Why Don't We Bill Insurance for Labs, Imaging, and Other Services?
As you may know, the doctors at Health Suite 110 started down the Direct Primary Care (DPC) path because we were frustrated with the headaches, inefficiencies, and rising costs created by the traditional insurance-based healthcare system.
One of the greatest advantages of DPC is that we are able to provide high-quality, accessible care at a fraction of the cost of traditional practices because we have intentionally eliminated much of the bureaucracy that drives healthcare costs. We do not bill insurance, contract with third-party payers, or maintain a billing department. Instead, we focus our time and resources on taking care of patients.
Because we are not tied to insurance contracts, we have been able to negotiate excellent cash pricing for laboratory testing, imaging, medications, and other services. These prices are often significantly lower than what insurance companies allow, and dramatically lower than what many patients are ultimately charged through traditional healthcare systems.
As a DPC clinic, we do not profit from laboratory testing, imaging, or medications. Our goal is simply to make these services available to our patients at the lowest reasonable cost.
As you may know, the doctors at Health Suite 110 started down the Direct Primary Care (DPC) path because we were frustrated with the headaches, inefficiencies, and rising costs created by the traditional insurance-based healthcare system.
One of the greatest advantages of DPC is that we are able to provide high-quality, accessible care at a fraction of the cost of traditional practices because we have intentionally eliminated much of the bureaucracy that drives healthcare costs. We do not bill insurance, contract with third-party payers, or maintain a billing department. Instead, we focus our time and resources on taking care of patients.
Because we are not tied to insurance contracts, we have been able to negotiate excellent cash pricing for laboratory testing, imaging, medications, and other services. These prices are often significantly lower than what insurance companies allow, and dramatically lower than what many patients are ultimately charged through traditional healthcare systems.
As a DPC clinic, we do not profit from laboratory testing, imaging, or medications. Our goal is simply to make these services available to our patients at the lowest reasonable cost.
Why Don't You Provide Billing Codes for Insurance Reimbursement?
This is one of the most common questions we receive.
Insurance companies generally require diagnosis codes (ICD-10 codes) before they will consider paying for laboratory testing. While this sounds straightforward, it often becomes a complicated process of selecting diagnoses that insurance companies deem sufficient to justify specific tests. Different insurance plans have different rules, and even medically appropriate testing may be denied if the insurance company disagrees with the diagnosis submitted or determines that the testing is not covered under a patient's particular plan.
Participating in this system requires significant physician and staff time spent selecting codes, correcting coding errors, responding to insurance requests, appealing denials, and answering billing questions. Most traditional medical practices employ dedicated billing and coding staff specifically to manage these administrative requirements.
We intentionally chose not to build our practice around insurance billing.
By avoiding the coding and billing infrastructure required by insurance companies, we are able to keep our overhead low and offer transparent pricing. The time we would otherwise spend dealing with billing paperwork is instead spent caring for patients.
For this reason:
• We do not submit laboratory charges to insurance.
• We do not generate insurance claim forms.
• We do not provide diagnosis coding intended to obtain insurance reimbursement.
• We do not employ coders or billers to determine which diagnoses might maximize insurance coverage.
Instead, we focus on providing transparent pricing upfront so you know exactly what your costs will be before services are provided.
While we understand that some patients would prefer to use their insurance benefits whenever possible, our experience has been that many patients ultimately spend less—and encounter far fewer surprises—when paying our negotiated cash prices than when navigating deductibles, coinsurance, prior authorizations, coverage determinations, and claim denials.
For example, we charge approximately $12 for a Comprehensive Metabolic Panel (CMP). We have seen patients charged well over $1,500 for the exact same test when performed in other healthcare settings. If insurance denies coverage, applies the charge toward a deductible, or determines that the submitted diagnosis does not justify the testing, the patient may still be responsible for the full amount billed. We believe our approach provides a much more predictable, transparent, and affordable experience.
This is one of the most common questions we receive.
Insurance companies generally require diagnosis codes (ICD-10 codes) before they will consider paying for laboratory testing. While this sounds straightforward, it often becomes a complicated process of selecting diagnoses that insurance companies deem sufficient to justify specific tests. Different insurance plans have different rules, and even medically appropriate testing may be denied if the insurance company disagrees with the diagnosis submitted or determines that the testing is not covered under a patient's particular plan.
Participating in this system requires significant physician and staff time spent selecting codes, correcting coding errors, responding to insurance requests, appealing denials, and answering billing questions. Most traditional medical practices employ dedicated billing and coding staff specifically to manage these administrative requirements.
We intentionally chose not to build our practice around insurance billing.
