It used to be that when one would go to a physician’s office, the greatest cost was paying for the visit itself. Nowadays, that cost is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help us through the un-Affordable Care Act. In the last few years, add the cost of laboratory testing to that list.
Most people can remember the days when lab testing was done in the physician’s office and the billing for it was reasonable in most instances. If a physician had prices that got too high, patients could choose to go elsewhere. Competition would take care of any price gouging problem with no government intervention was needed. How all of this morphed into the current problem started with the introduction of CLIA laws which were intended to improve laboratory standards and were generally well intentioned, but have increased costs. After CLIA laws went into place, many physicians stopped offering in-house lab work, but there were still many continuing to operate labs in their practices. It was then decided later by Medicare that if a patient had lab testing done which was not approved as “medically necessary” (that means they don’t want to pay for it, not that it isn’t necessary), the patient was not responsible for it and they could not be billed for it. After several years of that, the last nail was driven into the coffin of most physician office labs. While the physician labs were declining in numbers, the large reference lab companies were growing in leaps and bounds. Eventually, most lab work was being done by these lab companies and still is. Then, Medicare decided to change the rules again in allowing that patients could now be billed for any lab work that Medicare didn’t approve. Whereas before in the physician office, a much lower price, or even a negotiated amount, could have been charged for a non-approved lab test, now there is hardly an option as larger and larger lab companies have made it difficult for patients and physicians to avoid these companies and their policies.
For one example, patients are restricted in how many lipid profiles that they can have performed within a year, but if there are complications with adjustments to medications being required, then the rechecking may not be approved. It is certainly necessary to know how a medication is working or not. A lipid profile is reimbursed by Medicare at just under nineteen dollars, but if Medicare denies it, these companies are sending bills to patients for over one hundred dollars. If one could make over 500% more money instead of the usual payment, it is not a stretch to think that these companies would not have as much interest in trying to help patients get their lab work covered through Medicare. Medicare has went from one extreme to another and patients are being put into financial jeopardy. A common sense solution is for anyone performing lab tests to be able to charge the patient what they would have gotten from Medicare had it been approved, but allowing over five times as much to be charged is allowing inflated pricing to occur.
Upon learning about what these reference lab companies are being allowed to do, I contacted via telephone one of Congressman Gregg Harper’s (R-MS) offices and discussed my concerns with one of his staff members. I had thought that there would be interest in protecting people from being charged such outrageous prices for inexpensive lab work. However, I was accused of not being a “capitalist” and questioned about how could I possibly “desire for (them) to tell these lab companies what (they) can charge”. I was stunned at such indifference and at being made to feel as though I was out of the mainstream, maybe even not American in my thought, according to their viewpoint. I replied to them Medicare, which is regulated by Congress, certainly did not mind telling physicians what we can charge and restrict us all so severely that hospitals and clinics are having trouble making ends meet now. If it is good enough for the doctors, hospitals, and other health care suppliers and workers, why should these large reference lab companies be exempted from price regulation? I could not get an answer to that question and was left frustrated that this is apparently okay with Congress while patients are being fleeced. Just as Congress is allowing this to occur, they can also decide to not allow it to occur. Concerned citizens should contact their U.S. Representative and U.S. Senator and let them know that they should reign in this unnecessary extra expense being placed on the backs of those who are already overloaded.