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In California, That MRI Will Cost You $255 -- Or Maybe $6,221

by Joe Mobley
12 replies
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Prices for common medical tests like mammograms and MRIs are notoriously opaque. Negotiated rates between insurance companies and doctors or hospitals are sealed tight by contract. We know there's price variation, but comparing what one insurance company pays versus another is virtually impossible.
"I was told the procedure was $1,850. I have a $7,500 deductible. So I talked to (an employee) who said if I paid up front and agreed not to report the procedure to Blue Cross that it would be $580."
A new law in Massachusetts requires insurers to make their prices public in advance.
The interesting article is here,

In California, That MRI Will Cost You $255

Joe Mobley
  • Profile picture of the author KenThompson
    Well, didn't take long for the commenters to politicize the discussion. Easy to do considering the topic, though.

    The cost variation reminds me of other products or services that vary in price. There are lots of reasons for price variation. I'm not necessarily inclined to think it's a bad thing. I'll admit that I cannot make too much of an intelligent opinion since I don't know many facts.

    So should the cost of an MRI be the same across the board? I don't think so, but it seems they could be in the same ballpark at least.

    I think the entire thing is such a behemoth, and so many people and organizations have meddled with it, that it's hopelessly AFU.

    Ken
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    • Profile picture of the author seasoned
      Originally Posted by KenThompson View Post

      Well, didn't take long for the commenters to politicize the discussion. Easy to do considering the topic, though.

      The cost variation reminds me of other products or services that vary in price. There are lots of reasons for price variation. I'm not necessarily inclined to think it's a bad thing. I'll admit that I cannot make too much of an intelligent opinion since I don't know many facts.

      So should the cost of an MRI be the same across the board? I don't think so, but it seems they could be in the same ballpark at least.

      I think the entire thing is such a behemoth, and so many people and organizations have meddled with it, that it's hopelessly AFU.

      Ken
      That is ANOTHER thing! MRI tells you NOTHING other than the method. Some may be quicker and lower power, and have lower cost, and some may cover a larger area. The last MRI I had was lower than the previous one. SAME HOSPITAL! SAME DOCTORS! SAME INSURANCE! HOW can that be? Well, the "MRI" actually had SEVERAL types! Considering ONLY the area covered, I figure they could have maybe 7! I can't see a reason really for 3 of them, so let's say four. Coincidentally, I happen to have had ALL FOUR! I had 1 this year, to look at my head. Last year, I had 2(upper and mid abdomen). The year before THAT, I had THREE!(upper, mid, and lower abdomen) I was REALLY upset when I found out they had three, and had LONG discussions about it. Unless you are very observant, and keep your eyes open, you might NEVER know whether they are doing 1, or all four. Even THEN, you will have trouble seeing if they are. But THEY ARE SEPARATE CHARGES! And the initial cost FOR EACH was around $4,000.

      ALSO, people may see like FMRI, and think that is an MRI. TECHNICALLY, it IS. It uses the same technology. But it uses more resources and time, so it may cost more, and it is for another purpose.

      Steve
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    • Profile picture of the author Joe Mobley
      Ken,

      I don't understand how the contractual manipulation of prices by a third party is not price fixing? Or racketeering.

      But hey, what do I know.

      Joe Mobley
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      • Profile picture of the author ThomM
        Medicare and health insurance are pretty much responsible for the high costs of medical care. I've explained it all here before, so I won't bother again.
        Here's a personal example. The last doctors bill I got was for $375, when I told the doctor I didn't have insurance he dropped it to $150.
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      • Profile picture of the author seasoned
        Originally Posted by Joe Mobley View Post

        Ken,

        I don't understand how the contractual manipulation of prices by a third party is not price fixing? Or racketeering.

        But hey, what do I know.

