Charging for Blood Draws

March 1, 2008

We recently started charging patients $20 for blood draws in our office rather than billing the health plan, because reimbursement was so low. We have patients sign a form stating they have a choice between paying the $20 for a blood draw in our office, or being referred to the lab. Response from patients has been enthusiastic; they like the convenience. But a colleague recently pointed out that this may be in violation of our health plan contracts. What do you say? Our small physical space prevents us from having the lab provide a phlebotomist for us.

Question: We recently started charging patients $20 for blood draws in our office rather than billing the health plan, because reimbursement was so low. We have patients sign a form stating they have a choice between paying the $20 for a blood draw in our office, or being referred to the lab. Response from patients has been enthusiastic; they like the convenience. But a colleague recently pointed out that this may be in violation of our health plan contracts. What do you say? Our small physical space prevents us from having the lab provide a phlebotomist for us.

Answer: You’ll have to read your contracts to know for sure, but yes, it could be a problem. Most contracts don’t allow you to charge patients for services already covered under their insurance. In the payers’ eyes, you are asking patients to pay twice - once in the form of the insurance premium and again in cash to your practice.

Remember that if it is a convenience to your patients, providing the service without charging them may be worthwhile despite the low reimbursement from payers. Take a look at your actual costs to make this decision.