Lab fees

As winter is progressing, I am getting busier, as are most pediatricians. It's amazing the difference between June and say, January or February, numbers. I appreciate my slower days in the summer, but I have to say that winter days in the office simply tend to fly by!

However, this winter is going to be a bit different. I've mentioned in a previous blog that our clinic now requires patients to pay for labs at the time they're done if they don't have any health insurance. This is awkward and annoying to me to have to explain that I want a particular test done, and, by the way, that will cost you ten bucks! I have the power to waive the fee if the family cannot pay, and I document exactly why the test is required. Yet, when I do this, there are many phone calls back and forth between our main office and my office to find out exactly why the fee was not paid. I could go on about this, but I've already complained about it in a previous blog.

Today, what brought this back to the forefront of my thoughts was that I had to ask a family to pay for a test, and I also happened to read another blog about lab fees: http://thecountrydocreport.wordpress.com/2009/01/15/the-price-is-right-country-doc-style/
I was shocked to see the prices he posted for labs. I had been told by the powers that be that we got a special rate for our labs and that we did not have to charge the administrative fees. So, just to show the stark differences, here is a list of some our fees, without the additional administrative fees: (admin charge is approx $10.)

1. CBC (complete blood count with differential): $2.70
2. BMP (basic metabolic panel): $2.70
3. CMP (comprehensive metabolic panel with BMP): $2.76
4. PSA (prostate specific antigen, a test for prostate cancer): $7.20
5. TSH (thyroid stimulating hormone, a test for monitoring thyroid disease): $ 3.60
6. Lipid panel: $2.58
7. Urine culture: $6.00

The most expensive test on our basic listing is a hepatitis C RNA PCR for $181.20. Now, you can see an enormous difference in the costs I've listed versus those listed by the Country Doc. Why is there this difference? Admittedly, one needs to add $10 to the fees I've listed, and the rates I've listed have been negotiated for a large group of 8 health centers. In addition, the lab company is willing to accept some loss with uninsured patients, but this cost gets passed on to those with insurance. On a side note, it would be interesting to see what that particular lab charges insured patients for the same labs. But why is there so much difference between the two labs? Again, it brings to mind the problems we have with our health care system. Imagine saving $12 on each CBC that is drawn throughout the US - if 1/3 of the US population of ~305 million received one CBC per year, that would add up to 1.2 billion! I'm sure it's the same with the pharmaceutical companies and saving $12 per script written in the US would also add up.

I'm just hoping, come January 20, that the debate on healthcare will start up with actual results this time. I do know that SCHIP is already being re-addressed and will not be vetoed by the new president, so I have hope.