Cost Comparisons of Physician-Ordered Versus Direct-to-Consumer Laboratory Testing

Objectives To determine if direct-to-consumer (DTC) laboratory testing is less expensive for patients, as is generally advertised, and whether it has any role in managing uninsured or underinsured patients. Methods The costs of six commonly ordered laboratory tests were obtained through two major DTC laboratories and compared with 42 physician-ordered, hospital-based laboratories in Florida. The costs of DTC tests were also compared to concurrent reimbursements from Medicare and Medicaid. Results The costs of DTC tests were generally lower than the mean insurance-negotiated hospital-based prices and much less costly than physician-ordered tests for patients without insurance. Charges were greater than reimbursements from Medicaid and Medicare. The inter-hospital variation in the pricing of laboratory tests was remarkably wide for both insured and uninsured patients. Conclusions Charges to insured patients for physician-ordered laboratory tests tend to be higher than those offered directly to consumers, but out-of-pocket costs will vary depending on deductibles and co-pays. DTC costs would be substantially less for uninsured patients when ordered by a patient under the supervision of a physician.