Does anyone have advice on how to get bloodwork done for a reasonable price?

I'd like to monitor various bloodwork values on at least an annual basis and perhaps more frequently if the price is reasonable. I have found that my primary physician is reluctant to sign off on labwork beyond the most basic tests (cholesterol, hematocrit), and if they do, they want to charge me pretty substantial amounts for each additional test. Adding just a few items to the basic panel would have driven the price to something above $1500.

I'm sure that there are labs that specialize in testing for athletes / fitness that offer reasonable rates and services targeted towards the athlete's needs but I haven't been able to find any.

Has anyone looked into doing this?

Also, if anyone has a reference or suggestions on what items are worth monitoring I'd love to hear about them.

I'm in the San Francisco bay area.

All the best,

sminar

Does anyone have advice on how to get bloodwork done for a reasonable price?

I'd like to monitor various bloodwork values on at least an annual basis and perhaps more frequently if the price is reasonable. I have found that my primary physician is reluctant to sign off on labwork beyond the most basic tests (cholesterol, hematocrit), and if they do, they want to charge me pretty substantial amounts for each additional test. Adding just a few items to the basic panel would have driven the price to something above $1500.

I'm sure that there are labs that specialize in testing for athletes / fitness that offer reasonable rates and services targeted towards the athlete's needs but I haven't been able to find any.

Has anyone looked into doing this?

Also, if anyone has a reference or suggestions on what items are worth monitoring I'd love to hear about them.

I'm in the San Francisco bay area.

All the best,

sminar


What bloodwork values, or what physical ailments are you trying to monitor or prevent? If you are relatively young and healthy, there may be no need for additional bloodwork.

Sports physiology testing is becoming more common these days, and here's one of the better-known facilities in the US. Is this what you are looking for? Your post is vague about what you are really looking for.

http://www.ucdmc.ucdavis.edu/sportsmedicine/programs/performance_testing.shtml

Your primary care physician is probably reluctant to sign off on "additional" tests because he knows that it most likely will not be covered by your insurance. Or because he is your physician, not your coach, and he's not really interested in knowing whether your power at LT is 310 watts or 340 watts ;-).

Call me cynical, but for the kind of money you are likely to be spending it may be more worthwhile to hire a good coach. Most coaches have access to some sort of power-measuring device such as Powertap, and can give you a crude estimate of your LT power. It will not be accurate on an absolute basis, but probably consistent enough for you to measure your progress by using the same equipment for evaluation from one time to another.

If somebody were to give me a free assessment of my VO2max, LT power, etc etc etc at one of these established facilities I would be happy to have it done, but I would not know what to do with these numbers. I suppose I can compare my numbers with famous cyclists who have also been tested with similar accuracy.

Fortunately, one of the features of the UC Davis coaching program is:
"Interpretation of any physiological test performed (whether done here or at another testing site) by the athlete."

What bloodwork values, or what physical ailments are you trying to monitor or prevent? If you are relatively young and healthy, there may be no need for additional bloodwork.

My attitude is young and healthy but my body is 44 and asking for proactive assistance :)

I am generally healthy & reasonably fit. I have been focusing on improving my fitness the last 2 years after realizing that I could no longer rely solely on youth and enthusiasm :( . I started with riding (mostly MTB & trainer), core body work, some additional weight work, stretching and nutrition. After about 8 months of relatively unguided effort, I decided that if I was going to continue making an effort, I might as well get smart about it. I picked up Friel's book and promptly identified some critical training mistakes which I mostly avoid now. I'm training primarily to improve my overall fitness rather than training for a season of racing but I am working towards getting faster on the bike as well. I brought the road bike out of retirement at the beginning of summer (since replaced with a new bike) to have more control over my riding topology / workout as MTB in my area is nearly all climbing.

At a minimum, I'd like to track:
Hematocrit and Hemoglobin
Blood Glucose
Full Lipid Profile / Cholesterol
Various hormone levels
1 marker for cancer (symptom free for 20 years now)

I have not studied biochemical testing for athletic performance so I imagine there are many other useful values worth knowing about. I have heard there are markers for overtraining and nutritional assessment. I'd love to find out more about what's possible / what's reasonable.

