Question about MRI Bill: Is $12k Fair Price?

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In summary: I can not believe they would charge that much for that procedure. I would go to an independent imaging place.
  • #1
humanino
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Dear PFers,

The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not know whether this is a fair price, which I find suspicious. The same procedure in France costs $300. As I am unsure what to do, I would appreciate advices from people here. Is this possibly a fair price ? Is there anything I can do to have them re-evaluate this price ?

Thank you in advance !
 
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  • #2
woah that is insane! I got a pelvic MRI with contrast for $600 a few months ago.
 
  • #3
I had a cat scan when I was a teenager because I had stomach pains. Didn't have insurance. They also sent me a bill for 12k. That was like 10 years ago. I never paid it.
So yeah if a cat scan is 12k, I could easily see an MRI being 12k.
 
  • #4
at my local ER, a head CT alone is $5k so your price tag is likely nation wide. Why is it like this, should we really have a long discussion on healthcare cost
 
  • #6
Did they perform the MRI with contrast agent? That price is in the 2-3k range at the hospitals I've dealt with.
 
  • #7
Yes chemisttree, and yes that would be the price range I would consider fair in this region. Is there any third party assistance I can find apart from going to court ?
 
  • #8
humanino said:
Yes chemisttree, and yes that would be the price range I would consider fair in this region. Is there any third party assistance I can find apart from going to court ?

2-3k is not fair, they are ripping you off. Go to an independent imaging place. Smart Choice MRI did mine for $600 total.
 
  • #9
humanino, did you go to a hospital or to an outpatient imaging center? The difference can be thousands of dollars higher at a hospital. If you went to an ER first, tack on a couple thousand more.

You didn't have any type of insurance? Many hospitals will get you in touch with charities that can help pay that bill for you. They will even help fill out and submit the paperwork.

Request an itemized bill.

Evo Child had hives and it was at night, so her friends took her to the ER, she had always been covered by my insurance, so didn't give it a second thought. Two hours later she was released with some cream for the rash. The bill, over $5,000.
 
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  • #10
Greg Bernhardt said:
2-3k is not fair, they are ripping you off. Go to an independent imaging place. Smart Choice MRI did mine for $600 total.
Thank you for this advice. We will investigate other local facilities for the next MRIs (which will happen regularly, as the $12k turned up unfortunately useful). I anticipate to find better offers, and I want to present them as evidence.
 
  • #11
Evo said:
humanino, did you go to a hospital or to an outpatient imaging center? The difference can be thousands of dollars higher at a hospital. If you went to an ER first, tack on a couple thousand more.

You didn't have any type of insurance? Many hospitals will get you in touch with charities that can help pay that bill for you.

Request an itemized bill.
It was not an emergency. We went to a hospital because her doctor prescribed the diagnostic. We already switched plan from 20% to fixed $250 copay for the MRI. I went yesterday to ask for itemized bill. The contrast agent was $300. There are two items for two parts of the head although she went only once in the magnet ! One is priced $5k the other $7k. They were not professional.
 
  • #12
humanino said:
It was not an emergency. We went to a hospital because her doctor prescribed the diagnostic. We already switched plan from 20% to fixed $250 copay for the MRI. I went yesterday to ask for itemized bill. The contrast agent was $300. There are two items for two parts of the head although she went only once in the magnet ! One is priced $5k the other $7k. They were not professional.
Did you have insurance at the time of the MRI? If you did and you gave them your insurance card, you only pay the copay, regardless of the amount of the bill. Some places will send you the entire bill while insurance is being processed, but you don't owe it as long as your insurance pays.
 
  • #13
Evo said:
Did you have insurance at the time of the MRI?
Yes, and the insurance has agreed to pay 80% and claims they negotiated the price.
 
  • #14
humanino said:
Yes, and the insurance has agreed to pay 80% and claims they negotiated the price.
That sounds right. I would ask the insurance company and hospital to show you the negotiated price. I have serious problems believing $12k was the negotiated price, which you would pay 20% of. Something does seem wrong.

