Blue Cross paid $1,650 for my $8,000 MRI

October 22, 2012 in health care costs, Hospital Bills

Well, this world of medical billing and costs is really wild.

I wrote a few weeks ago about getting bills that totaled just under $8,000 for an MRI (actually I got two tests while in the machine although I didn’t know this at the time)

Last week, the hospital sent me a more detailed bill that shows how much of what they charged Blue Cross actually paid. The total charge from Newton Wellesley Hospital (two tests plus fee to read the test) was $7,876.  Blue Cross paid $1,650 (that’s $1,360 for the tests and $290 in physician’s fees).

Two things jump out at me.

1) the difference between what Newton Wellesley charges anyone who pays cash, and what they pay the largest insurer in Massachusetts is $6,226. Patients who pay cash for these tests are getting a really horrible deal if they don’t shop around.

2) the difference between what Blue Cross pays Newton Wellesley and what Blue Cross paid the cheapest place I found for an MRI, Shields, is not much.  Shields would have been paid, $1,221 for the two tests (they read their own with no extra charge at some facilities including the one closest to me). So I could have saved Blue Cross (and my fellow members) $429 by going to Shields.

OK, I’ll be honest.  If that’s my $429, it means a lot more than if that’s the amount I’m saving Blue Cross.  But the difference for Blue Cross is a lot less than the thousands in charges that the two facilities post. Is the message that insurers are negotiating aggressively, that hospitals are giving in or that these charges are just an altered reality.  How are we supposed to make sense of this world?



3 responses to Blue Cross paid $1,650 for my $8,000 MRI

  1. It does make sense but you won’t like it. There are 2 reasons for the disparity in price: 1) Blue Cross has ostensibly negotiated the cost of your MRI with the facility where you had it done. By doing so they are able to bring down costs because, as with everything, the more you buy from someone selling an item the less you will pay for that item. In essence, it’s a matter of scaling of prices; 2) Hospitals are obligated to provide emergency care to anyone who walks in the door whether they can pay or not. Further, a large percentage of the people who are actually hospitalized as inpatients do not end up paying their bill or they pay only a small portion of it, leaving the hospital with what can be huge debts that it must somehow pay. The way that hospitals attempt to pay their bills is by charging those people who pay cash who can pay the bill a hugely inflated price for the services they get.
    One of the reasons which Obamacare makes sense to put into place is because the second factor above also affects how much insurers have to pay hospitals and thus how much people who are insured have to pay as premiums. If everyone is insured, then the amount of deadbeat and/or bankrupt and jobless patients which the hospital will have to eat the bill for will be vastly reduced and thus health insurance premiums will be reduced as well.

  2. Blue Cross is an insurance bully. Witness the issues with medication/pharmacy coverage. They tried to demand certain prices (below cost) from Walgreen’s for some medications and Walgreen’s, bless their hearts, told them to take a hike. For 9 months, BCBS in MA wouldn’t cover any rx submitted to Walgreen’s. They relented as of September 2012.

    Because they are a major insurer, hospitals find it wise to take the pittance they offer for certain procedures and costs so they can be assured of at least some coverage for patients who need acute hospital care, because the hospital can not turn you away, insurance or not, if you are acutely ill. But it’s the insurance company who is driving the bus here, not the hospital, not the patient, not the doctor, not the government, and not the actual cost of care. And the people picking up the slack are the ones who can least afford it.

    Blue Cross Blue Shield of Massachusetts is MA’s largest health insurance company. They are supposedly “not for profit”, yet they reported net income of $136.1 million in 2011. That being the case, I am trying to understand why our MONTHLY premiums rose almost $200 monthly for our family for 2012. That is nearly $2400 for a family of 3 (two adults and one college student), especially considering that they have tiered prices for all bit the least expensive generics, which are cheaper at WalMart ($3 moths for $10) than our $15-30 monthly co-pay.

    I’m tired of BCBS playing the victim card. They need to pay the same as everyone else – all insurers should. They have “not for profit” status in MA, a HUGE tax benefit, and they make more $11 million a month in profit. What is wrong with this picture?

  3. Hello Martha,
    I am the curator of healthworks collective, the healthcare website in the social media today network. We are doing a video interview series on high quality, low cost healthcare and I have interviewed Jeanne Pinder who sent me your way. I love your website and what you are doing and I would really like to interview you for the series. It’s really simple – a 5 minute skype interview where you can “tell your story”. If you go to our site and look at the other interviews, you can get an idea of what it’s about. I have interviewed Neel Shah, Jeanne, David Wong, Daniel Wolfson from Choosing Wisely and others. Please let me know your thoughts! Thanks, joan

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