Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped.
He called around for price quotes on the CT scan his doctor ordered. After all, his plan’s $2,000 deductible meant paying the full cost out of pocket. Using information from his insurer, he found a good deal — $473.53 at Coolidge Corner Imaging in Boston, a half hour from his house.
But the bill he got later was for $1,273.02 — more than twice as much — from a hospital he had no idea was connected to the imaging center.
Kaiser Permanente: KP Select CO Gold 0/20. Coverage Period: Beginning on or after. Summary of Benefits and Coverage: What this plan covers and what it costs. Coverage for: Individual/Family. Imaging (CT/PET scans, MRIs) $250 Copay. Multiple cost shares may apply per encounter.
“I was shocked,” said White, a doctor of physical therapy who thought he knew his way around the medical system. “If I get tripped up, the average consumer doesn’t have the slightest chance of effectively managing their health expenses.”
- This is a low dose CT scan for lung cancer screening for patients who do not exhibit any symptoms of lung cancer. How Much Does a Low Dose CT Lung Screening Cost? On MDsave, the cost of a Low Dose CT Lung Screening ranges from $80 to $556. Those on high deductible health plans or without insurance can shop, compare prices and save.
- Kaiser Permanente 2018 Sample Fee List. CT Scans, and Other Imaging Studies. You may have no cost or you may only have to pay a copay or coinsurance.
A national study by Consumers Union basically comes to the same conclusion, suggesting that there are millions of Douglas Whites lost in the medical billing maze.
Nearly one in three Americans with private health insurance surveyed by the research group got a surprise medical bill in the past two years — defined as when a plan paid less than expected and doctors and hospitals tried to recover the balance from the patient.
Of those with surprise bills, nearly a fourth got bills from doctors they had no idea were involved in their care and nearly two-thirds were charged more than they expected.
“When we talk about transparent health care and the need for consumers to shop around, it’s just not possible in many situations,” said Blake Hutson, a senior associate for Consumers Union, the policy arm of Consumer Reports. “Even if you work for a big company and have what you think is a good health insurance plan, you can get a surprise medical bill.”
The deductible is what patients pay before insurance kicks in. The higher the deductible, the more you pay out of pocket. Deductibles of $3,000 or $5,000 are not unusual these days, although the health law caps out-of-pocket costs at $6,600 for individuals and $13,200 for families.
Making plan members pay more in this way is supposed to prompt them to check prices and put competitive pressure on medical providers.
Kaiser Copay List
The problem is that you can’t buy medical services the way you buy a phone plan. Doctors, hospitals and other providers generally don’t advertise their prices and often keep them confidential, even when asked by patients about what to expect. Providers charge different amounts for the same service depending on the insurance.
One episode of treatment can generate bills from multiple caregivers, especially in the hospital.
A new study by the Employee Benefit Research Institute shows that members of high-deductible plans have higher incomes and are more educated on average than the typical American. But a post-grad degree from MIT might not be enough to figure out some bills.
The system is so complicated that one patient in three who got a surprise bill in the Consumers Union study didn’t investigate or fight it.
“I didn’t think it would make a difference,” or “I was confused about what to do” were common reasons for inaction.
That’s the wrong response, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who studies how the health system affects consumers. (Kaiser Health News is an editorially independent project of the foundation.)
“It’s always advisable to ask questions if you receive a surprise bill or if insurance pays less than you expect,” she said. “Mistakes happen and following up can save you money. If it gets too confusing or frustrating, ask for help.”
Consumers Union offers an online tool for finding the relevant agency in your state and its contact information.
White’s billing problems were cleared up — many months and phone calls later and after a reporter started inquiring.
His plan, Harvard Pilgrim Health Care, said it had given him an incorrect quote for the CT scan last fall. The plan eventually paid the imaging center the full $1,273, saying it wasn’t White’s fault that the plan’s quote was wrong.
The bill had come from Brigham and Women’s Hospital, which owned the radiology center, even though White said there was no indication of that when he went to get the scan.
Harvard Pilgrim said it didn’t know Brigham and Women’s was affiliated with the center, either. Hospital-owned facilities are often far more expensive than independently owned doctors’ offices.
So how does he like the transparency revolution in health care, boosting competition and empowering patients?
“There is nothing transparent about most health care billing,” White said.
CT Prices on Average
CT (also called CAT) scans can range from $270 to $4,800 depending on what type of CT scan is performed, the location you choose to have the procedure performed, and whether you add additional services.
![Kaiser Ct Scan Cost Copay Kaiser Ct Scan Cost Copay](/uploads/1/2/8/3/128395943/361126644.jpg)
Kaiser Permanente Copay
The average cost of a CT scan in the U.S. is $1,694.
Additional prices can be added to the initial CT procedure being performed as well, including if your doctor recommends additional testing or treatment.
CT Prices with Cash
For uninsured customers, many testing facilities offer a 15% - 40% discount when cash or credit is used to pay the full discounted amount within 60 days of the procedure.
The average CT scan price without insurance can range from $1,016 to $1,440.
Again, this can drastically change depending on where you go and what kind of discount they are willing to provide you for paying up front.
How Much Is A Ct Scan At Kaiser
CT Prices with Insurance
Most insurance companies will reimburse the cost of getting a CT scan. Typically when a medical professional requests a CT scan, the procedure is automatically reimbursable depending on your insurance plan. If it is not fully covered, many insurance companies will cover some of the expense. Visit your insurance company’s website and/or contact them directly to figure out what is covered prior to the procedure. A good imaging facility can help you determine this with your insurance company as well.
CT Prices with Medicare
Medicare Part B covers diagnostic non-laboratory tests including CT scans when your doctor or other health care provider orders them as part of treating a medical problem. All people with Part B are covered, but deductible and copayment may apply. Cash pay price varies for those only covered under Part A. Visit the Medicare website for more information (www.medicare.org).
CT Prices with Medicaid
![Kaiser ct scan cost copay card Kaiser ct scan cost copay card](/uploads/1/2/8/3/128395943/722336487.jpg)
Kaiser Copay Cost
States establish and administer their own Medicaid programs and determine which services are included within broad federal guidelines. The required mandatory benefits include performing diagnostic tests to follow up when a risk is identified. The optional benefits include other diagnostic, screening, preventive and rehabilitative services, which means it is going to vary from place to place whether or not the procedure is covered. It is strongly advised to determine your coverage based on the state you live in, prior to getting the procedure done. Visit the Medicaid website for more information (www.medicaid.org).