$4800 for a CT Scan??

[LisaR]

I work for an insurance company and I can tell you that is high. You are paying for the name. Your insurance company will reduce the charge.

Yeah, I expect BC/BS to reduce that amount significantly. We've met our deductible and our out of pocket max thanks to DH's surgery so I am not worried about our cost. I just think it is ridiculous! The charges that I expected to be high were the office calls with the doctors. Instead, those were totally in line with what one would expect for a specialist. Go figure!

 

[CanBeGrumpy]

Did they explain why they needed a new CT scan if he just had one this past summer? If your son is having the same issues as he was then, why couldn't they look at the old one and save your son from all that radiation exposure? Did they really think something would have changed from 6 months ago if the symptoms are the same? I think you are being ripped off not just from the price, but also, was it even necessary to do a 2nd one?

As for the cost, maybe it was a more extensive test--more slices, views, etc. And really, if it wasn't a more extensive scan, I would again be wondering why they couldn't just read the one from the summer.

 

[LisaR]

Did they explain why they needed a new CT scan if he just had one this past summer? If your son is having the same issues as he was then, why couldn't they look at the old one and save your son from all that radiation exposure? Did they really think something would have changed from 6 months ago if the symptoms are the same? I think you are being ripped off not just from the price, but also, was it even necessary to do a 2nd one?

Yes, it was very much necessary. The one in June showed that he needed surgery. We put the surgery off and tried mega medications. The new scan shows a 90% improvement and no need for surgery!! Unfortunately, he can't continue on those high doses of medications so this may come back.

 

[CanBeGrumpy]

Yes, it was very much necessary. The one in June showed that he needed surgery. We put the surgery off and tried mega medications. The new scan shows a 90% improvement and no need for surgery!! Unfortunately, he can't continue on those high doses of medications so this may come back.

I hope it does not come back! I feel bad for your son that he's had to suffer with this! Wishing him all the best and continued improvement!!

 

[LisaR]

I hope it does not come back! I feel bad for your son that he's had to suffer with this! Wishing him all the best and continued improvement!!

Thanks!!

 

[robinb]

I'm always amazed when I examine my EOBs at how much the insurance contracted amounts vary from the cash price. We have a high deductible plan so end up paying OOP for most things - we would be bankrupt if we had to pay the cash price. Maybe it is like hotel rack rates but medical costs are totally out of hand.

I had an MRI this summer. My Dh called our insurance company *and* the hospital to get an estimate (we have to pay 20%). Both said about $2500. The EOB was $7500! When we called to complain both said, "It was only an estimate." Grrrr. It turns out that our portion of my whole cancer treatment was above my max out of pocket expenses but I was STILL angry.

 

[JanaDee]

The facilities were identical. Both were done at hospitals with medical clinics attached. He was not an in-patient at either facility.

I simply can't understand how one can charge $800 and the other one can charge $4800 for the same thing. I get medical expenses are insane. DH had rotator cuff surgery four weeks ago. The bills have been astronomical! But at least the charges are in line with our other things. For instance, he had to have an MRI of his shoulder and it was $2500. As I noted earlier, DD had an MRI of her knee for $1950. The MRI's were done at two separate facilities and the prices seem to be in line with one another. If either had an MRI at the Mayo, I'm guessing those same tests would have been close to $10,000.

You can't compare your local hospital with Mayo. Was the CT done at Mayo or St. Mary's?

 

[LisaR]

You can't compare your local hospital with Mayo.

I understand that. But a CT scan is a CT scan. As I mentioned, I expected the charges from the specialists to be high because I am supposedly getting the best of the best. Those charges weren't out of the norm at all. The only ridiculous charge was the CT scan. The ENT stuck a camera up his nose, and had very modern technology. DS had this same thing done locally and the machine was very old, no computers or anything. The Mayo Clinic only charged $200 more than the other place. That seems totally reasonable. There was nothing unique about the CT scan.

 

[mnrose]

I will once again recommend the Time magazine report on the high cost of medical care in this country (from Feb). It was the ENTIRE issue, and was quite interesting. They really break down a number of different bills, and why stuff gets charged the way it does. Fascinating.

I will also say that if you have decent insurance, the amount billed by the hospital bears very little relationship to what they actually get paid. It is usually a small fraction of that. We had a hospital bill from earlier this year that was over 80K (hospital only....no doctor's fees in there), and insurance ultimately paid less than 25% of that (the insurance "discount" was over 60k!). The really scary part was that at first, my insurance refused to pay. The hospital was fully prepared to chase me for the full amount, but apparently was happy to settle for an insurance payment substantially smaller.

And, that, is the real irony of the system. If you are very poor, Medicaid pays (and a much lower cost), if you are insured, your insurance pays (and a much lower cost). If you are not very poor, and don't have insurance, you get to pay the full amount. Lucky you.

 

[Lintasare]

The Docs need to keep up with their Porsche payments.

More likely trying to keep up with his malpractice insurance.