My doctor bill, for example, says "office visit: $135, negotiated cost: $65, my copay: $5 The $5 is all I pay with the option I chose. The insurance pays the remaining $60 to the doctor.
 
  • #15
The original price was $13k which was taken to $12k. So our share is $2.4k. When I read MRI price $2k to $3k am I to understand that is after the insurance share ?
 
  • #16
Evo said:
Did you have insurance at the time of the MRI?

That's key.

Here's a summary as I understand it, from my husband who used to work for a big hospital.

All hospitals have a "hospital billing charge", also called a "billing charge rate", for every procedure. These rates are insanely high! But large insurance companies negotiate much, much lower rates. Medicare (US government health care for people over 65) also pays a much, much lower rate.

What you saw was probably the billing charge. You need to contact your insurance company to clear this up.

The health care billing system is insane here. Hospitals purposefully obscure patients' actual cost because they don't want to empower the customers, IMO.
 
  • #17
humanino said:
The original price was $13k which was taken to $12k.
WTH?

So our share is $2.4k. When I read MRI price $2k to $3k am I to understand that is after the insurance share ?
Yes. But an insurance company could only manage to negotiate $1k? Something sounds very wrong. I've had a number of MRI's and CAT scans, and I paid from a low of $40 to a high of $150 (insurance plans changed)
 
  • #18
Evo said:
WTH?
At the time of the procedure, it was ACE.

I appreciate your feedback very much.
 
  • #19
humanino said:
At the time of the procedure, it was ACE.

I appreciate your feedback very much.
You can contact the insurance commissioner for your state, also the state's Attorney General's office.
 
  • #20
Did you go out of network for this service?
 
  • #21
Locrian said:
Did you go out of network for this service?

No, the hospital was prescribed by the regular general practitioner.
 
  • #22
humanino said:
No, the hospital was prescribed by the regular general practitioner.
I'm also surprised that the doctor did not send you to an outpatient imaging center, or at least give you an option. It's possible the doctor gets a kickback from the hospital for sending them business.

Oh, also, they should give you a free CD with the actual MRI on it as well as the radiologist's report. Everywhere I've gone, the first CD with report is free, each additional copy is $25. You will want this. The CD includes the software to view the MRI.

Also, did you get this insurance through your employer? If so, your employer's benefits department should be able to help you sort this out. The insurance company should have a specialist dedicated to your employer's plan.
 
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  • #23
Evo said:
I'm also surprised that the doctor did not send you to an outpatient imaging center, or at least give you an option. It's possible the doctor gets a kickback from the hospital for sending them business.
That is one scary thought to me :frown:

Evo said:
Oh, also, they should give you a free CD with the actual MRI on it as well as the radiologist's report. Everywhere I've gone, the first CD with report is free, each additional copy is $25. You will want this. The CD includes the software to view the MRI.
Yes, we have the CD.
 
  • #24
humanino said:
No, the hospital was prescribed by the regular general practitioner.

Whether it is in network depends on whether your insurance company has a contract with the provider; the GP may not have that information.

If the insurance company was negotiating with them after the fact, then I suspect (but can't say for sure) the provider is out of network. If it was, that would be helpful information in ensuring this doesn't happen to you again.
 
  • #25
Locrian said:
Whether it is in network depends on whether your insurance company has a contract with the provider; the GP may not have that information.

If the insurance company was negotiating with them after the fact, then I suspect (but can't say for sure) the provider is out of network. If it was, that would be helpful information in ensuring this doesn't happen to you again.

The insurance did agree to pay 80% of the $12k so the provider can not be out of network (unless I misunderstand).
 
  • #26
PPO and POS insurance policies often pay out of network expenses, but at increased cost to the insured.

I don't know that this is what happened here, but it sure does smell like it.

You could give them a call and ask.
 
  • #27
Locrian said:
PPO and POS insurance policies often pay out of network expenses, but at increased cost to the insured.

I don't know that this is what happened here, but it sure does smell like it.

