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Why are Labs so Expensive with Insurance? How to save money and get the labs you need in Austin

Updated: Mar 22

In recent years, there has been a trend in the world of healthcare: the increasing costs of lab work and the simultaneous decrease in preventive care lab recommendations. This is especially concerning, as it impacts both the financial burden on patients and the quality of healthcare services. The out-of-pocket costs for labs vary significantly depending on the Insurance policy and where it is performed. Patients can expect to pay an average of $500 in cost-sharing fees even when paying high monthly premiums. And this sky-rockets to thousands of dollars in larger health systems and hospitals.


Doctors are forced to order labs in the terms of what a patient’s insurance will cover so they are often not ordering all the labs they would like to order including labs that focus on wellness and prevention of disease as they would ideally be able to order. Most insurance plans also limit the frequency of preventative visits to once a year, and not all tests are covered. Then, they’re pushed into a complex system of billing and coding that makes doctors less likely to order preventative and wellness focused lab work just to avoid the administrative burden, and creating expensive out of pocket expenses for their patients which can lead to decreased patient satisfaction scores through Press Ganey which then leads to lower reimbursements.


In this post, we will discuss more about our current insurance-driven healthcare system’s flaws, and educate you on how METSI Care can be 3 to 10 times less expensive than the traditional system and at the same time increase your health and wellness.


Why is the cost of lab work so high?


Over the past years the cost of routine lab work has seen significant increases in costs. This problem is a major concern as it directly impacts patients' lives and their access to quality health care. A range of factors contribute to this increase, as seen below:

  • The power of Negotiation of Big Companies: Large healthcare providers and their power of negotiation have a big influence on lab work cost. They tend to demand higher reimbursement rates for lab services. That’s why the same lab test can cost up to 10 times more in a large hospital system than in a smaller independent lab. This creates a “cascade like” effect on the system, leading to inflated costs that affect patients.

  • Inefficient Billing Practices: Insurance companies require arbitrary and complex billing practices, severing a doctor’s ability to order the desired preventive and wellness labs unless they falsely code the patients chart with diseases the patient doesn’t have just to get the labs covered. This leads to doctors ordering less focused on true health and wellness and only ordering labs focused on managing the patients diseases, hence merely treating disease but not preventing it. Insurance companies and hospitals alike prefer this as it leads to more money in their pockets.

  • Lack of Price Transparency: Patients usually are unaware about the actual cost of lab tests when paid by their insurance, making it challenging for them to make informed decisions about what labs are ordered. Unfortunately, once the labs are ordered, patients are often stuck with expensive bills, paying for both “covered” and non-covered labs. This leads to patients choosing to delay or avoid getting labs at all to avoid the burden of large shared healthcare costs when using their insurance.

  • Complex Insurance System: As we explained in our previous post, the complexity of the cost-sharing structures with insurance companies makes patients pay up to thousands of dollars between their co-pays and co-insurance.

  • Geographical Location: Where you live can have a substantial impact on cost of lab work. Cost of living and differences in healthcare market competition can contribute to these geographical variations.

  • Regulations and Public Health Policies: Government regulations and public health policies can affect lab work prices. Some researchers note the effects of ACA on increased healthcare cost prices, especially after 2013.

(Graphic taken from New York Time's arcticle: https://www.nytimes.com/2019/04/30/upshot/health-care-huge-price-discrepancies.html)


Why can't I get preventive labs?


Diving deeper into this discussion, we should highlight the rising concern about the insurance industry and their coverage for preventative labs. While the Affordable Care Act (ACA) mandates that certain preventative measures should be covered by insurance, the list of covered services is limited, and many services are not covered early enough to prevent disease in most cases. For example: type 2 Diabetes screening is covered for adults aged 40+ who are overweight, but according to studies[1] blood sugar dysregulation precedes diagnosis of diabetes for at least 20 years.


Cost-sharing models lead to people paying significant amounts for necessary lab work that should ideally be the most accessible medical services. This discourages individuals from seeking essential preventative care. Doctor’s often see themselves asking for lab work only when the patient’s health is really compromised, or when the health problem is advanced when the ideal approach would be more proactive focused on prevention of disease.


The treatment of otherwise preventable disease generates a greater expense for patients, which could have been avoided with a preventive medicine model, as hospitals and insurance companies are focused on profit. As the saying goes: “An ounce of prevention is worth a pound of cure” and this is becoming less and less possible in the insurance model of healthcare.


How can I pay less for labs?


At METSI Care, we have changed the incentives of Care back to having a quality doctor-patient relationship and providing personalized care all for an affordable monthly membership fee. Included in the membership is access to discounted, transparent lab fees that are about 60-80% less than when ordered and paid for by insurance. This allows us to order all those preventative and wellness labs without worrying about expensive fees from the insurance company when trying to keep our patients health. No longer to patients have to worry about the interference of their Insurance company in the way of their health.


As mentioned before, traditional insurance models often result in inflated prices for lab tests, leaving patients with large out of pocket expenses. At METSI Care, we help alleviate this financial burden by negotiating our own discounted rates directly with labs, cutting out the unnecessary middlemen, and reducing administrative costs putting our patients' health and financial wellness as our highest priority.



METSI Care empowers patients to take back the control of their health through preventive care by offering transparent, affordable labs to our patients. Preventative labs play a crucial role in identifying potential health issues before they escalate into symptoms and more serious conditions. Regular screenings can detect early signs of diseases such as diabetes, cardiovascular disease, inflammation that can lead to strokes or cancer, and many others.


When you have a membership with METSI Care, our patients have access to the most advanced tests all at an affordable rate. This allows our patients to have a proactive approach to their health and get these labs regularly to ensure their bodies are still healthy. This helps reduce overall healthcare costs in the long run by addressing potential health concerns early on.


METSI Care's commitment to providing discounted labs and promoting preventive care is transforming how patients approach their healthcare journey.


Would you like to join this revolution of improving your health at a fraction of the cost? Please visit our website at www.metsicare.com. We are currently accepting new patients and welcome you to join!

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