I have a personal history of hematocrit values borderlining anemia. Not a good thing for cycling / endurance sports. I have been taking a low dose of iron the last 3 months or so and have noticed a performance improvement but I have no lab data to see how my hematocrit is tracking. I also have a history of some hormone levels being at the edge of the normal range. I have a family history of vitamin B12 deficiency. Other than that, cholesterol & blood pressure are generally excellent, resting pulse is in the high 40s and bood sugar values are fine.

I'm open to learning more about blood testing for athletes. If anyone has book or website suggestions, I'd love to hear about them.

Sports physiology testing is becoming more common these days, and here's one of the better-known facilities in the US. Is this what you are looking for? Your post is vague about what you are really looking for.

http://www.ucdmc.ucdavis.edu/sportsmedicine/programs/performance_testing.shtml

Thanks for the url! It's not what I was originally looking for but may be a better overall solution to my needs. I responded with another message giving a few more details about what my first thoughts/desires were, but I'm open to considering a coaching arrangement.

Your primary care physician is probably reluctant to sign off on "additional" tests because he knows that it most likely will not be covered by your insurance.
I could probably start several threads related to this topic alone. Getting a "full physical" under the various health plans I've had over the last 10 years has been a joke, frankly. The doctor is usually over scheduled and has little time for a thorough assessment. I typically get little more than a quick listen to the lungs, a look at the eyes, ears & mouth, a palpatation of the organs, time to ask a question or two and a slip for the blood draw. I never get a followup call after the lab results come back. I have to call to find out. (I see this as good & bad: good since nothing was drastic enough to inspire a call from the doctor, bad since I don't get any assessment / recommendations about proactive heath steps).

About 2 years ago I asked the phlebotomist if to send me copies of my lab results directly. I noticed a few things in the results so I requested copies of previous lab work. There are some trends in various values that I find interesting. I believe they are worth tracking and feel that improving them would be worthwhile. I have been supplementing and focusing on better nutrition as a first step

You are right about the GP being reluctant to add tests due to insurance issues. I understood and was willing to pay cash, as long as the fees were reasonable. It turns out that the fees from their associated lab are outrageous, often more than 10x the price from other sources. I find this is not uncommon in the medical world. Lot's of strange pricing models / anomolies.

I'm not willing to believe that my GP doesn't care about preventitive health / proactive efforts, but I do feel that it is not their priority and the time pressure they are under puts it further down the list. I do think some of their reluctance is due to their lack of expertise in the subject area. They are more focused on treating specific problems and watching for critical developing issues than helping a relatively healthy patient improve.

...it may be more worthwhile to hire a good coach....

This is probably the approach I should be taking. I have been shying away from this due to the cost / time commitment and because my needs seem minimal compared to someone who is competing. While I'd enjoy competing at some point, my family / life commitments make it a low priority for now. I'm just grateful that I can squeeze in training time at the moment.

If I can, I'd love to find a coaching situation where I go in for an initial assessment, develop a personal game plan and then return for followup assessments / plan tweaking as necessary say 1-4 times a year, perhaps with an online monitoring component. I am generally self motivated enough to follow a plan I've set, especially at the level I'm focusing on now.

I don't have any power measuring equipment (yet!) but I do use a Polar 725 to track my current Friel based plan. I'm improving, but I suspect I could improve at a faster rate.

My attitude is young and healthy but my body is 44 and asking for proactive assistance :)

I am generally healthy & reasonably fit. I have been focusing on improving my fitness the last 2 years after realizing that I could no longer rely solely on youth and enthusiasm :( . I started with riding (mostly MTB & trainer), core body work, some additional weight work, stretching and nutrition. After about 8 months of relatively unguided effort, I decided that if I was going to continue making an effort, I might as well get smart about it. I picked up Friel's book and promptly identified some critical training mistakes which I mostly avoid now. I'm training primarily to improve my overall fitness rather than training for a season of racing but I am working towards getting faster on the bike as well. I brought the road bike out of retirement at the beginning of summer (since replaced with a new bike) to have more control over my riding topology / workout as MTB in my area is nearly all climbing.

