Like many things in life, the retail or "rack rate" of blood tests is often much higher than you really need to pay. This is another way that those who pay cash for their health care get the shaft. The list cost of a PSA screening test for prostate cancer, for example, is about $78 in many labs. Most insurances pay about $15. Likewise, a cholesterol panel may be billed as four separate tests for about $90, where few insurances pay more than $18. A TSH thyroid test may be billed at $120, where the contract rate is usually about $12.

The problem for patient and doctor alike is that when you (or your blood) is sent to the lab, we never know whether or not the tests will be covered by your insurance. Patients will reassure me that their tests will be covered by the insurance, and then later they get a bill for $200 from the lab. They are then mad at me, even though I had nothing to do with it!

For blood testing I have contacted a local lab that will provide those without insurance with reasonable rates - equivalent to the Medicare rates. I have also contacted a local pathologist that will do the same for Pap Smears and skin biopsies that we may do.

I will be working on finding imaging centers that will do the same for x-rays, mammograms, MRI's, etc. In the meantime - if you have no insurance coverage for these items, realize that charges may be negiotiable - if you need a mammogram, call the office manager or billing manager and ask them for the lowest rate possible - be sure to tell them that you will pay at the time of service. Also make sure that the price you are quoted includes the radiologist fee for interpretation. The "rack rate" for an MRI at one local hospital is $2,000, which is what you might get billed if you pay cash - but most insurances pay about $600 for that same test. Negotiate ahead of time!