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SethInMI

a brief tale of costing an MRI

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A short tale of the challenge of finding out how much I would have to pay for an MRI (the US health care system is weird).

Back in July I was having some low back issues, doctor recommended an MRI. Since I have an health plan with a $8k deductible, I wondered how much I would have to pay for it.

First I called the hospital where the MRI was scheduled. I gave them the code for the procedure, they said it would be $2300, but to get the price I would pay I would have to call the insurance company. I called the insurance company (BlueCross/BlueShield). I was told they can’t tell me what the cost will be, I have to call the hospital.

Then I found the bc/bs website had a "estimate costs" link so logged in with my plan code. Searched prices for MRI, found it was $342.00 . I called bc/bs back and asked them about the website. They had no idea it existed.

The day before the MRI I got a call from the hospital. They said they estimated my cost at $1743 for the procedure, based on my insurance coverage. I asked her why the bc/bs website said $342. She did not know, she did say bc/bs will also factor in an additional in-network discount but she could not tell me what that was, so the actual payment would be less than $1743, but not $342.

So I had the MRI, and yesterday I finally got the bill. Total cost before in-network adjustment :$2688. After in-network adjustment, I had to pay $336, which is like 87% off the "list" price, which is crazy, and it just strikes me as odd that even though the hospital and ins. co. must have negotiated the rates, no person at either facility had access to that information.

I am really happy I only had to pay $336 for an MRI, and I am sure glad I found someone made a website with accurate prices so I knew that upfront.


Seth
It's flare not flair, brakes not breaks, bridle not bridal, "could NOT care less" not "could care less".

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SethInMI


So I had the MRI, and yesterday I finally got the bill. Total cost before in-network adjustment :$2688. After in-network adjustment, I had to pay $336, which is like 87% off the "list" price, which is crazy, and it just strikes me as odd that even though the hospital and ins. co. must have negotiated the rates, no person at either facility had access to that information.

I am really happy I only had to pay $336 for an MRI, and I am sure glad I found someone made a website with accurate prices so I knew that upfront.


Seth


So, basically you have a health insurance plan and still have to pay $336, which is what a fair price would be for an MRI in a reasonable world.

I have a friend who is severely disabled and has straight Medicaid with no out of pocket costs. The insurance company is only billed between $200 - $300 depending on the type of MRI.

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SethInMI

***The reason is "Chargemaster".
Entertaining explanation: https://www.youtube.com/watch?v=CeDOQpfaUc8



:S>:( That is some grim humor right there. The "out of network" concern is scary.

A few years back, over an 18 month period, I had 3 unrelated minor out-patient surgeries. When I looked over the billing paperwork afterward, I knew something like this must be happening. In one case, what the insurance paid the hospital was one seventh the "list" price! I only learned about the "Chargemaster" name for it very recently.
"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

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SethInMI

A short tale of the challenge of finding out how much I would have to pay for an MRI (the US health care system is weird).

Back in July I was having some low back issues, doctor recommended an MRI. Since I have an health plan with a $8k deductible, I wondered how much I would have to pay for it.

First I called the hospital where the MRI was scheduled. I gave them the code for the procedure, they said it would be $2300, but to get the price I would pay I would have to call the insurance company. I called the insurance company (BlueCross/BlueShield). I was told they can’t tell me what the cost will be, I have to call the hospital.

Then I found the bc/bs website had a "estimate costs" link so logged in with my plan code. Searched prices for MRI, found it was $342.00 . I called bc/bs back and asked them about the website. They had no idea it existed.

The day before the MRI I got a call from the hospital. They said they estimated my cost at $1743 for the procedure, based on my insurance coverage. I asked her why the bc/bs website said $342. She did not know, she did say bc/bs will also factor in an additional in-network discount but she could not tell me what that was, so the actual payment would be less than $1743, but not $342.

So I had the MRI, and yesterday I finally got the bill. Total cost before in-network adjustment :$2688. After in-network adjustment, I had to pay $336, which is like 87% off the "list" price, which is crazy, and it just strikes me as odd that even though the hospital and ins. co. must have negotiated the rates, no person at either facility had access to that information.

I am really happy I only had to pay $336 for an MRI, and I am sure glad I found someone made a website with accurate prices so I knew that upfront.

Mine didn't cost a cent. Nor did the 30k surgery. 25k just for the operating room for a couple hrs. Join a union. :o

Seth


I hold it true, whate'er befall;
I feel it, when I sorrow most;
'Tis better to have loved and lost
Than never to have loved at all.

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akarunway


Mine didn't cost a cent. Nor did the 30k surgery. 25k just for the operating room for a couple hrs. Join a union. :o



You are lucky, not all unions are that way. My wife is in a teachers union, and sure 15 years ago it was no deductible & no premiums, but not now. I think we could have a low / no deductible plan through her work, but the premiums would be like $6K more than we pay now. No thanks.
It's flare not flair, brakes not breaks, bridle not bridal, "could NOT care less" not "could care less".

