I figured why not throw down an extra $15.38 and spring for a more comprehensive look at my blood chemicals. Little did my doctor know, I already priced this particular test out before he even ordered it. I suspected he might take this approach with my annual labs. As they say, go big or go home. I get six more levels measured with this test and a closer look at how my liver is functioning. Since I like to throw back a little too much Canadian Moosehead from time to time, it might not hurt to check in on that organ.

We learned a few weeks ago about the basic metabolic panel and how much it might cost. Today, we will take a look at the comprehensive metabolic panel. I often hear it called CMP for short. This is another lab test that might be ordered during a preventive physical exam.

This falls under CPT code 80053 for all you coding experts out there.

What Is A Comprehensive Metabolic Panel?

A comprehensive metabolic panel is a lot like the basic metabolic panel. It just has a few more tests in it. Instead of looking at 8 blood chemicals we get to look at 14. I bolded the additional chemical levels we get to measure with this panel below.  

• Albumin
• Bilirubin
• Calcium
• Carbon Dioxide
• Chloride
• Creatinine
• Glucose
• Phosphatase
• Potassium
• Protein
• Sodium
• Transferase (ALT)
• Transferase (AST)
• Urea Nitrogen

Wow. Talk about comprehensive.

Just like the basic metabolic panel, this test checks the status of a person’s metabolism. This includes the health of the kidneys, blood glucose levels, and electrolytes. But the CMP goes beyond that. It checks in on liver function, and the liver is a pretty important organ.

Although it is a pretty detailed test, it does have its limitations and can sometimes produce false positives on some of the indicators causing additional testing we may or may not need. I am willing to take that risk, but it is definitely worth reviewing these options with your doctor.

The hospital lab will take my blood and use special instrumentation to get my levels on all the indicators above. It even spits out the normal reference ranges to help me and my doctor easily identify if anything looks out of sync. You can learn a little more about this test at labtestsonline.org. I have no affiliation with them.

How Much Should It Cost?

Price-wise, my comprehensive metabolic panel will come in a little higher than the basic version. That makes sense considering we are getting six more tests added to the panel. The retail price for the CMP is about $108 at the hospital I go to. This is $23 more than I would be charged for the basic version of the metabolic panel. That’s about $3.83 for each additional blood chemical.

I have personally seen charges for this test range between $90 and $275 at hospitals. The 50^th percentile price for the CMP would come in at about $190. A hospital I priced about an hour from me charges $185 for the exact same lab test I get for $108 at my local hospital.

Now if we have this drawn in a clinic and done by a reference lab, it is likely to come in at a much lower price. I would say $35 – $65 would be more reasonable in a lower-cost setting. If you have any examples of this you are willing to share, please do so in the comments below along with your geographical region.

How Much Will My Insurance Pay?

You might remember, I priced out the basic metabolic panel through my insurance and they negotiated the price down to $61.76 when done at my local hospital. I like to compare the negotiated price to the sale price you might see at T.J. Maxx.

So I also priced the CMP out with my insurance. This test comes in $15.38 higher with a negotiated rate of $77.14 when it is done in the hospital I go to. In other words, they won’t pay the full $108 retail price; they will get the test on sale for $77.14. It is always a good idea to ask for these insurance rates before having the test.

Here is a side by side look at the BMP and CMP pricing where I get services and the negotiated rate my insurance gets to pay. This is obviously a sample size of one and pricing for only my market.

How Much Will I Have To Pay?

This is where I get to say every insurance plan is different, and make sure you understand your benefits package. Since I am on a High Deductible Health Plan (HDHP), I would have to assume that this test would hit my deductible. In that case, I would have to pay the full $77.14 my insurance company negotiated this test down to.

In reality, my doctor ordered this with the Z00.00 (Encounter for general adult medical examination without abnormal findings) diagnosis code. I talked about this code when we covered the free cholesterol screening. This code triggers the insurance company to waive my deductible and pay preventative preventive services in full. So in this case, they will likely pay the $77.14 on my behalf even though they technically have no legal obligation to do so. It doesn’t work for all lab tests, but I believe my insurance considers this particular test preventive in nature. We will verify this when the claim processes.

How Much Would Medicare Pay?

I like to throw the Medicare payment amount here just to expose the gap in reimbursement. I like to say Medicare has more pricing power than Walmart. In 2019, Medicare is paying most non-rural hospitals $11.74 for the comprehensive metabolic panel. You can download this information here.

There is that “problem gap” again, we just keep seeing this trend here at Max Out of Pocket.

$77.14 (my negotiated rate) – $11.74 (Medicare rate) = $63.34 (problem gap)

Final Thoughts

The decision to have this test done is between the patient and the medical provider. If it happens to hit my deductible, I am willing to shell out the $77.14 to have this panel of 14 tests done. It is worth the money to me to make sure my levels for these blood chemicals are within normal ranges. Will I have it every year? Maybe, maybe not.

My max out-of-pocket for a comprehensive metabolic panel in 2019? About $77.14, unless my insurance pays this in full.

*This is not a recommendation to get or not get a comprehensive metabolic panel. That decision can only be made by you and your doctor. The content of this article is based on my experience and my own opinions.

The post How Much Should A Comprehensive Metabolic Panel Cost? appeared first on Max Out of Pocket.

That’s right, we’re going to get scientific here today at Max Out of Pocket. Don’t worry, I think you can handle it.

It is a good idea to always be prepared for other things that might be ordered by a doctor during an annual exam. That way, we can prevent unexpected medical bills for out-of-pocket costs. If you haven’t figured it out yet, Max doesn’t like surprises. But I am always willing to take one for the team and put myself at risk for some extra out-of-pocket costs so others can benefit and learn from this process.

