Labs
As a Sidecar Health member, you can shop for your care; labs are no different and prices for labs vary widely. Shopping for labs presents a unique opportunity to keep the savings.
Sidecar Health works differently versus traditional insurance, especially when it comes to receiving services your provider is used to calling in for you, like lab work and pharmacies. While providers may default to doing labs in-house or sending them to an outside lab, you are often able to choose where your labs are processed. Choosing an outside lab is often the most cost-effective option. This article breaks down what you need to know and provides tips and pointers on how to “shop” for labs given the concept of “shopping” may be new to you and your provider.
A quick cheat sheet:
- Always ask about the price and compare against your Benefit Amounts to understand your financial responsibility or, better yet, see how much savings you get to keep.
- You can ask your provider for a lab requisition order and work directly with an outside lab of your choice (it’s easy: options below under “direct labs”).
- If you have a deductible and labs are needed, you will be responsible for paying the cash price of the lab work and the Benefit Amounts for each test done will apply toward your deductible.
This article further helps you understand how to shop for lab services.
What are lab services?
Lab services generally refer to the testing of a specimen collected to detect, diagnose, or monitor disease processes, susceptibility, or to determine a course of treatment. Different types of lab services are used for different reasons. The most common types include:
- Diagnostic tests to detect presence of diseases
- Screening tests to detect or predict diseases for at-risk individuals
- Monitoring tests to monitor progress or response to an active course of treatment
What are my lab benefits under my Sidecar Health plan?
Your plan’s Benefit Amounts are visible in the Sidecar Health member portal through Estimate care. Your Member Care team is also available to help you navigate your benefits for each option. You can review full coverage details by visiting the My coverage page in your account, clicking on the three-line menu, and selecting “Full benefits.”
Where can labs be performed?
Depending on your situation, lab services can be done in a multitude of settings—at the doctor's office, during a procedure, or at a lab facility collection site.
- Planned labs are labs that you or your provider plans for you to have at the doctor’s office or other facilities (e.g., your doctor will plan a lipid panel for you if your cholesterol needs to be checked).
- Direct labs are when you go directly to a lab facility for services (e.g., you may already know that you need an annual comprehensive metabolic panel and would like to skip going to the doctor’s office).
- Unplanned labs are labs that neither you nor your provider planned for you to have before the service is rendered (e.g., while under anesthesia during surgery, samples may be taken for labs).
How should I shop for Planned labs?
Planned labs are often not included in the cost of your doctor’s visit or planned procedure. Providers may default to doing the labs in-house or sending them to an unknown lab. However, you can choose your own lab. Often, choosing your own labs will be the most cost-effective option.
Helpful hints when you need labs:
- If using the provider’s default lab, always ask about the price. Compare the price against your Benefit Amounts in the member portal to understand your financial responsibility or savings. You may be able to do this before your visit if they are planning to do labs.
- If labs aren’t time sensitive, you can also ask your provider for a lab requisition form and take it to a direct lab (see “How should I shop for direct labs”). In this case, ask your provider where to send the lab results back to their office.
How should I shop for Direct labs?
With your Sidecar Health coverage, you are in the driver’s seat and can go to any provider for your lab services. Labcorp and Quest Diagnostics have direct collection sites (what they call Patient Service Centers). Other members have also had success using online lab-ordering resources such as JasonHealth, UltaLabTests, and RequestATest.*
Shopping for direct labs is simple:
- Ask the cash price. Ask the lab (or a few different labs) what the lab service will cost for cash-pay or self-pay patients. If possible, request a Good Faith Estimate.
- Look up your Benefit Amounts. Visit the Estimate care tab in the member portal, call your Member Care team at 877-653-6440 for help, or submit the Good Faith Estimate as a pre-bill to understand your Benefit Amounts for your labs.
- Compare the costs and select your lab. Compare costs of the labs against your Benefit Amounts to decide on the best lab for you.
- Schedule your lab.
How should I shop for Unplanned labs?
Unplanned labs may be ordered when you are already in a provider’s office or when undergoing surgery. If you are planning to go under anesthesia or will be unable to respond to your doctor when they determine a lab, we recommend having a conversation ahead of your medical event.
- Let your provider know your choice of lab and that you want to reduce out of pocket costs to yourself.
- Ask your provider for all potential labs you might receive and the prices so that you can compare those costs against your Benefit Amount.
My provider requires labs to be taken in their office or facility. What do I do?
If you are experiencing these issues, please contact your Member Care team at 877-653-6440.
*Sidecar Health does not utilize a network of providers. External websites and information on healthcare providers, including cost and quality information, is provided for convenience and informational purposes and is not an endorsement or guarantee of pricing, quality, or availability of the provider. Contact the provider for pricing and availability. Sidecar Health bears no responsibility for the accuracy, legality or content of any external websites or for subsequent links from an external site.