Asking the really tough questions in health care like, how much is an MRI?
August 2, 2012 in health care costs, Member Stories
If you listen to enough health care experts in Massachusetts these days, it sounds like “price transparency” is going to fix the problem of rising health care costs. The theory is that if patients know how much a test or procedure costs, and they are paying a good part of that cost themselves, then patients will start going to the lower priced hospitals and the higher priced hospitals will drop their charges to compete. Nice theory.
The problem is very few people know what anything costs and trying to get them to tell me is sometimes possible. Today I tried and largely failed. I’m supposed to get an MRI. It will cost me $25, no matter where I go, but I’m trying to be an “engaged” patient, so I called around to compare prices. I didn’t bother to ask who offers the “best” MRI. No one knows how to measure the quality of an MRI so there’s no way to tell who does the best job.
TIP: get the exact code for your procedure, you’ll need this when calling around.
I started at Newton Wellesley Hospital which is where the very nice secretary in my doctor’s office booked me an appointment. No one in my doctor’s office knew how much the MRI would cost. They may have to soon. Massachusetts is about to make sharing prices and quality information with patients the law. But back to Newton Wellesley where I called Radiology – they had no idea. I called patient billing. Another very nice woman said she thought her supervisor would know how much an MRI would cost. She would call me back. She didn’t. I tried three more times. Each time I got a message saying call back later.
So I tried Shields, a network of labs. I’ve heard they’re the cheapest place to get and MRI. I was not on hold at all. The woman asked me what kind of insurance I had and gave me a price based on that insurance. (She also asked really smart questions that made me wonder if I had the right MRI code, but anyway…) The price at Shields was:
70552 (w/ dye/contrast) $ 603.31
70553 (w and without dye, to get the baseline test and then one with dye) $1294.58
70551 (no dye) $615,
(The secretary in my doc’s office wasn’t sure if I needed the test with dye. How confusing can this get? And ordering a test is supposed to be simple! Trying to find the price for something like a hip replacement, where there are dozens of variables seems even more impossible.)
I figured I’d compare Shields with Mass General. It’s often the most expensive place to go for care and was just named the best hospital in the country. I tried Radiology – no idea. I called billing. A nice man said I had to call the office of “financial access.” I was on hold for 22 minutes the first time I called (I had to hang up to do some work). The second time, I tried a different extension and got a woman who seemed a bit flustered by my question, but then told me the price for one of my codes:
70552 (w/dye) $5,315.00
That was the price, she said, for someone without insurance. She couldn’t tell me what the price would be for someone who has my insurance. Your insurance company might have that, she said. I called Blue Cross, nope they can’t give me the price of an MRI at Mass General. I know they both have the info, but they aren’t giving it up.
I tried one more place – Atrius, which includes Harvard Vanguard, where my kids are patients. Their prices are in the range of or lower than Shields – which is interesting because Atrius has been one of the higher priced providers in Mass.
70552 (w dye) $670
70551 (no dye) $558
So where should I go? Darn, I forgot to ask about wait times and referrals. Back to the phone.
Debbi Lieberson said on August 3, 2012
My recent experience trying to find out the cost of several medical tests was virtually identical to Martha Bebinger’s; i.e. it was essentially impossible – multiple phone calls, extended periods of time on hold, unclear/contradictory information etc. As someone who is self-employed and whose income is slightly above the eligibility limit for subsidized insurance through Commonwealth Care, I chose a Commonwealth Choice “bronze” plan which requires me to pay 35% of lab costs and 50% of Rxs – (after I meet my deductible), making the cost of a test or medication relevant to my decision-making. (It’s also worth pointing out that the cost of this less than ideal coverage: 14% of my adjusted gross income.) Like Ms. Bebinger, I work in the health care field and consider myself to be a pretty knowledgeable, savvy patient/consumer. It’s truly frightening to think what happens to people who don’t have the time or flexibility to make multiple calls and/or to sit on hold for extended periods of time, people whose first language is not English, individuals who aren’t familiar with medical terminology or are easily intimidated by authority. . .
Martha Bebinger said on August 3, 2012
Hi Debbi – might you be interested in registering for Savvy and posting a short version of your “shopping” experience on the home page?
Debbi Lieberson said on August 3, 2012
Absolutely. How does one go about registering for Savvy to post? (I thought that was what I was doing when I wrote/submitted the above.)
Martha Bebinger said on August 3, 2012
Hi Debbi – your comment was added to the bottom of my post. I’m suggesting that you write a short post with your own headline for the homepage. It’s kind of like updating your status on Facebook. To write a post on Savvy, you have to go to the top right corner of the homepage and register. Sound OK? Thanks!
Debbi Lieberson said on August 4, 2012
Hi again,
I tried several times to register but unfortunately I keep getting the same error message – “only use lower-case letters and numbers” – which I am. Perhaps there’s a problem with the Savvy website. I’ll try again later since I would like to post my comments and read others’.
Martha Bebinger said on August 5, 2012
Hi Debbi – I’m so sorry about this. Could you email me at healthcaresavvy@wbur.org and I’ll see if I can fix this with you? I really appreciate your persistence! Thanks very much -
Lorna said on October 1, 2012
Consumer driven healthcare, where higher patient costs are intened to drive selection towards lower cost facilities and services, is indeed a “Nice Theory”. Unfortunately the contractual arrangements between insurance companies and healthcare providers and the current functionality of healthcare systems have not evolved to meet the needs of a such a cost comparison. It will be interesting to see how “global payments” impact this cost comparison scenario. Will it become a moot point?
Martha Bebinger said on October 3, 2012
Lorna – I don’t see this becoming a moot point anytime soon – but we’ll see!