        Joe Mobley
        Price fixing is when several companies in the same industry conspire to fix the prices a certain way to achieve a given goal. Here is how Wikipedia decribes it:

        Price fixing is an agreement between participants on the same side in a market to buy or sell a product, service, or commodity only at a fixed price, or maintain the market conditions such that the price is maintained at a given level by controlling supply and demand.
        So an agreement is legal. BTW Walmart and amazon do the SAME things! They have special agreements with suppliers to give them a different price.

        Steve
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  • Profile picture of the author seasoned
    Well, to listen to the government, even people that CREATED this GARBAGE, ****THEY**** know NOTHING about how this works! and HOSPITALS do their BEST to confuse the issue! And Insurance companies don't help.

    To find out the REAL cost, you would have to reconcile the bills from doctors, other providers, hospital, and insurance company. And THEN, WHICH price do you pick? There are SEVERAL!

    1. The price the hospital wants to charge. SUPPOSEDLY, this is before the insurance company gets involved, but many say it is more of a list price.
    2. The price the insurance company NEGOTIATED with the hospital to pay. This is what YOUR starting cost is.
    3. The amount the insurance company MIGHT pay, if you met your obligations. The flip side could be considered your lowest price.
    4. The amount the insurance WILL pay.
    5. The amount they expect YOU to pay. Your price for this item

    Realize that one hospital may list the MRI as the MRI, and another may have the MRI, various other fees, the operator, the doctor. And they could be on different bills from different places. I had no less than 4 different bills for my operation. One for the ambulance, one for all things at the hospital, one for all professionals associated with the hospital involved, and another from another person.

    The Obamacare plans for a given company COULD have different costs for ALL of these, but you would expect only 3,4, and 5 to vary. So even if you know all the "prices", there are a lot of questions.

    Steve
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    • Profile picture of the author Alexa Smith
      Banned
      Oooh, that's a big price-variance for an MRI-scan?! (Mind you, $255 sounds terribly cheap for any MRI?).

      Prices here vary considerably, for them, too, according to who's paying, how the price is worked out and various factors the public often doesn't find out about. National Health Service hospitals that don't have their own MRI-scanner "outsource" them to the private sector, who typically charge the NHS on something like a "wholesale-cost basis" to try to generate some additional income toward the loan repayments on the financing of the scanners they've bought. (Of course, there are also plenty of smaller private hospitals and clinics which either don't have their own whole-body MRI scanner or share one.)

      I offer a little tip for anyone having a "whole-body MRI-scan": take ear-plugs with you: they're incredibly loud, and they go on for over an hour.

      .
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  • Profile picture of the author HeySal
    I don't get why people don't understand that prices vary or are just outrageously high. Medicine is an I-N-D-U-S-T-R-Y. Do we all understand what an industry is? Okay then - now put that together with that fact that this is not a non-profit industry. You are dealing with corporations. Period.

    This particular industry has no price controls on it. Pharmaceuticals are sold to you for as far as thousands of times their cost. If we still had usery laws we might be able to fight that somewhat, but we don't.

    These corporations are solely there for their bottom line. If you think that we have these pharms, hospitals, etc for humanitarian reasons, you're naive. If they weren't making healthy (sometimes outrageous) profits, they wouldn't exist.

    When you start seeing medicine for what it is here - a medical industrial complex, a lot of your misconceptions will make sense.
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  • Profile picture of the author seasoned
    SAL,

    Almost EVERY "non profit" industry, of which I believe hospitals are one, makes a profit. Apparently the idea of non profit says they put most of the money into the business.

    Resources: "Nonprofit" vs. "Not-for-profit"

    The reason why hospitals cost so much is basically SEVEN reasons! And ACA addressed NON of them,and even made some WORSE!

    1. REGULATIONS! Hospitals do things that PEOPLE should be allowed to do, but AREN'T
    2. The FDA/DEA have their tenticles ALL OVER IT, and drive costs SKY HIGH!
    3. LAWSUITS! Some of them are LUDICROUS!
    4. They are openly allowed to IGNORE, AND CLAIM IGNORANCE, of BASIC business etiquette!
    5. They can get a TON of money from INSURANCE!
    6. Medicare and Medicaid rip off hospitals, so they must charge others MORE!
    7. Education costs have gone up, so doctors expect higher pay going in.