I already know I am going to get a free lipid panel (cholesterol test) ordered during this exam, but what else should I expect? Today, we are going to dive into the basic metabolic panel.

What Is A Basic Metabolic Panel?

I like labs because my doctor and I get to see what is going on inside my body. The basic metabolic panel looks at a wide range of blood chemicals to make sure nothing is imbalanced. Just like my free lipid panel, this lab test measures more than one indicator. The results will give my doctor some information about how my metabolism is functioning. This includes the health of my kidneys, blood glucose levels, and electrolytes. 

For all my coding friends out there, the basic metabolic panel (BMP) is often referred to as CPT 80048. That is how it is reported on the claim form to the insurance company.

What does it measure?

Specifically, this lab test measures these eight indicators and compares them to the normal ranges for other humans just like me.

• Calcium
• Carbon Dioxide
• Chloride
• Creatinine
• Glucose
• Potassium
• Sodium
• Urea Nitrogen

Wow. Eight tests in one, I like this deal already.

Max will be the first to say, I am not a doctor and I have absolutely no idea what half of these blood chemicals are. But I am happy to have my medical provider evaluate where I stand in comparison to normal ranges.

In my case, I will take my lab order over to the hospital lab and they will start by drawing my blood. They will then put it into some fancy instrumentation that will spit out a report with my individual levels on all the components listed above. The report will even provide the normal reference ranges to help me and my doctor easily identify anything that looks out of sync. You can find out a little more about this test at labtestsonline.org.

I think if we went back a few hundred years and told people that in the future we would be able to screen blood to help identify disorders, it would blow their minds. They might even wait in line to have this test done. Nowadays, people yell and throw fits because the lab is running behind and they have to wait an extra 15 minutes to have their blood drawn. Hedonic adaptation at its best. Have we lost touch with where we are with healthcare? But I digress…

How Much Should A Basic Metabolic Panel Cost?

If I get a basic metabolic panel lab test after my clinic visit in October, it will have a retail “out-the-door price” of about $85 at my local hospital. In my experience, this is on the low end of the pricing spectrum for a basic metabolic panel in this setting. 

Max OOP’s 2019 out-the-door price for basic metabolic panel = $85

I have personally seen hospital charges that range between $70 and $250 for this test. Another hospital an hour from me charges about $151 for the exact same test I am getting for only $85. That $66 difference might just cover the time and gas for someone to drive across town to get a cheaper test. The 50^th percentile of hospitals would charge about $140 for the BMP.

Again, this is where we need to let price transparency and competition do its thing to help get things normalized.

Now, if I were to have this drawn in a clinic and have them send it off to a reference lab for processing, it is likely to come in at a much lower price. I would say $30 – $60 would be a more reasonable price in a lower-cost setting. I am making a conscious decision to have mine done in a hospital.

How Much Will My Insurance Pay For a Basic Metabolic Panel?

I happen to already know that my insurance has negotiated the hospital’s price for this test down to $61.76. In other words, they won’t pay the full $85 retail price; they will get the test on sale for only $61.76. Everyone’s insurance rate will be different, and it is always a good idea to get these rates before having a test like this.

How Much Will I have To Pay?

This is where I get to reiterate that every insurance plan is different. Just like the sale price for the BMP is different from insurance to insurance, so are the out-of-pocket costs. So, make sure you understand your benefit package. Since I am on a high deductible plan, I have to assume that this test would hit my deductible and I would have to pay the full $61.76.

In reality, my provider will likely order the BMP with the following diagnosis code:

Z00.00 (Encounter for general adult medical examination without abnormal findings)

After all, I am a perfectly healthy individual and we are only using this test to screen for possible issues. I believe the Z00.00 code will trigger my insurance to waive my deductible and pay the full $61.76 on my behalf.

Technically, they have no legal obligation to pay this test in full and they could let it hit my deductible. But, I have seen it covered in the past as a preventative preventive benefit and paid out in full with no out-of-pocket cost to me. The verdict is still out for 2019 and I will keep everyone posted on how it pans out.

How Much Would Medicare Pay For A Basic Metabolic Panel?

I like to throw out the Medicare price here just to get people fired up. They might also choose to use the rate for negotiation tactics with a hospital or reference lab. As I like to say, Medicare has more pricing power than Walmart. In 2019, Medicare is paying most non-rural hospitals $9.40 for the basic metabolic panel.

You can download this information here.

There’s that ‘problem gap’ again. I mentioned it briefly when we looked at the price for a hernia repair surgery last month. My insurance is paying $50.71 more than Medicare pays most for the exact same test. A ‘Medicare For All’ scenario would need to address this ‘problem gap’ or we are going to see some serious financial problems across the industry.

$61.76 (my price) – $9.40 (Medicare’s price) = $52.36 (problem gap)

Final Thoughts

Max OOP clearly does his research before consuming elective healthcare services. Since it is reasonable to think a basic metabolic panel is something I might see ordered during my annual preventive exam, it is worth getting it priced out to help me manage out-of-pocket costs. I need to know both the retail price and the sale price my insurance gets it for. Since the Affordable Care Act does not mandate coverage for this test, I also need to be ready for this test to hit my deductible.

Max Out of Pocket for my basic metabolic panel (BMP) = $61.76

Do you have a metabolic panel ordered annually?

*This is not a recommendation to get or not get a basic metabolic panel. That decision can only be made by you and your doctor. The content of this article is based on my experience and my own opinions.

The post How Much Should A Basic Metabolic Panel Cost? appeared first on Max Out of Pocket.