Navigating Lab Fees in Direct Primary Care

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Learning to manage lab fees has been a game-changer in my practice.

Client billing has worked really well for a lot of my patients — with or without insurance — mostly because the pricing tends to be better overall. That said, I’ve run into a few snags along the way, and here’s what helped:

1) The system auto-assumes client billing and charges accordingly. Fix: Call the lab and ask them to remove client billing for that transaction, then provide updated insurance and ICD-10 codes. This usually does the trick — but not always.

2) Patients still end up with a high bill from their insurance, even with new ICD-10 codes. Fix: Call again, request a re-evaluation, and throw in even more ICD-10 codes.

3) You’re using client billing and the bill comes back shockingly high. Fix: Call the lab and ask them to switch to a lower-cost lab code. Fair warning — this can take some legwork. One example: a Bioavailable and Free Testosterone order came in at over $700. After multiple calls and about three months of back-and-forth, we got it down to $200 with a different code. Still not cheap, but way more reasonable. Now I always follow the code my local agent recommends and reference the Tier 1 pricing sheet.

That Tier 1 pricing came through group purchasing, and it’s been a huge help in getting patients the best rates possible.

None of this is quick or easy — it takes patience, persistence, and a little creativity. The good news? DPC docs have all three in spades.

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About April Soto, MD

April Soto was born and raised in Guatemala to Puerto Rican Missionaries. She came to the US to attend university and medical school at University of California San Francisco. She completed her residency in Family Medicine at White Memorial Hospital in Los Angeles, Ca , a 1-year Fellowship in HIV Medicine at Los Angeles County-University of California, 2-year fellowship in Integrative Medicine through Academy of Integrative Health and Medicine in San Diego, Ca. She worked at Kaiser Permanent for 13.5 years in Family Medicine, Infectious Diseases, Family Medicine Surgical Services and served as the Wellness Champion for the Family Medicine Residents. Dr Soto is also trained in psychedelic services and offers Ketamine, Breathwork and Biofield Medicine/Energy Healing services for patients with mental health concerns. She enjoys complementing western medicine along with addressing the physical, mental, spiritual, and emotional needs of her patients as well. She meditates daily and enjoys time in nature. Boogie boarding alongside the surfers brings her great joy! She lives in Los Angeles, Ca with her beloved husband Chris.