Her insurer’s Price Tool Estimated Less Than $1,375 for a Breast MRI. Then She Got a Bill for $3,200. | Medxoom Skip to main content

Her insurer’s Price Tool Estimated Less Than $1,375 for a Breast MRI. Then She Got a Bill for $3,200.

Jul 2019

Price Calculators are one of the few tools patients have to help shed light on the murky prices across the Healthcare industry, but not always accurate. One patient, Michelle Smith, used her insurance company’s price tool to shop for the costs of her upcoming MRI. Unfortunately, the tool Smith used was incorrect, resulting in a shock when she received her bill. Smith expected to pay between $783 and $1,375 for her MRI, according to UnitedHealthcare’s price estimator, but received a bill for $3,237 because she had the MRI in a hospital, not a cheaper free standing radiology center. Had her employer used Medxoom’s proprietary pre-service price and quality comparison tool, she would have been easily notified to NOT get an MRI in a hospital for the lowest price and could have compared the same service across multiple locations outside of a hospital within her network and near her home.

From The Philadelphia Inquirer:

“‘What good is a cost calculator if it’s not accurate? I’d be better off with no information than false information,’ she said.

Health-care costs are difficult to pin down because prices vary widely and are part of confidential agreements between insurers and providers. But in response to growing demand from patients spending more out of pocket than ever before, insurers and even health systems are investing in price estimator tools that claim to offer at least a ballpark price. Still, the tools have been slow to catch on, in part because they’re clunky and, as Smith learned the hard way, not always useful.

‘It doesn’t seem like too much to ask, ‘How much is this going to cost? What’s a provider that’s in-network?’ Those are reasonable questions and insurers need to improve their ability to answer those questions. They’re working on it, but they’re not there yet,’ said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.

Each insurance company negotiates its own set of rates with every provider in the network. The size of your health plan’s deductible (the amount you pay out of pocket before the plan pays) and how the plan splits cost between itself and its members after the deductible is met will also affect how much you owe.”

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