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When I broke my ankle the retail costs before discounts and adjustments for the ambulance ride, two days in hospital, two surgeries, and one ER visit when I thought I was stroking out was over 250k dollars.

The health care industry can straight up go fuck themselves.

They deserve what ever crushing regulations are dealt to the whole bunch, from the hospitals to the insurers. >:(

"The restraining order says you're only allowed to touch me in freefall"
=P

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Well without wandering into Speakers Corner to far. trump made a couple promises to go after the excessive costs of the US "Medical Industrial Complex" (quote mine). Some industry lobbyists must have got to him.

$336 is a decent price but there are people that get scammed by hospitals, insurers and the industry. Those who don't understand how it works.

" about 643,000 Americans declared bankruptcy annually due to medical bills."
http://www.snopes.com/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/

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DougH

When I broke my ankle the retail costs before discounts and adjustments for the ambulance ride, two days in hospital, two surgeries, and one ER visit when I thought I was stroking out was over 250k dollars.

The health care industry can straight up go fuck themselves.

They deserve what ever crushing regulations are dealt to the whole bunch, from the hospitals to the insurers. >:(



I don't understand how you guys do it down there.

I broke my fibula - didn't take an ambulance, but my out of pocket expenses for the whole thing amounted to about a couple hundred bucks for two trips to the ER, surgery, follow ups at the fracture clinic, and a year of physiotherapy.

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SethInMI

***
Mine didn't cost a cent. Nor did the 30k surgery. 25k just for the operating room for a couple hrs. Join a union. :o



You are lucky, not all unions are that way. My wife is in a teachers union, and sure 15 years ago it was no deductible & no premiums, but not now. I think we could have a low / no deductible plan through her work, but the premiums would be like $6K more than we pay now. No thanks.Was working non union in Fl. B4 joining union in Ca. United Healthcare. Femuredin. Not a cent payed on that one either. Just depends I guess.
I hold it true, whate'er befall;
I feel it, when I sorrow most;
'Tis better to have loved and lost
Than never to have loved at all.

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I audit medical billing records for a living. We are a third party vendor hired by the insurance company ( most of the big guys, including BCBS) to go through their records and contracts with different providers and find all the times they paid out too much. It is literally all the time, neither the hospital nor the insurance Co really know how much you should get charged and there is tons of variation. Often for in network providers the insurance companies pay about 10%-15% of billed charges or even less if a per diem is applicable.

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one page piece of legislation to solve a lot of these problems. "Thou shalt publicly and accessibly publish all your rates for all procedures"

problem solved. we would at least have competition and the ability to shop around. If we are going to stay with a private insurance system, the least we can do is be able to know what the prices are.

New businesses would spring up to shop a hip replacement for example, given that a surgery like that is a pretty standard set of things that one could expect. Sure there are extras, but that is case by case... The major items could easily be compared and customers could find the best deal for their situation.

The better fix is medicare for all. Merge the VA, the medicare and medicaid systems into one, and offer it to everyone. That would be some competition that would drive down prices I expect. Combine with some torte reform as well.

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I personally negotiated an MRI years ago after the insurance company denied the coverage, but only right before the appt. The MRI clinic of course then was left with an opening they could not fill. They wanted something like $1400. I ended up getting it for $375 or so, cash. I have done that with other procedures as well over the years, but generally small stuff, not major surgeries or admissions.

I thought it was weird, even then, that I was negotiating with the 'business manager' at the location and thought 'how fucking weird that an MRI clinic has a business manager', but of course, in this fucked up healthcare system it makes total sense.

But sometimes you get a break just by saying "Fuck no, I am not paying that" when you get presented with a bill. After I broke my neck 16 years ago, my credit was destroyed by several small bills from companies that I had never heard of or had any idea what they did for me. Some of those bills were actually paid, and even though I proved it to them, it took 12-18 months to fix the credit report damage.

Other companies I simply threatened with legal action if they did anything to harm my credit report, and some were then willing to negotiate. I told a bunch of debt collectors to go fuck themselves. Even 7 years later, there were things following me around. I had a file 8 inches thick full of statements and bills within 6 months of the accident.

Anyone who thinks that this is a good system, or thinks that your average american can manage that sort of burden of paperwork is simply naive to how the system really works. It is a great system as long as you can afford it and ONLY if you can afford it.

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tkhayes


The better fix is medicare for all. Merge the VA, the medicare and medicaid systems into one, and offer it to everyone. That would be some competition that would drive down prices I expect. Combine with some torte reform as well.



Absolutely!
Single-payer makes sense, but I've never understood why the hell the US tries to maintain an entire parallel separate single-provider system for vets. Why is it not already operated just as an insurance provider for them???:S
"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

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ryoder

***
The better fix is medicare for all. Merge the VA, the medicare and medicaid systems into one, and offer it to everyone. That would be some competition that would drive down prices I expect. Combine with some torte reform as well.



