Running Your Business
|
July 11, 2023

How to Explain The Benefits of Cash Pay Labs to Your Patients

Medically Reviewed by
Updated On
September 17, 2024

The need for other health options continues to grow, including the need for different lab approaches. Complementary and integrative medicine (CIM) is expected to grow to $315.5 billion by 2027. CIM often has complementary approaches to standard medical care to provide other comprehensive patient options. This approach also includes the use of specialty labs for further insights into the patient's health that standard labs may not offer. This article will provide practitioners looking to use CIM or functional medicine within their practice with the tools they need to address specialty labs with their patients.

[signup]

Understanding The Concept Of Cash Pay Labs

Cash-pay labs are labs where insurance isn't taken as payment for completed labs. Cash-pay labs are often considered specialty labs, and the forms of payment for these labs include credit cards, debit cards, bank transfers, health savings accounts (HSAs), and Flex spending accounts (FSAs). Insurance-based labs are labs paid for by insurance companies. They must be deemed medically necessary in order to be accepted, often limiting the information needed for a well-rounded assessment of the patient's health issues. The key reason for the emergence of cash-pay labs is functional medicine providers regularly use them, and most do not accept insurance.

Why Do Most Insurances Not Cover Specialty Labs?

Most insurances do not cover specialty labs as these labs do not fall under what is deemed medically necessary. For the test to be deemed medically necessary, it must fall under the Medicare guideline that states, "Reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Within the practice of functional medicine, other labs are often explored to find the underlying root cause of the issue and its connection to other body systems. Functional medicine doctors will also look at optimal ranges of lab values that fall outside of the standard lab values to help provide insight into disease progression that can be missed within the standard lab values.

Benefits Of Cash Pay Labs For Patients

There are many benefits of cash-pay labs for patients. These include cost transparency, affordability, accessibility, convenience, greater control, and privacy. With specialty labs, patients will always know what they are paying for and which labs they are completing, as these labs use a transparent pricing model. Since these labs are cash-pay, the prices of each lab are stated. In contrast, patients may have high deductibles, leading to larger bills with less transparency with insurance-based labs. They may also get denied if the labs are out-of-network.

Many times specialty labs will provide bundles of the most utilized labs, making these bundles more cost-effective than paying for these labs a-la-cart with standard labs. Specialty labs are also accessible and convenient due to the elimination of insurance pre-approvals, reduced paperwork, and administrative hassles. These labs will usually offer walk-in services for blood draws. Functional medicine practitioners will often collaborate with their patients on which labs are a priority and should be completed providing patients with greater control over their health. All specialty labs are HIPPA compliant and provide enhanced confidentiality of personal health information because they avoid insurance claims that have potential privacy concerns. Practitioners can explain these benefits to help mitigate some patients' concerns about cash-pay labs.

Tips For Effectively Explaining The Benefits To Patients

Functional medicine providers will often get the question, "Why don't specialty labs accept insurance?" Therefore, we wanted to provide practitioners with tips to explain specialty labs' benefits to their patients effectively. Here are those tips:

Clear and Concise Communication

Practitioners should be clear and concise when communicating services to their patients by using simple language, avoiding medical jargon, and providing examples and visuals, if possible.

Highlight Cost Savings and Transparency

Practitioners should always be transparent with their patients regarding the cost of the labs. Itemizing the labs, their costs, and any associated fees is extremely helpful. Showing the itemization provides practitioners with an opportunity to discuss price comparisons and potential savings by highlighting the possible out-of-pocket expenses with insurance-based labs.

Emphasize Accessibility and Convenience

Specialty labs typically utilize the latest technology to offer easy scheduling for patients and to provide results. Practitioners can describe the ease of using this technology or make it easier for the patients and provide the scheduling and results as a service. It is helpful to mention the shorter waiting times and faster turnaround for test results that come with some of these specialty labs.

