I recently went to Quest Diagnostics for a TB test and a couple of basic labs my doctor ordered. At check-in, I recalled my insurance had changed in the new year and I did not have the updated information readily available. I did not have time to reschedule nor sort it out so figured I could pay cash and reconcile it later. That seemed reasonable, if inconvenient.
When I asked what the cash price would be, no one could tell me. The phlebotomist tried to look it up, apologized, and explained that pricing was difficult to determine but looked like it would be over $900. That number was framed as an estimate rather than a certainty. What stood out was not only the cost, but the ambiguity surrounding it. At no point could anyone say, with confidence, what I would ultimately be charged.
Standing there, I stepped aside and ordered the same tests through a clinician-facing platform that allows licensed clinicians to order labs outside of the insurance system with transparent, upfront pricing. The total cost was $78. The tests were identical including the phlebotomist and the lab processing them. The only meaningful difference was the payment pathway. Within 20 minutes, I had them drawn and was out the door.
Why patients seek alternative pathways
This experience clarified a broader pattern many doctors have observed for years: Patients are increasingly seeking alternative avenues, not only to access laboratory testing, but to access care itself.
Physicians are often uneasy when patients arrive with self-ordered labs or care obtained outside traditional systems, and that discomfort is understandable. Diagnostic testing without clinical context can mislead, provoke anxiety, and generate unnecessary downstream care. Pretest probability, history, and interpretation matter. They are also increasingly difficult to explain in a society that demands answers faster than ever.
Unfortunately, accessing high-quality care in the traditional, physician-guided manner has become increasingly difficult. Cost is one barrier, but it is not the only one. Appointments are harder to obtain and more transactional than ever. On top of that, people have several concerns that may or may not be related but insurance barriers create time restrictions such that a physician can barely address one issue, let alone the list that most people have saved up for their visit.
In this environment, patients are not simply seeking convenience; they are seeking certainty, clarity, and predictability. They want to know what they are purchasing, how much it will cost, and what to expect in return.
The appeal of intelligibility
What distinguishes many alternative care pathways, whether direct-pay clinics, subscription models, or non-insurance-based platforms, is not necessarily superior medicine, but intelligibility. Prices are posted. Timelines are clear. The transaction makes sense. For patients navigating chronic symptoms, limited energy, or financial constraints, that clarity can feel stabilizing.
At the same time, transparency does not replace clinical judgment. Physicians are trained not only to decide which tests to order, but which tests not to order, and how to interpret results within the broader context of a patient’s health. When that guidance is absent, data can quickly become noise. The irony is that the system designed to support careful, evidence-based care increasingly prices patients out of accessing it.
Uncertainty on both sides of the counter
Standing at the lab counter, I was struck by how familiar this uncertainty felt from the physician side of the system. Physicians routinely provide care without knowing what reimbursement will ultimately be, if any. Payment varies by insurer, contract, and billing interpretation, often months after the encounter. This unpredictability is one reason many physicians are leaving insurance-based practice altogether. A system that obscures cost on both sides of the transaction erodes trust and sustainability for everyone involved.
Patients are not turning to alternative lab-ordering or care pathways because they want to practice medicine on themselves or bypass expertise. They are responding to a system that has normalized delay, opacity, and financial unpredictability. When even a physician cannot obtain a clear answer about pricing at the point of care, it becomes easier to understand why patients gravitate toward models that offer clarity, even if those models are imperfect.
The issue is not patient behavior. It is a health care economy that has accepted opacity as a feature rather than a failure. That acceptance deserves scrutiny.
Sally Daganzo is an internal medicine physician whose work bridges rigorous scientific inquiry with compassionate, whole-person care. Through her concierge-style practice, she partners with individuals seeking to understand the root causes of complex or unexplained symptoms, restore balance, and cultivate long-term physical and mental well-being. Patients can learn more about her clinical approach on her website or connect with her on Facebook, LinkedIn, and Instagram.
Dr. Daganzo is affiliated with the California Pacific Medical Center, where her interests span internal medicine, psychopharmacology, and integrative strategies that support mind–body resilience. Her academic background includes case-based publications such as “Pot Shots: Cannabis Arteritis of the Digits,” “Cold Case: Bedside Diagnosis of Mycoplasma Pneumonia,” and “Chickenpox in a Vaccinated Adult.” Her earlier scientific work includes contributions to radiation oncology and chromatin biology, including studies on pediatric primitive neuroectodermal tumors, the structure and function of the histone deposition protein Asf1, and the formation of MacroH2A-containing senescence-associated heterochromatin foci. Her clinical insight is further reflected in observations such as “Young Woman with Yellow Palms.”
Across all areas of her work, Dr. Daganzo is committed to providing thoughtful, evidence-informed, and individualized care to patients seeking clarity and vitality.