At a minimum, I'd like to track:
Hematocrit and Hemoglobin
Blood Glucose
Full Lipid Profile / Cholesterol
Various hormone levels
1 marker for cancer (symptom free for 20 years now)

I have not studied biochemical testing for athletic performance so I imagine there are many other useful values worth knowing about. I have heard there are markers for overtraining and nutritional assessment. I'd love to find out more about what's possible / what's reasonable.

I have a personal history of hematocrit values borderlining anemia. Not a good thing for cycling / endurance sports. I have been taking a low dose of iron the last 3 months or so and have noticed a performance improvement but I have no lab data to see how my hematocrit is tracking. I also have a history of some hormone levels being at the edge of the normal range. I have a family history of vitamin B12 deficiency. Other than that, cholesterol & blood pressure are generally excellent, resting pulse is in the high 40s and bood sugar values are fine.

I'm open to learning more about blood testing for athletes. If anyone has book or website suggestions, I'd love to hear about them.

Okay, well, to start, I would not put much stock in your Hematocrit result, outside of hematologists, most of us pay little attention to it, outside of correlation with your Hemoglobin. When diagnosing, or monitoring anemia, the Hemoglobin is a much more valuable and sensitive tool, Hematocrit values tend to fluctuate greatly due to hydration status. If you have a history of cancer, depending on the type, a marker may be useful in following you, and having one done yearly should be covered by insurance. Concurrently, a blood sugar test, and lipid panel should also be performed yearly at no cost to you. I would not worry about pursuing B12 testing, as it is expensive, and any changes as far as B12 deficiency will show up on a regular CBC. This should be performed semiannually or annually if your Hemoglobin (Hgb) result is borderline. You will be able to tell if you are experiencing a drop in your B12 levels by watching the MCV or Mean Corpuscular Volume level, if it is elevated, this signifies a macrocytosis, and if your Hgb is low, then you have a macrocytic anemia, which can be due to either B12 or Folate deficiencies, and then obtaining a B12 level is required. I would start with the other poster's suggestion of retaining a coach, I think you probably obtain much more meaningful data from that. The problem with monitoring blood values within the body, is that most of them will vary slightly, even hour to hour, which is why we provide for normal ranges. Having slight variations is normal, and may be hard to interpret, unless they are outside of the normal ranges. I hope this is of use to you, and I will be happy to answer any further questions you may have.

Per the other posters, you will gain a lot more from working on a training plan, with or without a coach, than from focusing on numbers in your blood profile. Most of what you list is subject to fluctuation, like Hct being very dependent on hydration level and lipids swinging significantly depending on whether you had that double cheese, stuffed crust pizza last night. These numbers are interesting to look at sometimes, but they are most typically RESULTS rather than CAUSES.

Per the other posters, you will gain a lot more from working on a training plan, with or without a coach, than from focusing on numbers in your blood profile. Most of what you list is subject to fluctuation, like Hct being very dependent on hydration level and lipids swinging significantly depending on whether you had that double cheese, stuffed crust pizza last night. These numbers are interesting to look at sometimes, but they are most typically RESULTS rather than CAUSES.

I appreciate your input. Your posts are often a great reality check.

I hope my posts haven't implied that I believe tracking my blood profile is a critical step in moving my fitness level forward. I deem it more of a nice-to-know / personal interest step. I do understand there's variability in the results and that specific numeric values are not always useful. I have a trend history of several of my own values that are right at the boundary of the "normal" range. Since I'm taking steps towards improving those values I feel it would be helpful to take a peek at how they are tracking from time to time. While I can't eliminate the variability in the results completely without becoming a lab experiment, following fasting protocols and using common sense can help smooth things out a bit.

If I'm going to have lab work done at some regular interval, say 1 to 4 times a year, I'd like to find a way to do it at reasonable cost and preferrably get some input/analysis towards improving my health. I'm interested to learn about other blood panels that are commonly studied among elite athletes. Perhaps there isn't anything that would be useful for me, but I'm curious about the possibilities.

