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.

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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.

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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.