Address Concerns and Answer Questions

It is helpful for patients if practitioners have an FAQ (Frequently asked questions) segment on their website to address common patient concerns with labs. Then when practitioners discuss the labs with their patients, this allows the patients to get clarification on any questions they have, or it may bring up other questions for them. Setting expectations, being transparent, and providing accurate and comprehensive answers to patient inquiries leads to more empowered patients.

[signup]

Summary

Patients may need clarification as to why specialty labs are typically cash-pay only. Cash-pay labs offer many benefits that insurance-based labs don't, such as transparency, control, ease, and convenience. Practitioners can utilize some of the points made in this article to explain the differences between insurance-based and cash-pay labs to highlight some of the many benefits often involved with specialty labs providing patients with more options and more well-rounded care.

The need for other health options continues to grow, including the need for different lab approaches. Complementary and integrative medicine (CIM) is expected to grow to $315.5 billion by 2027. CIM often has complementary approaches to standard medical care to provide other comprehensive patient options. This approach also includes the use of specialty labs for further insights into the patient's health that standard labs may not offer. This article will provide practitioners looking to use CIM or functional medicine within their practice with the tools they need to address specialty labs with their patients.

[signup]

Understanding The Concept Of Cash Pay Labs

Cash-pay labs are labs where insurance isn't taken as payment for completed labs. Cash-pay labs are often considered specialty labs, and the forms of payment for these labs include credit cards, debit cards, bank transfers, health savings accounts (HSAs), and Flex spending accounts (FSAs). Insurance-based labs are labs paid for by insurance companies. They must be deemed medically necessary in order to be accepted, often limiting the information needed for a well-rounded assessment of the patient's health issues. The key reason for the emergence of cash-pay labs is functional medicine providers regularly use them, and most do not accept insurance.

Why Do Most Insurances Not Cover Specialty Labs?

Most insurances do not cover specialty labs as these labs do not fall under what is deemed medically necessary. For the test to be deemed medically necessary, it must fall under the Medicare guideline that states, "Reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Within the practice of functional medicine, other labs are often explored to find the underlying root cause of the issue and its connection to other body systems. Functional medicine doctors will also look at optimal ranges of lab values that fall outside of the standard lab values to help provide insight into health trends that can be missed within the standard lab values.

Benefits Of Cash Pay Labs For Patients

There are many benefits of cash-pay labs for patients. These include cost transparency, affordability, accessibility, convenience, greater control, and privacy. With specialty labs, patients will always know what they are paying for and which labs they are completing, as these labs use a transparent pricing model. Since these labs are cash-pay, the prices of each lab are stated. In contrast, patients may have high deductibles, leading to larger bills with less transparency with insurance-based labs. They may also get denied if the labs are out-of-network.

Many times specialty labs will provide bundles of the most utilized labs, making these bundles more cost-effective than paying for these labs a-la-cart with standard labs. Specialty labs are also accessible and convenient due to the elimination of insurance pre-approvals, reduced paperwork, and administrative hassles. These labs will usually offer walk-in services for blood draws. Functional medicine practitioners will often collaborate with their patients on which labs are a priority and should be completed providing patients with greater control over their health. All specialty labs are HIPPA compliant and provide enhanced confidentiality of personal health information because they avoid insurance claims that have potential privacy concerns. Practitioners can explain these benefits to help mitigate some patients' concerns about cash-pay labs.

Tips For Effectively Explaining The Benefits To Patients

Functional medicine providers will often get the question, "Why don't specialty labs accept insurance?" Therefore, we wanted to provide practitioners with tips to explain specialty labs' benefits to their patients effectively. Here are those tips:

Clear and Concise Communication

Practitioners should be clear and concise when communicating services to their patients by using simple language, avoiding medical jargon, and providing examples and visuals, if possible.

Highlight Cost Savings and Transparency

Practitioners should always be transparent with their patients regarding the cost of the labs. Itemizing the labs, their costs, and any associated fees is extremely helpful. Showing the itemization provides practitioners with an opportunity to discuss price comparisons and potential savings by highlighting the possible out-of-pocket expenses with insurance-based labs.