I have been following a fitness plan the past 14 months. I haven't followed it perfectly and the plan itself is probably ripe for improvement, but I have seen clear results from my efforts. It's tailored towards my needs/goals, it's based largely on input from Friel's book with modifications based on a variety of input. I worked with a personal trainer early on to setup a good routine in the gym for weights, stretching & core work. I'm reasonably well read on the nutrition side of things and don't think I'm making big mistakes there, but it's probably an area worth tightening up on :D

It's been a productive 2 years. I'm much fitter, I'm faster and I'm having fun on both my MTB and my road bike. I'm looking forward to working smarter over the next year and beyond to see where I'll end up.

All the best,

sminar

Okay, well, to start, I would not put much stock in your Hematocrit result, outside of hematologists, most of us pay little attention to it, outside of correlation with your Hemoglobin. When diagnosing, or monitoring anemia, the Hemoglobin is a much more valuable and sensitive tool, Hematocrit values tend to fluctuate greatly due to hydration status. If you have a history of cancer, depending on the type, a marker may be useful in following you, and having one done yearly should be covered by insurance. Concurrently, a blood sugar test, and lipid panel should also be performed yearly at no cost to you. I would not worry about pursuing B12 testing, as it is expensive, and any changes as far as B12 deficiency will show up on a regular CBC. This should be performed semiannually or annually if your Hemoglobin (Hgb) result is borderline. You will be able to tell if you are experiencing a drop in your B12 levels by watching the MCV or Mean Corpuscular Volume level, if it is elevated, this signifies a macrocytosis, and if your Hgb is low, then you have a macrocytic anemia, which can be due to either B12 or Folate deficiencies, and then obtaining a B12 level is required. I would start with the other poster's suggestion of retaining a coach, I think you probably obtain much more meaningful data from that. The problem with monitoring blood values within the body, is that most of them will vary slightly, even hour to hour, which is why we provide for normal ranges. Having slight variations is normal, and may be hard to interpret, unless they are outside of the normal ranges. I hope this is of use to you, and I will be happy to answer any further questions you may have.

Thanks much for sharing your expertise. Greatly appreciated. I'll need to dig through my files to get the specific results, but generally my hematocrit & hemoglobin have been on the low side. I became aware of this 20 years ago after radiation therapy. I haven't pursued trying to get data from before the radiation so I don't know if that impacted the values. Since then, I have sometimes raised a flag for anemia in my lab results and the rest of the time been right at the low normal range. I'm a confirmed carnivore with an adequate red meat diet. I eat lots of green veggies & supplement with a good multivitamin. I started taking a low dose of iron (1/2 std dose every other day) about 10 weeks ago. I've noted a marked improvement in my lung function the past 5 weeks or so but I don't know if it's related to the iron or not. I've had no negative side effects from taking the iron, but I'm proceeding with caution.

From a performance standpoint, lung function is usually my limiter. I don't think it's a mechanical / functional problem as my FVC & VC are both excellent. I'm hoping that the last 2 years of effort has been successful at increasing capillary function, so given my lab work, history and performance experience, I'd guess that the slight anemia is a possible factor.

The B12 issue is a touchy issue. My maternal grandfather, my mom & my sister all suffer from pernicious anemia. None of them have macrocytic MCV values. My mom & sister both have auto-immune issues. My grandfather's health got so bad about 10 years ago that we thought he wouldn't survive the year. He was diagnosed with Parkinson's disease and severe depression. Several physicians adamantly ruled out pernicious anemia based on his normal MCV values. An uncle finally coerced the doctor into trying a B12 injection. He experienced an unbelievably miraculous overnight recovery. He was a different person in 24 hours and with continued B12 injections he's enjoyed a very healthy and productive life. He started with injections once a month and is now up to once a week, but at 89 years old he's bright, happy & healthy.

Since that experience, physicians have encouraged his descendants to watch for pernicious anemia. My mom & my sister both get B12 injections and have a marked improvement in their lack of fatigue as well as other related symptoms.

