I know many of you are young or haven’t had much experience going to doctors or shopping for insurance, so I am sharing what I have learned over the years.
I am in the US and have good insurance. With my insurance plan, any labs done through Labcorp or other preferred labs are covered 100%. Drug copays are usually $10. Most providers are preferred providers, as are most local pharmacies and all 3 hospitals. My plan does not cover non-preferred providers at all.
In the US, when you have insurance, the doctor’s office bills the insurance company. That is the billed amount. The insurance company has an allowed amount for each line item billed. That is the most the insurance will pay for that item. The amount the patient pays depends on the insurance plan and whether or not the doctor/hospital/lab/pharmacy is a preferred provider.
On my EOB’s (explanation of benefits from the insurance company), the paper will show columns for each of these amounts by line item. The doctor will bill the office visit based on established tiers that are based on the length of the office visit in minutes and the complexity of the visit.
I have seen billed amounts for a longer, complex appointment at $350. Normal office visits are billed around $250. Quick followups around $100-150. Time spent with the doctor is typically anywhere from 5 - 30 minutes. Maybe longer if they do any kind of procedure like taking a skin biopsy or washing your sinuses out or removing ear wax.
If you are self-pay and uninsured, the amount billed to the patient is often much lower than the amount billed to insurance. It’s a really cooky system. In reality, a standard appointment for self-pay in my area would likely be $50-150 with a primary doctor. This would be your typical 5-30 minute appointment. A specialist would cost more.
Office visits are completely separate from labs, even if the doctor’s office draws the blood or collects the urine or tissue sample. The doctor’s office will bill the insurance a fee (around $25) for collecting the sample. That covers the time they have to pay their nurse or tech to get the sample, the supplies used, and likely courier fees to transport the samples to the lab.
There may be Lyme doctors or alternative doctors who have in-house labs, but those are not typically the case. They would still bill for both the office visit and the lab testing. They may quote you an inclusive price upfront, but paperwork from them would itemize costs.
If you have insurance that pays anything for office visits with non-preferred providers, you may be able to file a claim yourself with your insurance. Just because a doctor doesn’t “take insurance” doesn’t necessarily mean that insurance will not cover any of the costs.
When shopping for insurance, you need to read and review more than just a comparison chart or a sales pitch, for lack of a better word. Start there, but once you narrow it down to 2-3 plans, you need to read the actual policy. Pay attention to wording. Ask questions if you don’t understand something important. Employees who have a choice of insurance often have health fairs where reps from different insurance companies will come to the workplace. That’s your chance to shop around and ask questions.
Understand what your insurance covers and what it doesn’t. Know which labs, pharmacies, hospitals, and providers are preferred under your insurance plan. Understand that companies like Blue Cross and Aetna have numerous plans. Those plans can vary drastically as to cost and coverage. Don’t be naive and think because you have insurance with xyz company that your policy covers everything. You must be aware of the coverage of your specific plan.
Post Edited (WalkingbyFaith) : 11/30/2021 8:57:16 AM (GMT-7)