I’ve been told several things by people who work in the professional laboratory and insurance industries, who would seem to know more about this than I would. Some have been mentioned above.
They’ve lowered testosterone ranges over the years as more men dropped out of the lower normal range into low or deficient. This would follow the bell curve which would have 90-95% normal and those are the very top and bottom out of range.
Ranges vary dependent on the technique and equipment utilized, or individual lab procedures.
Ranges are negotiated with major insurance carriers. For example, I don’t know if this is true but, reportedly, BC/BS negotiated with Quest to drop the testosterone bottom range from 350ng/dL to 250. So, as mentioned by iron_yuppie, fewer would qualify for treatment, as a guy at 290 is now “in normal range” which saves BlueCross money. To motivate Quest to agree, they pay them a little extra for other tests, so it’s a win win. I suppose they have actuarial people who figure all this out.
So, Quest is “in network” with BlueCross, and that is nationally, and there is a bulk discount. This is why, if you didn’t have insurance to bill, the cash fee for your labs is $2600. They do bill that to BC, but BC pays $320 as the negotiated discount, and you may pay pay $80, your %, or a co-pay. When you get your explanation of benefits, you’ll be told you “saved” $2200 by using an “in network” provider. They would allow a larger reimbursement to an out of network lab, but your end will be higher as well, with either a larger out of network deductible or larger co-payment, or both, applied.
Smaller labs have picked up on all of this, and offer to provide labs at a cheaper cash fee for those that do not have insurance which would approve, or cover, certain tests and allow one to order their own tests, though some states do not allow that.
I use a certain MRI facility for patients who have terrible or no insurance. They’ve agreed to charge the Medicare allowance to cash patients, which would be something around $300-400 of the $1800 billed.
The health of the public is controlled by the government, the pharmaceutical companies, the major insurance companies, and to a lesser extent, large hospitals. When I go to BHRT conferences around the country and meet other doctors, from multiple specialties, the #1 reason I hear behind their interest in running a hormone practice is to get out from under insurance company control. I’d say the #2 reason is to get into a wellness care model and keep people healthy, rather than treating them after they are sick.
I have some friends who just quit, brilliant doctors with skill and tons of knowledge and experience, retiring in their 50s. They’re happy, they hang out or travel, take up hobbies, whatever, but it is sad. They are simply ground down and beat up by the system, their words. I understand, but I see a huge waste of talent and ability.
I just noticed I went on a bit of a rant. Sorry.