    You ever notice that, as a financing vehicle appears, prices SKYROCKET? It happened with homes, cars, college, healthcare, etc...

    BTW as I said before, I did some work with a medical billing system. Medicare sometimes came up with crazy rules, and ALL PROVIDERS had to hire custom coders to handle new rules! For example, when epogen was used in a dialysis, we had to send them a special code according to the pattern of use under some circumstances. THAT was one of the more reasonable changes, but some were just off the wall. STILL, companies have to pay MILLIONS of dollars to retain all these programmers to handle such things.

    Steve
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    • Profile picture of the author HeySal
      Originally Posted by seasoned View Post

      SAL,

      Almost EVERY "non profit" industry, of which I believe hospitals are one, makes a profit. Apparently the idea of non profit says they put most of the money into the business.

      Resources: "Nonprofit" vs. "Not-for-profit"

      The reason why hospitals cost so much is basically SEVEN reasons! And ACA addressed NON of them,and even made some WORSE!

      1. REGULATIONS! Hospitals do things that PEOPLE should be allowed to do, but AREN'T
      2. The FDA/DEA have their tenticles ALL OVER IT, and drive costs SKY HIGH!
      3. LAWSUITS! Some of them are LUDICROUS!
      4. They are openly allowed to IGNORE, AND CLAIM IGNORANCE, of BASIC business etiquette!
      5. They can get a TON of money from INSURANCE!
      6. Medicare and Medicaid rip off hospitals, so they must charge others MORE!
      7. Education costs have gone up, so doctors expect higher pay going in.

      You ever notice that, as a financing vehicle appears, prices SKYROCKET? It happened with homes, cars, college, healthcare, etc...

      BTW as I said before, I did some work with a medical billing system. Medicare sometimes came up with crazy rules, and ALL PROVIDERS had to hire custom coders to handle new rules! For example, when epogen was used in a dialysis, we had to send them a special code according to the pattern of use under some circumstances. THAT was one of the more reasonable changes, but some were just off the wall. STILL, companies have to pay MILLIONS of dollars to retain all these programmers to handle such things.

      Steve
      There are a few hospitals that actually work on charity (not 100%, but they take cases regardless of ability to pay). Most hospitals are corporations, though - and they aren't the C-501 type of corp. They are solely for profit. It can cost thousands just to be parked there overnight even before the bill for any treatments.

      I realize non-profits make some money. They are mostly built to give the exec's and staff a wage. The actual profit does go back to the "cause", but the owners and staff can draw some huge wages. Mostly it's just the upper echelons that make the big bucks, though. They're no different from any other corporation - they pay staff crap a lot of times. They also can get over by having volunteers that believe in the "cause" do a lot of the work. While these corporations do put money into a cause (which makes them valuable at all), most exist solely for the benefit of the executives. Take their lucrative salary and they'd not think twice about shutting down.
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  • Profile picture of the author rondo
    "I have a $7,500 deductible."

    Seriously? Is this common?

    Andrew
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    • Profile picture of the author seasoned
      Originally Posted by rondo View Post

      "I have a $7,500 deductible."

      Seriously? Is this common?

      Andrew
      It is NOW!!!!!!! It USED to be closer to $3000! I actually had a policy earlier this year that had a $500 deductible! And IT was one of the ones that "harry reid" called crap! It was the SAME one that got me same day major open heart surgery, with a negotiated rate of about HALF, and paying 80%. OH, and *********EVERY********* doctor I checked out in like 5 states and perhaps 10 hospitals was IN THE NETWORK!!!!!!!! But last september, they changed it, and raised the premium over 50%. They NEVER raised it that much before.

      Steve
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