You could give them a call and ask.

Thank you for the advice. We will certainly call them again in the next days.
 
  • #28
Maybe this will help next time. Then again, maybe you can use the data to negotiate a reasonable price.

Site for comparing costs of procedures from one hospital to another.
Healthcare Blue Book

The government CMS site where the data actually comes from:
CMS.gov

Search on the CMS site:
Physician Fee Schedule Search
 
  • #29
That is very helpful Borg, thank you very much. For my locality, the blue book indicates $815 and some steps we should take to negotiate the price.
 
  • #30
humanino said:
That is very helpful Borg, thank you very much. For my locality, the blue book indicates $815 and some steps we should take to negotiate the price.
Glad to help. Best of luck getting the price down.
 
  • #31
Evo said:
I'm also surprised that the doctor did not send you to an outpatient imaging center, or at least give you an option. It's possible the doctor gets a kickback from the hospital for sending them business.

If the doc was connected to the hospital they are discouraged from doing so for the obvious reasons. My MRI was going to cost me $2500 and they booked it for me right away and didn't share options with me. I had to insist I was going to shop around after hearing a medical imaging ad on the radio. They sheeply said ok.
 
  • #32
humanino said:
The insurance did agree to pay 80% of the $12k so the provider can not be out of network (unless I misunderstand).

Sometimes your insurance company will offer to pay an out of network provider what they would pay an in network provider. It is difficult to negotiate with an insurance company.

If you were indeed sent to an out of network facility, talk to your doctor and ask why. A call from your doctor to the MRI Lab may heavily influence whether or not the lab will negotiate the bill, especially if he refers a lot of patients to them.

My son successfully negotiated $3000 off of his bill. Actually in my sons situation the supervisor of his doctors billing office ended up calling the supervisor of the labs billing office and the lab agreed over the phone to write off the $3000.

Don't talk to the person at the desk in the Lab's billing office. Ask to speak to a supervisor.
 
  • #33
edward said:
Sometimes your insurance company will offer to pay an out of network provider what they would pay an in network provider. It is difficult to negotiate with an insurance company.

If you were indeed sent to an out of network facility, talk to your doctor and ask why. A call from your doctor to the MRI Lab may heavily influence whether or not the lab will negotiate the bill, especially if he refers a lot of patients to them.

My son successfully negotiated $3000 off of his bill. Actually in my sons situation the supervisor of his doctors billing office ended up calling the supervisor of the labs billing office and the lab agreed over the phone to write off the $3000.

Don't talk to the person at the desk in the Lab's billing office. Ask to speak to a supervisor.

That is certainly encouraging. The person at the billing desk was not helpful at all.
 

1. What factors contribute to the cost of an MRI?

The cost of an MRI can vary depending on several factors, including the type of MRI being performed, the location of the facility, and the complexity of the procedure. Additional costs may also include the use of contrast dye, anesthesia, and any necessary follow-up appointments.

2. Is $12k a fair price for an MRI?

The cost of an MRI can vary greatly depending on the factors mentioned above. It is best to consult with your healthcare provider and insurance company to determine if $12k is a fair price for your specific situation.

3. Can I negotiate the cost of an MRI?

In some cases, it may be possible to negotiate the cost of an MRI with the facility or your insurance provider. However, this is not always guaranteed and may depend on your specific insurance plan and the facility's policies.

4. Are there any ways to reduce the cost of an MRI?

If you have insurance, it is important to check with your provider to see if they have any negotiated rates with specific facilities. You can also ask the facility if they offer any discounts or payment plans for uninsured or underinsured patients. Additionally, some healthcare providers may offer lower-cost alternatives, such as a CT scan, if it is deemed medically appropriate.

5. How does the cost of an MRI in the United States compare to other countries?

The cost of an MRI in the United States is often significantly higher than in other countries. This is due to a variety of factors, including the use of more advanced technology and higher administrative and overhead costs. It is important to consult with your healthcare provider and insurance company to determine the best option for your specific situation.

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