The quarterly list has 16 different tests, some familiar and others not. If you have the book, there is a whole chapter (7) on which tests to get, and, importantly, how to control the costs.

You would not be pleased if you had to pay $40 for a dozen free range eggs, especially if your neighbor was somehow able to buy the same eggs for $4. Fortunately this isn’t how the egg industry works, but the same cannot be said of the blood testing business. In many cases, the amounts they can charge are set by negotiations with insurance companies, or with medicare. Importantly, in many other cases, they are not set and the blood test centers can charge any amount they wish. Amounts five to ten times higher are the norm. We would call this sleazy or predatory, but we don’t want to insult the used-car or the loan-sharking industries.

Beware of the Blood Test Trap

The Medicare Version

Medicare recipients are usually well protected. If the blood test isn’t covered, it will be cheap. Quite cheap. Unless…

There is one loophole that gives the blood test people the right to charge medicare patients anything they want. It is called ABN and stands for Advance Beneficiary Notice. It should be called LTS for License To Steal, because that is the net effect. It works this way. A doctor writes a blood test requisition. If he knows that medicare won’t cover it, he is supposed to inform the patient with an Advance Beneficiary Notice. This in effect warns the patient that he may have to pay for the test. However, what is often not stated is that the rate will not be the usual low medicare rate, but whatever the blood test company is in the mood for. Usually five to ten times higher.

Here is pricing that a blood test company carelessly left lying around on the internet, where it fell into the wrong hands—ours. It was basically instructions on how to fleece medicare victims that showed up with ABN notices:

Test	ABN Price at “Welcome To My Parlor” Labs	Walk in Labs, LabCorp Retail	New Century Labs, Quest Retail
PSA	$130	$35	$17
Triglycerides	$77	$27	$15
Hemoglobin A1C	$68	$27	$14
HDL Cholesterol	$87	Included with triglycerides	Included with triglycerides

Tidy chunk of change collected here by the ABN folk. What is this “retail” business? The two major national blood test chains, Quest and LabCorp, have deals with numerous third parties whereby the blood tests are offered “retail” at a low fixed price. You can get a test req on the internet, and unless you live in one of six states where this is forbidden, you will always get this price. You can usually call your nearby lab, ask for the cash price, and get the same price. Or you can walk into that lab with a requisition with an ABN attached and pay ten times as much. It is entirely up to you.

Avoiding the ABN

If a doc feels he has to issue an ABN to a medicare patient, or if the blood draw center insists on it. Just say no. Ask the doc to write a separate requisition and then go tell the blood draw center: “No insurance, give me the cash price.” They aren’t going to frisk you for a Medicare card. It should be close to the retail price. If it isn’t get the test via the retail method. In all cases, its the same test, done by the same people. Docs. Be aware that the blood test people will gouge your patient if you write an ABN. Instead, explain the situation and write a separate req.

The Standard Health Insurance Version

In principle, you can ask in advance if a blood test is covered. In practice, you are about as likely to get a straight answer as you are to win the lottery. If a test is not covered, it might be that you are entitled to a price that your insurance company pre-negotiated, or it might be that your insurance company doesn’t give a whit if the blood test companies clean your clock on uncovered tests. Is is safest to assume that any uncovered tests will be billed at “list price.” What to do here?

Your Doctor Will Know Which Tests are Covered

The doctor has to justify the test that are requested. The typical annual physical blood tests would usually be covered. This would include glucose and a lipid panel. Others would not be. Most likely your physician is well aware of which will not be covered. At this point you have a couple of options. However, it will simplify things is your physician writes two separate requisitions, one for the covered expenses and another for any that may not be.

For the uncovered expenses there are a couple of options. But first, educate yourself. Find the retail price for the test from Walk In Labs (LabCorp) and New Century Labs (Quest). This is the most you should have to pay. Then either just buy the test from one of these, or call or visit a blood draw center and ask for the cash price. It will probably be very close to the retail price.

The pricing obtained this way will be pretty low. If you got all the quarterly QM recommended sixteen blood tests, and insurance paid nothing, but you used the “retail” method, your out-of-pocket cost would be $231. Same quality tests, same labs, same everything, except the price.