Upon completion of a patient’s first visit, their provider will order labs for them. The patient must then determine if they would like to pay us directly, using our negotiated rates, or bill directly to their insurance. This decision must be made prior to going to the lab and we can not change this decision afterwards.

Negotiated rates

We have worked with Labcorp and Quest labs for many years to negotiate cash rates for our patients that are usually much less than testing anywhere else.

Insurance

We can not see a patient’s insurance policy to know if/what lab testing is covered. It’s not that we don’t want to help, it’s that we can’t!

  • We don’t know your family and individual deductible.
  • We don’t know which labs your insurance plan considers “in network labs”.
  • We don’t know if they require labs to be ordered by an in network provider.
  • We don’t know which CPT codes (labs) they will cover. We don’t know which Dx codes they require for those CPT codes. (For example, we learned that there is a BCBS plan that requires Dx code pregnancy to cover reverse T3.)
  • We don’t know how much the insurance company contract is with Labcorp for each test (and they will not disclose this to any one). We also don’t know if you have co-insurance (meaning even after all of that, we don’t know if they require you to pay a % of the labs).

It is the patient’s responsibility to communicate with their insurance company to verify lab testing coverage. Oftentimes insurance companies will cover SOME but not ALL lab tests. If certain labs are not covered by insurance, the lab will bill for these at a significantly higher rate than our negotiated rates. For example, a full thyroid panel with our negotiated rates is $53, but for this same panel the lab bills your insurance company over $300.

The most effective way of getting the information you need from the insurance company is to provide them with the individual CPT codes for each lab test on your order. We can provide you with an invoice that shows the negotiated rate cost as well as the CPT code for each lab that you can provide to your insurance to verify coverage. This will allow you to compare our pricing vs insurance coverage.

You can also inquire as to whether your policy will allow you to pay out-of-pocket for your lab order and then file those payments for reimbursement towards your deductible. This would allow us to give you our negotiated discounted rates.