Note: This article is 5 of 6 articles that have been posted to this website and are in a separate category from research articles, and that category is called “A Dietitian’s Journey”. These 6 articles document my recovery from profound hypothyroidism (June 3, 2022 – October 31, 2022) and represent only my personal experience. They should not be treated as scientific evidence or medical advice.
A Dietitian’s Journey (Part I) documented my personal weight-loss and health-recovery journey (March 5, 2017 – March 4, 2019) and is not posted on this web page.
Introduction
This past Monday, I went to the lab to have blood tests to measure my thyroid hormones, anti-thyroid antibodies, and an iron panel. When I met with my doctor last week, I learned that I would need to pay for the free T3 test because the British Columbia guidelines and protocols for ordering thyroid tests state that a free T3 test is only covered to rule out suspected cases of hyperthyroidism [1]. As I wrote about last Thursday, I was “more than willing to pay for a $9.35 test to have all the data.”
I think most people are aware that the healthcare system is economically stretched, and I certainly understand and accept the need to reduce costs. One way to do that is to restrict the ordering of laboratory tests to only medically justifiable circumstances, which makes good sense.
While I recognize that I am not objective in this situation, it would seem to me that when someone is on thyroid hormone replacement medication that includes both synthetic T4 and T3 hormones, that the expense of both a free T4 test and free T3 test should be covered by the provincial healthcare system as the cost is justifiable because the prescribing doctor needs to determine if the dosage of both synthetic hormones is adequate, but not too high.
As I said above, I knew last week that I would be paying for the free T3 test and was fine with that, but what I wasn’t prepared for was that I would be expected to pay three times the cost the government pays for the same test, and that there would be no patient-price list available.
Need for Price Transparency
When I arrived at the lab on Monday, I was told that the free T3 test would cost $32.00. I replied that there must be a mistake, because the cost of the test is $9.35. I was informed that the government pays $9.35 for the free T3 test, but the patient-pay cost for the same test is $32.00. I explained to the person at the desk that I could understand the test costing more if there was a set-up fee for a stand-alone test, or for a separate blood draw, but this test was going to be run with others using the same blood draw. I was informed that $32.00 is the patient-pay cost of the free T3 test, regardless of whether it is done with other tests or by itself.
I asked if I could please see the price list with the patient-pay costs, and was told that there isn’t one. I was asked if I wanted to have the free T3 test period formed, and if I did, I would need to pay $32.00. What choice did I have? It was not as though I could go to one of the lab’s competitors, as this private lab company is the only one providing laboratory services in this city.
[NOTE (October 28, 2022: I have spoken to people in other provinces, and it appears from what people have said that the practice of diagnostic laboratories not disclosing patient-pay prices occurs in Manitoba, Ontario, and British Columbia.]
I paid the $32.00 for the test because I needed this information to know the effect of the medication on my thyroid hormones, and for my doctor to know whether a medication adjustment was needed. I had the disposable income to pay for it, but what about consumers who need a laboratory test to make health decisions or for their doctor to be able to, and who cannot afford that?
Healthcare Costs Accountability
After my appointment, I wrote the regional office of the lab company and asked “to have the patient-pay lab prices for British Columbia.” I heard back from a Client Service Advisor who told me that “We do not provide a list of what we charge to patients”. I was flabbergasted. I’ve always made the assumption that private businesses are required to post their prices, or at least make them available when asked.
I have since found out that there IS a patient-pay price list, and it is titled “British Columbia Private Price List for Commonly Ordered Lab Tests” and is dated April 2021.
The prices cannot be posted because the notice at the top of the price list reads: “This is a confidential document. Please do not disclose our prices publicly except in conversations with your patients.” Why is the private-pay price of lab tests a confidential document?
Final Thoughts…
I believe that, as consumers, private-pay individuals have a right to have access to the prices for laboratory tests in advance, so that they can consider their decision to purchase, or not purchase, these services. Consumers expect grocery stores and department stores to post their prices, and it is my personal opinion that privately owned laboratories should be no different.
I am very grateful to live in a country where publicly funded medical care is available. I don’t even mind paying the same cost the government pays for tests that I want to have done. But as a private consumer, I believe the cost of services needs to be available and that there needs to be transparency.
References
- BC Guidelines & Protocols Advisory Committee, Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder, October 24, 2018
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Joy Erdile is the Registered Dietitian at BetterByDesign Nutrition Ltd., and has been supporting clients’ nutritional needs since 2008. Joy has a post graduate degree in Human Nutirion, more than 17 years of experience in private practice, and is a published in mental health nutrition. She is licensed in BC, Alberta, and Ontario, and her areas of expertise range from routine to clinically complex cases. Joy is passionate about helping people feel better and restore their health, and believes that there is no one-size-fits-all approach, but that Nutrition is BetterByDesign©.