This time last year I shared this bit of history with my GP at my annual physical and was somewhat surprised to get little support in my attempt to rule out B12 deficiency as a factor in my health. My MCV values are pretty normal, but so are my grandfather's, mom's and sister's. As you mentioned, more conclusive labwork is pretty pricey. I've been told that the best course of action is to ask for a B12 injection rather than lab work. B12 injections are cheap and fairly innocuous. I have not pursued this but I'm tempted to followup at my next physical.

Aside from the above issues, my curiousity is picqued regarding blood monitoring in elite athletes. I know that it's done, if for no other reason than to ensure hematocrit doesn't rise about the magic level suggestive of EPO or blood packing. I assume that precise LT values are monitored with some regularity. Are there other values that are examined frequently / infrequently?

Thanks much for sharing your expertise. Greatly appreciated. I'll need to dig through my files to get the specific results, but generally my hematocrit & hemoglobin have been on the low side. I became aware of this 20 years ago after radiation therapy. I haven't pursued trying to get data from before the radiation so I don't know if that impacted the values. Since then, I have sometimes raised a flag for anemia in my lab results and the rest of the time been right at the low normal range. I'm a confirmed carnivore with an adequate red meat diet. I eat lots of green veggies & supplement with a good multivitamin. I started taking a low dose of iron (1/2 std dose every other day) about 10 weeks ago. I've noted a marked improvement in my lung function the past 5 weeks or so but I don't know if it's related to the iron or not. I've had no negative side effects from taking the iron, but I'm proceeding with caution.

From a performance standpoint, lung function is usually my limiter. I don't think it's a mechanical / functional problem as my FVC & VC are both excellent. I'm hoping that the last 2 years of effort has been successful at increasing capillary function, so given my lab work, history and performance experience, I'd guess that the slight anemia is a possible factor.

The B12 issue is a touchy issue. My maternal grandfather, my mom & my sister all suffer from pernicious anemia. None of them have macrocytic MCV values. My mom & sister both have auto-immune issues. My grandfather's health got so bad about 10 years ago that we thought he wouldn't survive the year. He was diagnosed with Parkinson's disease and severe depression. Several physicians adamantly ruled out pernicious anemia based on his normal MCV values. An uncle finally coerced the doctor into trying a B12 injection. He experienced an unbelievably miraculous overnight recovery. He was a different person in 24 hours and with continued B12 injections he's enjoyed a very healthy and productive life. He started with injections once a month and is now up to once a week, but at 89 years old he's bright, happy & healthy.

Since that experience, physicians have encouraged his descendants to watch for pernicious anemia. My mom & my sister both get B12 injections and have a marked improvement in their lack of fatigue as well as other related symptoms.

This time last year I shared this bit of history with my GP at my annual physical and was somewhat surprised to get little support in my attempt to rule out B12 deficiency as a factor in my health. My MCV values are pretty normal, but so are my grandfather's, mom's and sister's. As you mentioned, more conclusive labwork is pretty pricey. I've been told that the best course of action is to ask for a B12 injection rather than lab work. B12 injections are cheap and fairly innocuous. I have not pursued this but I'm tempted to followup at my next physical.

Aside from the above issues, my curiousity is picqued regarding blood monitoring in elite athletes. I know that it's done, if for no other reason than to ensure hematocrit doesn't rise about the magic level suggestive of EPO or blood packing. I assume that precise LT values are monitored with some regularity. Are there other values that are examined frequently / infrequently?


That is unusual to have normal MCV values in the face of pernicious anemia, not unheard of, but fairly rare. Your anemia may have nothing to do with B12 if you have had previous radiation, obviously, without a great more deal of information, I could not tell you for sure. but if you have had radiation to any of your bones, this may in fact be causing this borderline anemia, and I'm not sure anything can be done about that with the exception of EPO injections to boost cell production. Elite athletes, from my experience, do very little monitoring of their blood testing, with the exception of required testing for doping or packing as you have alluded to. Most actually focus more on power meters, heart rates, LT, etc. A high hemoglobin of course will help you do better, but so will a low resting heart rate. And to me at least, Kerry can correct me if I'm wrong, but I put little stock in all of those numbers, because the most important factor in athletic performance cannot be quantified, and that is heart or desire, because at the elite level, they all have pretty comparable numbers, it's the drive that separates them.