Emphasize Accessibility and Convenience

Specialty labs typically utilize the latest technology to offer easy scheduling for patients and to provide results. Practitioners can describe the ease of using this technology or make it easier for the patients and provide the scheduling and results as a service. It is helpful to mention the shorter waiting times and faster turnaround for test results that come with some of these specialty labs.

Address Concerns and Answer Questions

It is helpful for patients if practitioners have an FAQ (Frequently asked questions) segment on their website to address common patient concerns with labs. Then when practitioners discuss the labs with their patients, this allows the patients to get clarification on any questions they have, or it may bring up other questions for them. Setting expectations, being transparent, and providing accurate and comprehensive answers to patient inquiries leads to more empowered patients.

[signup]

Summary

Patients may need clarification as to why specialty labs are typically cash-pay only. Cash-pay labs offer many benefits that insurance-based labs don't, such as transparency, control, ease, and convenience. Practitioners can utilize some of the points made in this article to explain the differences between insurance-based and cash-pay labs to highlight some of the many benefits often involved with specialty labs providing patients with more options and more well-rounded care.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

Learn more

No items found.

Lab Tests in This Article

No lab tests!
  1. Cloyd, J. (2023, June 13). Exploring complementary and integrative medicine: A comprehensive overview. Rupa Health. https://www.rupahealth.com/post/what-is-complementary-and-integrative-medicine-cim
  2. English, A., & Lewis, J. (2016). Privacy protection in billing and health insurance communications. AMA Journal of Ethics, 18(3), 279–287. https://doi.org/10.1001/journalofethics.2017.18.3.pfor4-1603.
  3. Greenan, S. (2021, November 19). What is functional medicine? How do I find a functional medicine practitioner? Rupa Health. https://www.rupahealth.com/post/what-is-functional-medicine
  4. Hamalainen, R. (2019, August 23). The average price of a functional medicine visit - here’s what the data says. Rupa Health. https://www.rupahealth.com/post/the-average-price-of-a-functional-medicine-visit
  5. Medicaid limited coverage policies. (2023). Quest Diagnostics. https://www.questdiagnostics.com/healthcare-professionals/billing-coding/medicaid-limited-coverage-policies
  6. Medical necessity. (2023). UP Health System. https://www.mghlab.com/necessity.php
Order from 30+ labs in 20 seconds (DUTCH, Mosaic, Genova & More!)
We make ordering quick and painless β€” and best of all, it's free for practitioners.

Latest Articles

View more on Running Your Business
Subscribe to the magazine for expert-written articles straight to your inbox
Join the thousands of savvy readers who get root cause medicine articles written by doctors in their inbox every week!
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Trusted Source
Rupa Health
Medical Education Platform
Visit Source
Visit Source
American Cancer Society
Foundation for Cancer Research
Visit Source
Visit Source
National Library of Medicine
Government Authority
Visit Source
Visit Source
Journal of The American College of Radiology
Peer Reviewed Journal
Visit Source
Visit Source
National Cancer Institute
Government Authority
Visit Source
Visit Source
World Health Organization (WHO)
Government Authority
Visit Source
Visit Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
Visit Source
CDC
Government Authority
Visit Source
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
Visit Source
National Institutes of Health
Government Authority
Visit Source
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Visit Source
Brain
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
Visit Source
Chest
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source
Visit Source

Hey practitioners! πŸ‘‹ Join Dr. Chris Magryta and Dr. Erik Lundquist for a comprehensive 6-week course on evaluating functional medicine labs from two perspectives: adult and pediatric. In this course, you’ll explore the convergence of lab results across different diseases and age groups, understanding how human lab values vary on a continuum influenced by age, genetics, and time. Register Here! Register Here.

Hey practitioners! πŸ‘‹ Join Dr. Terry Wahls for a 3-week bootcamp on integrating functional medicine into conventional practice, focusing on complex cases like Multiple Sclerosis. Learn to analyze labs through a functional lens, perform nutrition-focused physical exams, and develop personalized care strategies. Register Here.

< !--conditionally display announcement Banner-- >