 

[mhsjax]

That's ridiculous! Your insurance will cut the bill down again. I always feel like the doctors are testing the insurance companies, because obviously they know what is allowed to be charged. They're just hoping……

You would be wrong. The charge what they charge. Mayo clinic isn't sitting htere charging random figures to an insurance company. These fees are set and the insurance pays what it pays. Most of the time thye have a contract with the insurance company and they can only charge the patient what is left over after the allowable. The hospital and doctors sign a contract with the insurance company, but all are different and they don't sit down on list out different charges for different insurance companies. There are WAY too many procedures and WAY to many insurance companies that pay different amounts. They just do the adjustments after the insurance pays.

 

[gottaluvPluto]

More likely trying to keep up with his malpractice insurance.

Don't forget their student loans! However, malpractice insurance
Is a huge cost. In fact, my wonderful OB stopped delivering babies
Because it brought down the malpractice insurance bill.

 

[mnrose]

More likely trying to keep up with his malpractice insurance.

The Time article does make this point. And, if you follow the money trail (i.e., who's really getting wealthy in the chain of medicine), you would find that (in general) doctors are not getting all that wealthy, considering their years of training. General practitioners (the front line of medicine) are really struggling financially.

The money trail (and I'm summarizing a long article) would show that hospital administrators (the salaries were SHOCKING...and these are NOT people delivering medicine...not doctors at all in most cases), drug companies and equipment manufacturers are making the beau coup bucks. The mark ups for the latter two are outrageous, and make computer manufacturers look positively miserly in comparison.

One example was some sort of implant for the spine. It was placed in a patient with minimal insurance (and therefore, he was on the hook for the entire cost) was $45,000. (Procedure was done on an out patient basis, so we're not talking a long stay or anything like that). And, that was JUST the implant. The cost to the hospital? $15,000. That's a good markup. The cost to manufacture (FULLY loaded cost...including R&D, overhead, etc) was less than $1500. So, what's wrong with medicine? Really? That is absolutely outrageous.

Look, I am a capitalist. I believe in the free market. But, that is absurd. Absolutely absurd. A markup of 10X all costs? Does anyone think that's ok? And the poor guy who had to pay 45,000 for it?

 

[barkley]

You would be wrong. The charge what they charge. Mayo clinic isn't sitting htere charging random figures to an insurance company. These fees are set and the insurance pays what it pays. Most of the time thye have a contract with the insurance company and they can only charge the patient what is left over after the allowable. The hospital and doctors sign a contract with the insurance company, but all are different and they don't sit down on list out different charges for different insurance companies. There are WAY too many procedures and WAY to many insurance companies that pay different amounts. They just do the adjustments after the insurance pays.

I always thought this was the case but I have to wonder.

recently I was catching up on filing our insurance paperwork (eob's we get that show what was billed/what allowed/what insurance paid/what max provider can bill us per their contract) and I noticed that with both dh and I once we got supplemental coverage on top of our existing health insurance some providers changed the amount (increased) for certain types of appointments. we did not get the supplemental at the same time as each other, so it's not a matter of it just being a coincidence that the month our coverage increased (2 pools of insurance money to bill from) the doctors decided to increase their fees, so the only thing I can think is once the doctor's billing service saw the secondary coverage they increased the fee for service to whomever rate they had the higher contract rate with


btw, in our region there's a search engine you can use to find out the average local cost range for different medical tests and procedures. just for the heck of it I just did a search on it for ct scans-they range from a low of $925 to a high of $2500. the lower charging providers (from my experience) are the independent imaging centers who do the highest number annualy. the highest charging-the hospitals. I found similar results when dh needed an MRI a few years ago and our PPO had no preferred providers in the area (so much bigger out of pocket cost for us). dh's doctor (preferred provider) recommended a place but I explained that we needed to minimize costs so he suggested we call around, which we did and the difference between providers was as much as $2000

 

[mnrose]

I always thought this was the case but I have to wonder.

recently I was catching up on filing our insurance paperwork (eob's we get that show what was billed/what allowed/what insurance paid/what max provider can bill us per their contract) and I noticed that with both dh and I once we got supplemental coverage on top of our existing health insurance some providers changed the amount (increased) for certain types of appointments. we did not get the supplemental at the same time as each other, so it's not a matter of it just being a coincidence that the month our coverage increased (2 pools of insurance money to bill from) the doctors decided to increase their fees, so the only thing I can think is once the doctor's billing service saw the secondary coverage they increased the fee for service to whomever rate they had the higher contract rate with


btw, in our region there's a search engine you can use to find out the average local cost range for different medical tests and procedures. just for the heck of it I just did a search on it for ct scans-they range from a low of $925 to a high of $2500. the lower charging providers (from my experience) are the independent imaging centers who do the highest number annualy. the highest charging-the hospitals. I found similar results when dh needed an MRI a few years ago and our PPO had no preferred providers in the area (so much bigger out of pocket cost for us). dh's doctor (preferred provider) recommended a place but I explained that we needed to minimize costs so he suggested we call around, which we did and the difference between providers was as much as $2000

And, this is part of the problem with medicine. When we have a medical problem, we (the consumer) are not interested in general in finding "the low cost" provider. It's our health, we say, and therefore, we want "the best." We don't shop around. Considering the cost of medical care, it's funny that we don't. When we go the grocery store, we don't pick up whatever we want without regard to price. We don't buy cars this way. We don't buy houses this way.