I'm not a medical professional and so can't comment on the specifics of your blood profile and medical history. However, it seems like your doctor is telling you the same thing that the rest of us are telling you: your blood profile is not that big a deal. You say that you'd like "to have lab work done at some regular interval, say 1 to 4 times a year" and that you'd "like to find a way to do it at reasonable cost and preferrably get some input/analysis towards improving [your] health." Most people do just fine getting blood work done every other year, so you are thinking about somewhere between 2 and 8 times that frequency. It seems to me that you are overly focused on this, wanting 4 blood tests per year while you're being told that you really can't learn much from this blood work. Getting a good price on something that isn't all that useful is still not a good deal. It's good to have these conversations, but without some specific reason to pursue this idea, it seems like it would be a waste of money. You don't seem to have said "specific reason."

I'm not a medical professional and so can't comment on the specifics of your blood profile and medical history. However, it seems like your doctor is telling you the same thing that the rest of us are telling you: your blood profile is not that big a deal. You say that you'd like "to have lab work done at some regular interval, say 1 to 4 times a year" and that you'd "like to find a way to do it at reasonable cost and preferably get some input/analysis towards improving [your] health." Most people do just fine getting blood work done every other year, so you are thinking about somewhere between 2 and 8 times that frequency. It seems to me that you are overly focused on this, wanting 4 blood tests per year while you're being told that you really can't learn much from this blood work. Getting a good price on something that isn't all that useful is still not a good deal. It's good to have these conversations, but without some specific reason to pursue this idea, it seems like it would be a waste of money. You don't seem to have said "specific reason."

"Most" people sit on the couch and exercise the almighty remote control rather than set and work towards fitness goals. I can't believe any of us that are reading/writing here are striving to be like most people. :D I don't think I stated that I "wanted" 4 blood tests per year, just implied that I was willing if there was value in it. I'm interested in learning more about blood testing but it's not my focus. I think you can see from my posts that I've set goals, made and followed a training plan, worked on eating right, etc. My efforts have been fruitful so far and I hope (scratch that) plan to continue improving my health/fitness & cycling performance. I believe in working smart. I'm willing to work hard but I want to get the best for my time & effort.

If I could re-write this thread to illicit a different response I probably would. Perhaps I was a bit vague and/or broad in my earlier posts. While I've greatly appreciated the input, it wasn't my initial intention to acquire specific help regarding my lab work. I disagree with the notion "that you really can't learn much from this blood work." I don't think you mean this as a blanket statement but it could come across that way. Basic blood testing is part of most routine physicals which are commonly recommended as a once-a-year event. Once a year seems to be a no-brainer. Perhaps your reticence comes from my interest in the value of more frequent testing.

I think there are two directions we could take: one that is more focused on my specific needs/interests and another that makes it interesting for a wider audience.

Let me summarize my self-assessment and then attempt to ask some questions that might be more interesting for everyone.

For myself, I need to have lab work done at least once a year if for no other reason than to monitor a cancer marker. I have been watching a trend in several blood values which have garnered my personal attention and that of my medical professionials. One of these is borderline anemia which most certainly affects my performance capability. I have been taking nutritional steps in attempt to "solve" the anemia issue. I feel that there may be value in blood testing at a more frequent interval than once a year for tracking the success/failure of my nutritional efforts but I'm not committed to any specific frequency above and beyond once a year. As long as I'm having blood drawn for the basic necessary testing, I'm curious if there are other tests of value for health & fitness that are worth considering. I'd like to do this as cheaply as possible yet receive analysis of the results by experts in preventitive health & fitness which is what led me to ask for help in learning about lab options.

For a more general discussion, I have read / heard the following:

1) There are blood test panels that can help you assess your nutritional needs/failures.

2) There are markers in the blood that are clear indications of overtraining.

Are these true statements? If so, is it worth pursuing? Has anyone already been down this path? What was their experience? In addition, I'm curious to learn more about how coaches monitor the biological status of their athletes.

