back

by brandonb·10mo ago·view on hn ↗
(OP here) LDL is still a good biomarker, but ApoB is a better biomarker for the same undelrying risk factor -- each atherogenic particle (LDL, VLDL, IDL) has exactly one ApoB molecule.

The reason we offer the tests as cash pay is that it's the only way we can guarantee the price. In the past, when we've gone through insurance, the insurer's "negotiated rate" for the same exact panel comes out to $1,400-$1,500. If the insurer later decides to deny coverage for any of the tests, it's more expensive for the patient.

The $190 price is negotiated to be pretty low. It includes hs-CRP ($59 by itself online), but also the other major heart health biomarkers: ApoB ($69), Lp(a) ($49), A1c ($39), lipid panel ($59), eGFR ($99), other biomarkers, and a video consultation with a doctor to actually explain the results and what to do about them.

For hs-CRP in particular, it's not covered under the ACA as a preventive benefit, so you would usually need to hit your deductible before insurance kicks in at all. (That's assuming they count it as medically necessary at all -- for example, Aetna's current medical policy for hs-CRP requires 2 risk factors, LDL in a specific range, and overall cardiovascular risk to be in a certain range or the claim would simply be denied). It's possible this will change over time as the ACC/AHA recommend universal screening, and I hope it does, but it's a relatively a slow process since it depends on the US Preventive Services Task Force to issue a formal recommendation.

3 comments
Goodlabs prices:

https://app.hellogoodlabs.com/book-tests

  ApoB  $12
  LP(a) $20
  A1c   $ 4
  Lipid $ 8
  eGFR  $30 (Under "Cystatin C with Glomerular Filtration Rate, Estimated (eGFR)")

  Total: $74
So no, I wouldn't call $190 "pretty low", lol.
Their comprehensive men’s panel is $200, which seems like the most comparable package. (The list of biomarkers above is a subset of the ones in our panel—obviously if you remove biomarkers, you’ll end up with a cheaper price.)
Unrelated to the topic, but does anyone know if an equivalent service (à-la-carte blood testing with online booking) is available in Europe, specifically the Netherlands (or France) ?
Anecdotal advantage that I've heard of but not verified.

Cash also has the advantage of the person requesting the test not having to disclose it. For example if you're running the test for getting life insurance and need to lower cholesterol you could use the cash tests for this. Using insurance for this will expose the numbers when you grant access to the insurance company to troll through your records.

Don't you sign something to the effect that you have not hidden testing like this that you are aware of?
And how would they know?
True - they wouldn't unless it is discovered and disclosure is mandated by a legal process. otoh - OP could provide a service where these results are completely anonymized if the person requesting the test so desires.
FYI the above poster is the founder of the company selling these tests (EDIT: He edited his comment to include the "OP here" intro after I posted my comment. Thanks!)

> In the past, when we've gone through insurance, the insurer's "negotiated rate" for the same exact panel comes out to $1,400-$1,500.

hs-CRP is not going to be a $1500 negotiated rate under any insurance these days. No sane insurance company is going to pay that.

I understand that the negotiated rate you're talking about is for an entire panel of many markers, but most of these are not necessary for a quick screen and many would already be covered by an ACA annual checkup.

> It includes hs-CRP ($59 by itself online),

hs-CRP is $50 right now at privatemdlabs.com before the 25% off coupon they're blasting me with in the pop-up. It appears to be in the $40-45 range at a few other direct lab companies.

I updated the above post to say (OP here). I thought it was fairly clear from my phrasing of "we offer the tests as cash pay", but never hurts to be even more explicit.

I checked privatemdlabs.com, and they're asking $249 for a cardiovascular panel that covers the same biomarkers. So I think our pricing compares pretty favorably, especially when you consider that we offer an MD review.

> hs-CRP is not going to be a $1500 negotiated rate under any insurance these days.

The $1500 insurance price is for the $190 panel. We've actually dealt with this exact situation in the last month, since every so often labs will make a mistake when they process the order (we obviously fix these situations). Perhaps the insurance companies aren't sane (a topic for another day), but this is unfortunately how the system works today.

Commenting to add - Insurance negotiated rate may actually be 1500$. If it is and they charge insurance 1500$. They legally cannot charge an individual a different or lower rate. Even if that person doesn’t have insurance and offers to pay cash.

This is one of those weird horrible traps health insurance puts you into. OP may charge insurance 1500$, insurance may only pay 20%. But that now means they have to charge individuals the full 1500$ price.

So honestly, Cudos to the OP for identifying this trap and then moving to just charging a reasonable flat rate.

Why would the insurance pay only 20% if it's a negotiated rate?