By avoiding the coding and billing infrastructure required by insurance companies, we are able to keep our overhead low and offer transparent pricing. The time we would otherwise spend dealing with billing paperwork is instead spent caring for patients.
For this reason:
• We do not submit laboratory charges to insurance.
• We do not generate insurance claim forms.
• We do not provide diagnosis coding intended to obtain insurance reimbursement.
• We do not employ coders or billers to determine which diagnoses might maximize insurance coverage.
Instead, we focus on providing transparent pricing upfront so you know exactly what your costs will be before services are provided.
While we understand that some patients would prefer to use their insurance benefits whenever possible, our experience has been that many patients ultimately spend less—and encounter far fewer surprises—when paying our negotiated cash prices than when navigating deductibles, coinsurance, prior authorizations, coverage determinations, and claim denials.
For example, we charge approximately $12 for a Comprehensive Metabolic Panel (CMP). We have seen patients charged well over $1,500 for the exact same test when performed in other healthcare settings. If insurance denies coverage, applies the charge toward a deductible, or determines that the submitted diagnosis does not justify the testing, the patient may still be responsible for the full amount billed. We believe our approach provides a much more predictable, transparent, and affordable experience.
What This Means for Labs
• All laboratory charges are paid directly by the patient at the time the labs are ordered.
• Laboratory charges are included on your monthly invoice.
• We do not provide ICD-10 diagnosis codes or insurance billing paperwork.
• Our laboratory prices are often significantly lower than both insurance-negotiated rates and direct-to-consumer laboratory pricing.
• All laboratory charges are paid directly by the patient at the time the labs are ordered.
• Laboratory charges are included on your monthly invoice.
• We do not provide ICD-10 diagnosis codes or insurance billing paperwork.
• Our laboratory prices are often significantly lower than both insurance-negotiated rates and direct-to-consumer laboratory pricing.
What This Means for Imaging
• Imaging orders are typically sent to local facilities such as Element Medical Imaging who offer our members great cash pricing.
• Patients pay our negotiated cash price directly to the imaging facility.
• Imaging facilities may be able to submit claims to your insurance company if you choose (this is particularly true for screening tests such as mammograms, bone density testing, etc).
• In many cases, paying the cash price is less expensive than using insurance.
Example:
Cash-pay MRI: approximately $300
Insurance-billed MRI: often several thousand dollars
- If you have not met your deductible, you may be responsible for the full negotiated insurance rate. Even after meeting your deductible, coinsurance obligations may exceed the cash-pay cost.
• Imaging orders are typically sent to local facilities such as Element Medical Imaging who offer our members great cash pricing.
• Patients pay our negotiated cash price directly to the imaging facility.
• Imaging facilities may be able to submit claims to your insurance company if you choose (this is particularly true for screening tests such as mammograms, bone density testing, etc).
• In many cases, paying the cash price is less expensive than using insurance.
Example:
Cash-pay MRI: approximately $300
Insurance-billed MRI: often several thousand dollars
- If you have not met your deductible, you may be responsible for the full negotiated insurance rate. Even after meeting your deductible, coinsurance obligations may exceed the cash-pay cost.
What This Means for Medications
• Medications may be purchased through our in-house pharmacy at our discounted cost.
• Prescriptions can also be sent to the pharmacy of your choice.
• Retail pharmacies may bill your insurance if you choose.
• Cash pricing is often competitive, especially when combined with resources such as GoodRx.
• We encourage patients to compare options and choose whichever is most affordable.
• Medications may be purchased through our in-house pharmacy at our discounted cost.
• Prescriptions can also be sent to the pharmacy of your choice.
• Retail pharmacies may bill your insurance if you choose.
• Cash pricing is often competitive, especially when combined with resources such as GoodRx.
• We encourage patients to compare options and choose whichever is most affordable.
Our Philosophy
At the end of the day, we believe patients should have access to healthcare that is transparent, affordable, and easy to understand.
Our model isn't for everyone. Patients who want every service processed through insurance may be better served in a traditional insurance-based practice.
We have chosen a different path.
Rather than charging high prices, employing teams of billers and coders, and relying on insurance companies to determine what care should cost, we focus on delivering accessible primary care with clear pricing and no surprise bills.
In other words, we chose to spend our resources on doctors, nurses, and patient care—not paperwork.
At the end of the day, we believe patients should have access to healthcare that is transparent, affordable, and easy to understand.
Our model isn't for everyone. Patients who want every service processed through insurance may be better served in a traditional insurance-based practice.
We have chosen a different path.
Rather than charging high prices, employing teams of billers and coders, and relying on insurance companies to determine what care should cost, we focus on delivering accessible primary care with clear pricing and no surprise bills.
In other words, we chose to spend our resources on doctors, nurses, and patient care—not paperwork.