I just got out of the lab/pathology field in the army, and there is a simple answer to your question. Just go to the doctor, and tell him what labs you want ran. Everything you asked for is just a simple hematology or chemistry lab question, and any doctors office should do it. They will just end up running a chem 17, and a CBC...but you should get all the results you need cheap. Most cancer markers can be seen micro or get flagged in a CBC (complete blood count) or you can run them on a special chemistry machine...like for prostate etc. But if you have any specific questions you want answered in lamemans terms just ask. BTW my wife is still in the lab for the army, and we both have our degree in laboratory health sciences from GWU so hopefully we can put you in the right direction. Hope this helps at all.

AJ

I just got out of the lab/pathology field in the army, and there is a simple answer to your question. Just go to the doctor, and tell him what labs you want ran. Everything you asked for is just a simple hematology or chemistry lab question, and any doctors office should do it. They will just end up running a chem 17, and a CBC...but you should get all the results you need cheap. Most cancer markers can be seen micro or get flagged in a CBC (complete blood count) or you can run them on a special chemistry machine...like for prostate etc. But if you have any specific questions you want answered in lamemans terms just ask. BTW my wife is still in the lab for the army, and we both have our degree in laboratory health sciences from GWU so hopefully we can put you in the right direction. Hope this helps at all.

AJ

High AJ,

Thanks much for the post! Insurance issues complicate the cost of having blood chemistry done. I have a high deductible policy, so I'm sensitive to the price asked by the lab associated with my GP. This time last year I had a basic panel, which I believe was exactly a CBC and chem 17. The lab "retail" price was in excess of $650 which I thought was outrageous. This amount gets knocked down to the negotiated rate which was about 1/3 of the retail. At the time, I inquired about some additional testing and was quoted (a non negotiated rate) more than $1500. I assume that would have meant about $500 out-of-pocket which seems pretty high to me. I have been hoping to find a solution that is more cost effective and hassle free. I thought there might be labs out there that tailor services and pricing to athletes / others. Another possibility I've considered looking into is health/fitness/athletic performance research projects that are going on in my area. Perhaps they would like another willing subject.

Insurance cost / hassle is out of hand, at least in CA. I had the family (6 of us) on a basic HMO plan 5 years ago for ~500/mo. When they bumped the premium to $1284/mo in 2003 I changed horses to the high deductible. My overall cost is much less now, but I'm more sensitive to using medical services.

I appreciate the offer of additional info and may take you up on it. I'm determined to solve my borderline anemia, preferably through non-prescription means. I'm also determined to get a definitive answer about pernicious anemia.

All the best,

sminar

Just curious, but what is your basis for "outrageous"? Did you get prices from somewhere else that are much cheaper? Agreed, $1,500 is a lot of money. Is $1,500 unreasonable for what you're asking?

There are sports-specific testing facilities out there, and yes they are expensive, I wouldn't expect them to be any cheaper than your doctor--maybe more expensive. The facilities I'm familiar w/ cater to more serious athletes where they have to put up a good chunk of $$ and feel it's worth it.

Here's the type of place I'm talking about:
http://sportsmedicine.upmc.com/ServicesCyclingPerform.htm

Sports physiology testing is becoming more common these days, and here's one of the better-known facilities in the US. Is this what you are looking for? Your post is vague about what you are really looking for.

http://www.ucdmc.ucdavis.edu/sportsmedicine/programs/performance_testing.shtml

Your primary care physician is probably reluctant to sign off on "additional" tests because he knows that it most likely will not be covered by your insurance. Or because he is your physician, not your coach, and he's not really interested in knowing whether your power at LT is 310 watts or 340 watts ;-).

Call me cynical, but for the kind of money you are likely to be spending it may be more worthwhile to hire a good coach. Most coaches have access to some sort of power-measuring device such as Powertap, and can give you a crude estimate of your LT power. It will not be accurate on an absolute basis, but probably consistent enough for you to measure your progress by using the same equipment for evaluation from one time to another.

If somebody were to give me a free assessment of my VO2max, LT power, etc etc etc at one of these established facilities I would be happy to have it done, but I would not know what to do with these numbers. I suppose I can compare my numbers with famous cyclists who have also been tested with similar accuracy.

