FAQ About Medical Costs
A deductible is an amount of money that you are required to pay out of pocket each year before your health insurance company will begin to pay for items and services you receive.
Most employers are forced to increase the amount of the deductible you are responsible for in an effort to maintain the overall cost of the policy. The more cost the insurance company can shift to the members in the form of deductibles and co-payments the lower the premium they can charge for the plan.
A co-payment is established by the plan as part of the benefit package and is a fixed amount depending upon the service provided. An example of a co-payment would be the amount you have to pay when you go to your primary care doctor for a visit. You may have a different co-payment for a visit to a specialist or an emergency room. This payment will remain the same at each visit. A deductible will vary depending upon the service being performed and the amount your insurance company would normally pay for that service.
When you have a service such as a lab test done a claim is sent to your insurance company for payment. If you have not met your deductible, which means you haven't paid the amount you are required to pay out of pocket before your health plan will begin paying, the cost of the test is applied to your deductible. You are then required to pay for the test yourself. You will continue to pay for items and services until you have paid out an amount equal to your deductible. Your health plan will then begin to pay.
The amount you pay towards your deductible is determined by the amount your insurance company would have paid the supplier of the service if your deductible had been met. This means if you had a lab test and your insurance company would normally pay the lab $10 for the test you have to pay $10. The $10 is then subtracted from your deductible amount.
The advantage of using an independent provider such as East Side Lab instead of a hospital affiliated lab is that your deductible payment will be much less. The reason it will be less is because independent providers typically charge and are paid less than hospital labs for the same services. Since the independent provider is paid less the resulting charge to you for your deductible payment is less as well.
The reason it matters is because by using the lower cost provider you will ultimately pay less out of pocket. Let's say you have an annual deductible of $500 and you need a certain test done on a monthly basis. If you use an independent provider that would normally be paid $10 for the test you would end up paying $120 over the course of the year for those tests. If you were to use a hospital affiliated lab that was normally paid $40 for the test you would end up paying $480 over the course of the year for the same tests.
Hospitals are paid more than independent providers because hospitals generally have more negotiating power with the insurance companies.
* Insurance companies must have the hospitals in their provider networks in order to operate their plan and be able to offer all the services only a hospital can provide. The larger the hospital or hospital network the more negotiating leverage they have with the insurance companies and the higher fees they can demand.
Hospital charges are higher because they have much higher overhead (operating) costs and these higher costs are passed on to the consumer in the form of higher charges. These higher charges may be warranted for testing and services provided in the hospital but there is no reason these higher costs should be passed on to services performed in the community at large.
No. The quality of the testing is the same. All independent providers must be licensed and meet the same high quality standards as those imposed on the hospitals. We all utilize state of the art equipment, employ licensed personnel to perform the testing and are certified by accrediting agencies. Unless a facility meets all of these requirements they are not allowed to remain in business.
Using independent providers instead of hospital affiliated providers for services such as lab, x-ray and therapy could lower the overall cost of health care because the independent providers receive on average lower payments from your insurance company. These lower payments will decrease the overall amount your insurance company has to pay for the same number of services and this will help to keep the cost of your health insurance premiums and those paid by your employer lower.
Getting Lab Work Done
Most laboratory test collections do not require an appointment. Please contact your preferred Patient Service Center for any laboratory testing requiring timed collection or call Customer Service at 800.479.5227 with any questions you may have.
Information regarding our Patient Service Center locations and hours of operation can be found on our Locations page
All of our insurance providers are available here, please note that insurance providers does vary depending on location.
All you need to bring in with you is your laboratory order from your healthcare provider, valid identification and an insurance card.
Sometimes special preparation is necessary to improve the accuracy of laboratory testing. This may involve:
- Fasting (not eating any or certain foods) for several hours or overnight and possibly even avoiding coffee with cream/sugar until after laboratory testing has been performed.
- Drinking more or less water than usual.
- Avoiding certain medications or vitamin and herbal supplements prior to testing.
It is important to consult with your provider about the medications you are currently taking, including supplements and other over-the-counter medications, before making any changes to your routine prior to having laboratory tests performed.
Laboratory results can be obtained by filling out a patient records request form at the Patient Service Center.
Patients can pay at the time of service or pay online once the statement is received in the mail. Patients paying the bill in full at the time of service may get their bill discounted.
We will bill you. However if you pay for your tests at the time of service, you may be eligible for a discounted fee schedule.
Prior authorization is a process used by many insurance companies to determine if a procedure, service, or medication will be covered.
Learn more about Prior Authorization here.
Bills can be paid over the phone or online, click here to pay your bill online or contact us at 800.455.8400
If you'd prefer to pay by mail please send checks payable to:
East Side Clinical Laboratory: Billing Department
225 Willett Avenue
Riverside, RI 02915