Absolutely!
Single-payer makes sense, but I've never understood why the hell the US tries to maintain an entire parallel separate single-provider system for vets. Why is it not already operated just as an insurance provider for them???:S

Oh come on, you're a smart guy, you know the answer!
https://www.opensecrets.org/lobby/top.php?indexType=i
https://www.opensecrets.org/lobby/indusclient.php?id=F09

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The system is definitely fucked. Last year my wife had reached her limit on out of pocket so for the rest of the year everything should be covered 100%. She needed to go to a new clinic for a specific test. She called Cigna and was told yes that clinic is in your network. After the procedure Cigna denied the claim. " Well yes the clinic is in your network but not the particular doctor at that clinic that did the procedure. "

Fuck you very much Cigna. We tried arguing it but the system is totally screwed up when trying to fight with the insurance company.
You can't be drunk all day if you don't start early!

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Iago

****** Canadians... (snip) ...also have a parallel private health system that operates outside the national service, just like the insurance network that is used here in the US.



Could you kindly elaborate?

All these countries have private health insurance for sale. It's not all straight single-payer NHS.

Here in the US we have public primary and secondary education.
But some wealthy people choose to send their kids to private schools.
So this means we don't really have public education?
"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

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Iago

****** Canadians... (snip) ...also have a parallel private health system that operates outside the national service, just like the insurance network that is used here in the US.



Could you kindly elaborate?

All these countries have private health insurance for sale. It's not all straight single-payer NHS.

I can only speak from my own experience. We have private insurers that offer incidental policies that cover various things like prescription eye glasses, routine dental, some med's not prescribed in out-patient care.

None of these insurance offerings change my place in queue for any medical procedure or test. None of these offerings provide alternative medical treatments or an alternative medical system. I do not need to subscribe to these private offerings to access any or all of the best medical care provided in Canada.

I can't speak to the other nations you made claim of.

Incidentally: for comparison, I required an ambulance in my hometown just 6 weeks ago. I also needed an ambulance in Eloy in January 2016.

My ambulance ride in Arizona (03/16) - $1500 USD.
My ambulance ride in Canada - $65 (apprx $52 USD)

Had an MRI done in Tempe, AZ (Nov/16) - $900 USD
My recent MRI in Canada - $ nada

4 days of emergency care in AZ - $152,000 USD*
(reduced to $88,000* by my out-of-country insurance carrier)
27 days weeks hospitalization in Canadian ICU inluding 9 days of induced coma, and a massive battery of scans, daily x-rays, MRI's, & enough med's to choke a mule - $ nada

In fairness though, we don't own any aircraft carriers.

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Iago

I stand corrected. Thanks for clarifying.

Just out of curiosity, how big is the payroll tax to cover the system? Asking for comparative curiosity.



When I was last active with my business, we cost-shared 50/50 with our employees. (NB: this was in BC - other provinces might differ, example, in Alberta, there are NO insurance premiums)

Dollar cost of the monthly premium was a fixed amount;
(from memory, prior to the 50/50 split)

single employee - $62/mth
employee and one dependent - $86/mth
employee and (family) multiple dependents - $104/mth

That was a while back. I no longer have employees and I have my BC Provincial medical premium to myself so my coverage for myself (61 with cancer) and one dependent (60 with Multiple Sclerosis) costs me $136/mth

I listed the conditions ad ages only for reference as there are no deviations to the premium for age or conditions. A 30 year old with one dependent self-paying is the same amount. Same-sex couples and unmarried co-inhabitants included.

Again, in Alberta there is no premium at all, the same in ON - I think?

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Iago

I stand corrected. Thanks for clarifying.

Just out of curiosity, how big is the payroll tax to cover the system? Asking for comparative curiosity.



All taxes, GST, income, fuel, etc. cover national medical health plans in Canada, UK, EU, etc.

What is most relevant is that study after study shows these national plans cover more people, have better health outcomes(national basis) and usually do so for about 1/2 the cost (GDP basis) than the US system.

This thread provides a bit of a glimpse into the problems and issues of the US system.

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Funding the system is a constant battle here. Canadians are only slightly more willing to pay taxes than Americans. And we complain about both health care wait times and taxation levels. Like you, we want to have our cake and eat it too. The provinces pay the bills, and the feds supply a good chunk of the funding.

But there is a bottom line to think about. America spends about twice per capita what Canada spends. However it is funded, by taxes or by employer contributions, it really makes no difference in the end. America is allowing their insurance companies and health care providers to operate in a non competitive way and to to just plain rip them off.
Always remember the brave children who died defending your right to bear arms. Freedom is not free.

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Quote

America is allowing their insurance companies and health care providers to operate in a non competitive way and to to just plain rip them off.



bingo. Canadians have taxes and govts that do not want to spend money on healthcare, or at least struggle with the costs.

USA has insurance companies that do not want to spend money on healthcare either, and the system is rigged so that they never lose. And they can vacate the market if they like, whereas the govt cannot.

Bottom line is the outcomes are better in every civilized socialist system in the world than in the USA... and that absolutely 100% solidly should be the goal....delivery and outcomes of healthcare. The US system is about the delivery of profits. faulty from the very get-go and very definition.

Remove the insurance companies from the picture altogether, start delivering healthcare.

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