Fortunately, one of the features of the UC Davis coaching program is:
"Interpretation of any physiological test performed (whether done here or at another testing site) by the athlete."

I've been talking to my primary care physician about getting a referral to UCD (my alma mater, too, class of '90), to see if my insurance will cover it. Fortunately, UCD is part of my hmo group, so it's a bit simpler for me. But it might be worth a phone call or two to explain your background to someone at UCD, or a similar program near you, and explain your history, and ask for help in how to get insurance coverage for what you want.

The second issue which seems to underlie this thread is you don't seem real pleased with the feedback you're getting from your primary doctor. Might be time to look into switching primaries. I bounced around a bit until I found the guy I like, and it's made a big difference.

Just curious, but what is your basis for "outrageous"? Did you get prices from somewhere else that are much cheaper? Agreed, $1,500 is a lot of money. Is $1,500 unreasonable for what you're asking?

There are sports-specific testing facilities out there, and yes they are expensive, I wouldn't expect them to be any cheaper than your doctor--maybe more expensive. The facilities I'm familiar w/ cater to more serious athletes where they have to put up a good chunk of $$ and feel it's worth it.

Here's the type of place I'm talking about:
http://sportsmedicine.upmc.com/ServicesCyclingPerform.htm

Great question!

First, let me make sure that we are comparing apples to apples. The $1500+ pricing I was given was for blood work only. No sports-focused testing or analysis was included in that price. The results would have included basic CBC, cholesterol, a few hormone levels and a cancer marker. I asked about a specific test related to B12, but I can't remember if that was part of the price quote.

I could use some help here as I don't have any solid pricing to compare to. Perhaps I have no good basis for better pricing.

I think my belief that better prices are out there comes from a few factors:

1) I asked for my blood type at my last blood draw and was told that it would cost me $150. When you donate blood, generally they will tell you your blood type for free.

2) I recall local pharmacies offering inexpensive basic blood testing for cholesterol and blood sugar. I think it was $25, but I could be mistaken.

3) I've always disliked the "price high, take the negotiated rate" pricing strategy common in medicine. I presume (perhaps this is dangerous) they can make money at the negotiated rate. I'm offended when they quote 3x the negotiated rate. I would prefer to deal with straightforward pricing.

4) I have found that quite often medical services & supplies are cheaper outside of the doctor's office / hospital setting.

5) I don't have an accurate understanding of the time & material costs associated with the labwork, but my suspicion is that the common tests are largely automated and fairly inexpensive to perform. I'm sure that some tests are highly labor intensive, require expensive materials and machinery. Perhaps one of the items I requested was in that category.

6) Others have told me that I can get lab services for more reasonable pricing.

7) I heard a nutrition expert give a talk where he mentioned that a full nutritional analysis from bloodwork could be had for $195. He didn't outline the specifics of the lab work but stated that you would have a very useful view of your personal nutritional status and how you might eat and supplement better. Assuming that the tests are of the value he implied, I thought the service was quite reasonably priced.

I'd love to get a better feel for the real costs associated with lab work. Perhaps AJ or physasst could chime in with a more accurate assessment.

I've been talking to my primary care physician about getting a referral to UCD (my alma mater, too, class of '90), to see if my insurance will cover it. Fortunately, UCD is part of my hmo group, so it's a bit simpler for me. But it might be worth a phone call or two to explain your background to someone at UCD, or a similar program near you, and explain your history, and ask for help in how to get insurance coverage for what you want.

The second issue which seems to underlie this thread is you don't seem real pleased with the feedback you're getting from your primary doctor. Might be time to look into switching primaries. I bounced around a bit until I found the guy I like, and it's made a big difference.

Switching doctors is on my todo list! My doctor is fine for the basics and likely for more serious issues as well but my doctor just doesn't have time to do preventitive healthcare or help someone strive for excellent health. Switching is problematic though. I live in a smallish town in the bay area. There aren't many doctors here so I'll likely have to travel a bit. The clinic is where the whole family goes so it's quite convenient... I did have an exceptional GP there many years ago. There's been a lot of turnover.

I like your idea about calling UCD for help. I may also check the local university programs to see if there's a good match.