[smath]

One thing I’ve wondered is why getting a diagnostic test done out of pocket in the US of your own volition (without a doc prescription) isn’t possible. Why does it need to be controlled by a doc and insurance?

In India this is common. They probably use the same expensive machines for x rays and MRIs but anyone can walk in, and pay for a diagnostic test and get numbers (well, not everyone can afford it, but generally middle class folks can). I’m not saying the healthcare system in India is great, but this distinction intrigues me. Maybe the volumes are much higher in India so the diagnostic center can recoup costs? Are there laws preventing this business model in the US?

[benrapscallion]

Some of these imaging that are overdone in India involve radiation: the most problematic being (not low dose) CT. So there is a rationale for controlling these modalities.

[AnotherGoodName]

A Doctors refferal for preventative tests are easy though. I've done this in the USA fwiw due to a family member having a heart attack at a very young age. Go to a doctor and state "I have risk factors for heart disease and would like a reference to https://stanfordhealthcare.org/medical-clinics/preventive-ca... ". Other hospitals (eg. Mayo clinic) have similar programs.

Any decent doctor should agree to this. Once you have a reference you'll be put through a battery of tests. Blood tests, ECG, ultrasound, etc. A lot of it was covered by insurance anyway but it was out of network for me. That didn't matter to getting the reference though. The tests they do are all non-invasive and not risky in the first phase so definitely worth doing.

[username135]

Its not impossible to get diagnostic tests done outside the scope of a GP. It's generally very expensive.

[2Gkashmiri]

I get a 6 monthly KUB ultrasound and xray for around 1k inr which is around us$10. If I go to a government hospital and ask the emergency doctor for a test when there is a lean time for them, they prescribe the test and its done for a hundred bucks or $1.

[smath]

My impression (might be wrong) is that one can get this for some subset of blood tests but not say an MRI or x ray, let alone more complex tests. Are these just insurance company rules? If I found a way to make it profitable can I open a diagnostic lab independent of insurance companies?

[wrs]

Diagnostic labs are just for-profit companies. They’re happy to do tests as long as they get paid by somebody. The only practical restrictions are if you want to convince insurance to pay for it. If you’re paying cash, you can get anything from a simple blood test up to a full-body MRI scan [0].

I got a CT angiogram from a cardiologist here who started her own business specifically to do them. (It’s just her, a nurse, and a CT machine, in a trailer in a parking lot!) Insurance doesn’t pay for imaging like this until things have already gone very wrong, and she feels it should be used much earlier for people who have risk factors.

[0] https://prenuvo.com/

[LorenPechtel]

CT is radiation. This is a case where too much testing is detrimental, not merely wasteful. You're sucking up 4 years worth of background for that CT angiogram.

[wrs]

I agree, it’s not recommended to get CTs on a whim. I have high risk factors, a high calcium score, and a bad family history, so getting the data to guide our mitigation approach was worth it.

[AnotherGoodName]

The preventative heart health program i linked above at Stanford does an echocardiogram calcium score rather than a CT scan for the first phase. Saves you from radiation unless they see something that warrants it.

It is no issue at all to ask for and receive an echocardiogram referral since it has no risk, just ask for a referral.

The unwillingness to do anything involving radiation unless warranted seems reasonable. Just do the echocardiogram and go from there.

[username135]

You can have those tests done, it's just timing and cost.

For example: https://radiologyassist.com/MRI.html