Heck, we don't even know what it costs (generally) until weeks or months later when we get a bill or EOB from our insurance carrier.

This makes no sense at all. None. Either medicine is a "free market" item (in which case, we would know what is costs IN ADVANCE and be able to shop amongst providers) or it is not....in which case, enormous profits should not be made on it. I don't think it is a free market item really. It's not like a car....where I can choose used or new, or even choose to do without. Who can choose to do without their life? No one (of reasonably sound mind, anyway).

 

[mnrose]

I'll just give another example that happened to us recently. My son has unilateral hearing loss. He has had it since birth. It has been unchanged for YEARS. We had to switch to a different audiologist recently because of a move from the last time he needed a hearing aid. This audiologist REQUIRED that he be seen by an ENT associated with the practice before he got his aid. Ok, I do understand that. The ENT looked in his ears, asked me some basic questions, and cleared him for the hearing aid (as if I didn't know that would happen). He said "has he ever had a CT scan of his ear?" Answer: No. He recommended that we do that. I said "why....what would it tell me?" He says "it might show a structural issue to explain the loss, but it probably will show us nothing..." He explained that it might help us know whether his loss will get worse over time. My son is 14....hasn't changed a BIT since he was small boy. I'm not worried about the cause. Who really cares? It is what it is. It was not sudden. It is not progressive. It is a hearing loss he was born with.

I've opted not to do the CT scan. Yes, I have insurance that would pay most of it. But, I think it's a waste of money and time....and the doctor shrugged his shoulder and said that's ok because nothing horrible was going to happen...it would just give me a "reason" (maybe). Just because we can doesn't mean we should.

 

[sunshinehighway]

This is off topic but op, I'd be very cautious with CT scans and the like for your son. My mother has severe sinus issues and has had many tests and a few surgeries over the years. She ended up with thyroid cancer and her dr. said all those tests because of her sinuses were a likely cause. None of those tests or surgeries did anything to help with her sinus problems in the long term but they may have been a major contributing factor to her thyroid removal.

 

[kydisneyfans]

More likely trying to keep up with his malpractice insurance.

Up to 1/3 of a doctor's cost is malpractice insurance.
No healthcare overhaul will ever work until tort reform is part of the program, it's the largest driver of costs on the provider side. You have to lower the provider cost side to drive down prices.

That being said, my wife had a brain CT scan at an outpatient facility in March, the bill was around $2,000, $125 after insurance.

My wife tripped and had a concussion while on vacation, the ER CT scan, the same exact procedure in March, was billed out at $14,500 by a hospital. It was $125 after insurance.

As someone working inside the industry, if any type of test is ordered, I would call around a couple of different facilities to determine cost. You would be amazed at the price differences.

 

[robinb]

I've opted not to do the CT scan. Yes, I have insurance that would pay most of it. But, I think it's a waste of money and time....and the doctor shrugged his shoulder and said that's ok because nothing horrible was going to happen...it would just give me a "reason" (maybe). Just because we can doesn't mean we should.

My $7500 MRI was unnecessary. My second opinion doctor couldn't figure out how to access the ultrasound and mammogram I brought with me so she ordered a test that she liked. *sigh*

 

[LisaR]

And, this is part of the problem with medicine. When we have a medical problem, we (the consumer) are not interested in general in finding "the low cost" provider. It's our health, we say, and therefore, we want "the best." We don't shop around. Considering the cost of medical care, it's funny that we don't. When we go the grocery store, we don't pick up whatever we want without regard to price. We don't buy cars this way. We don't buy houses this way.

Heck, we don't even know what it costs (generally) until weeks or months later when we get a bill or EOB from our insurance carrier.

This makes no sense at all. None. Either medicine is a "free market" item (in which case, we would know what is costs IN ADVANCE and be able to shop amongst providers) or it is not....in which case, enormous profits should not be made on it. I don't think it is a free market item really. It's not like a car....where I can choose used or new, or even choose to do without. Who can choose to do without their life? No one (of reasonably sound mind, anyway).

Up to 1/3 of a doctor's cost is malpractice insurance.
No healthcare overhaul will ever work until tort reform is part of the program, it's the largest driver of costs on the provider side. You have to lower the provider cost side to drive down prices.

That being said, my wife had a brain CT scan at an outpatient facility in March, the bill was around $2,000, $125 after insurance.

My wife tripped and had a concussion while on vacation, the ER CT scan, the same exact procedure in March, was billed out at $14,500 by a hospital. It was $125 after insurance.

As someone working inside the industry, if any type of test is ordered, I would call around a couple of different facilities to determine cost. You would be amazed at the price differences.

$2000 and $14,500 for the exact same test is insane!