Medical imaging is one area of healthcare in which people can truly save money. It’s due to one simple fact.
Entities within medical imaging that are not owned by hospitals and health systems offer list prices and fees that are much, much less than behemoth hospitals. Numerous articles have been published on the subject, citing example after example of the disparity between potential costs people can incur if they are not cautious in their provider selection.
The same holds true for entities that provide services such as private physician practices and laboratory services. The same principal holds true. Those that are privately owned and not part of a health system will offer the same type of financial savings.
In being privately and independently owned, centers such as Diagnostic Imaging Services are more cost efficient, more streamlined in what we do and only do one thing: imaging. When you focus on one task, you become very good at it. Hospitals, on the other hand, try to be everything to everyone. That usually results in inefficiencies, spiraling and sometimes out-of-control expenses and a lack of appropriate patient service.
Healthcare, unfortunately, is not so simple as looking at prices posted online or in a retail store in order to due comparisons. Factors that are unique to healthcare that affect cost include the provider itself, the insurance coverage and insurance deductible and any copays. It can be a maze that appears daunting to navigate.
Here are a few tips on making this process smoother in order for anyone to perform comparisons.
Check your insurance and network coverage
The cost of a procedure, such as MRI, CT scan or ultrasound, will depend upon an insurance plan’s cost sharing structure. Based on the plan, a person may pay the full amount for the test, the amount of a deductible, a copay or perhaps coinsurance. It’s important to know your plan well and don’t hesitate to contact the insurance company if you need assistance or have questions.
Shop around for diagnostic testing facilities
When is it most appropriate to research facilities and investigating pricing? While it is an excellent idea to always investigate, most often if your insurance is a preferred provider organization (PPO) or an exclusive provider organization (EPO), you should look for a facility within your network. Remember that identify the cost of a test is more than knowing its price. Providers start with a price, often called a chargemaster price, and then discount from there based on their agreement with the insurance company.
One very important point in which price can “sneak” up on someone is by omitting to ask a very important question: Is this price cover everything for the exam or are there any additional fees?
At hospitals, typically an additional fee for the radiologist to interpret the study is tacked on to the price for the actual test. But at independent centers such as DIS, one price covers everything — with no additional fees or costs.
Here is an example:
A person has been recommended to have an MRI without the use of a contrast dye. The person’s health insurance plan includes a 30% coinsurance. A hospital may have a chargemaster rate of $3,000 for the test and the insurance plan discounts reduces that amount to $2,000. An independent center may have a chargemaster rate of $1,800 and the insurance discount reduces that to $900.
At a 30% coinsurance rate, the person has a choice of paying $600 to the hospital ($2,000 x 30%) or $300 to the independent center ($900 x 30%).
With the test being the same no matter where it is performed and with quality being even, most, if not all, people would choose the independent center.
Information needed for price comparisons?
Several elements are good to have to do accurate comparisons. One has already been touched on — knowing your insurance coverage, including providers that are in your network. Another is the code for the exam. A CPT (Current Procedural Terminology) code is a universal code to bill an exam. In medical imaging, as an example, CPT code 70551 is an MRI of the brain without contrast dye.
With this information, a medical provider should be able to provide you with the price information. However, be cautious. If a provider has a difficult time identifying pricing or perhaps even being reluctant to do so, you should ask yourself, “do I really want to go there?”
Insurance deductibles continue to climb as health care insurers stick with their movement of having people bear more of the financial responsibility in paying for healthcare.
So, know before you go. Choose independent and save. Say YES and spend LESS at DIS.