CT Scan | Cheaper to not use insurance, especially after 2pm (1 Viewer)

[SoBeDad]

I passed a kidney stone, after 2 days of constant urgency. No severe pain, but very uncomfortable always feeling like you need to go. I captured the stone, it was calcium oxalate, and the doc recommended a CT scan of the abdomen and pelvis. I could forego it, but it would be good to know if I have more stones. I passed one 30 years ago that was painful.

The cost for the CT scan using my insurance at one of 2 preferred locations, with "Maximum Savings" is $500 deductible. Those locations are hospital-based. At a nearby legit site the cost with no insurance is $400 before 2pm, $300 after 2pm. The after 2pm discount sounds like a good deal.

The $500 would satisfy my deductible for the year, but why the disparity in cost and why do insurance companies choose hospitals for preferred imaging sites when it's more costly? BTW, my employer is one of the hospital preferred sites for a CT and the doc also works there. Somehow, this must skirt the Stark Law. Medicine is a business too. 

 

[Foosball God]

I passed a kidney stone, after 2 days of constant urgency. No severe pain, but very uncomfortable always feeling like you need to go. I captured the stone, it was calcium oxalate, and the doc recommended a CT scan of the abdomen and pelvis. I could forego it, but it would be good to know if I have more stones. I passed one 30 years ago that was painful.

The cost for the CT scan using my insurance at one of 2 preferred locations, with "Maximum Savings" is $500 deductible. Those locations are hospital-based. At a nearby legit site the cost with no insurance is $400 before 2pm, $300 after 2pm. The after 2pm discount sounds like a good deal.

The $500 would satisfy my deductible for the year, but why the disparity in cost and why do insurance companies choose hospitals for preferred imaging sites when it's more costly? BTW, my employer is one of the hospital preferred sites for a CT and the doc also works there. Somehow, this must skirt the Stark Law. Medicine is a business too. 

Insurance companies negotiate networks, they typically wouldn't negotiate the individual prices for all procedures but take a more holistic view of cost for a particular provider.  As long as the prices fit into an average cost structure they won't blink at it.

 

[Van Dyman]

I passed a kidney stone, after 2 days of constant urgency. No severe pain, but very uncomfortable always feeling like you need to go. I captured the stone, it was calcium oxalate, and the doc recommended a CT scan of the abdomen and pelvis. I could forego it, but it would be good to know if I have more stones. I passed one 30 years ago that was painful.

The cost for the CT scan using my insurance at one of 2 preferred locations, with "Maximum Savings" is $500 deductible. Those locations are hospital-based. At a nearby legit site the cost with no insurance is $400 before 2pm, $300 after 2pm. The after 2pm discount sounds like a good deal.

The $500 would satisfy my deductible for the year, but why the disparity in cost and why do insurance companies choose hospitals for preferred imaging sites when it's more costly? BTW, my employer is one of the hospital preferred sites for a CT and the doc also works there. Somehow, this must skirt the Stark Law. Medicine is a business too. 

Interesting. Will the insurance apply the other place's $300 fee toward your deductible?

(sorry that's just curiosity and I'm aware it's tangential to the point of the thread)

 

[Gally]

Do they have a cash discount too?  Maybe they are laundering money and want some cash infusion for those late (after 2pm) appointment times.  

I have found that many places have a lot cheaper prices for non-insurance payments.  It's crazy at how much cheaper many things are if you don't have insurance.  

 

[SoBeDad]

Interesting. Will the insurance apply the other place's $300 fee toward your deductible?

(sorry that's just curiosity and I'm aware it's tangential to the point of the thread)

Good question. I'll ask my insurance company. I've already spent a couple of hours on the phone, at some point I think most people give in or give up. 

 

[SWC]

if you go in there and tell them their grandma is a brohan there is a good chance they will give you the grandmama brohan discount which could result in even more savings im just saying give it a shot you never know take that to the bank brohans 

 

[arrow1]

It's two-for-one on Friday with coupon.

 

[SWC]

can you get a ct scan for gout take that to the bank brohans 

 

[belljr]

I've never had a CT Scan at a hospital unless I was in the ER/admitted.

We always go to an imaging place

 

[SoBeDad]

Interesting. Will the insurance apply the other place's $300 fee toward your deductible?

(sorry that's just curiosity and I'm aware it's tangential to the point of the thread)

My insurance company said no. If I pay $300 without using my insurance for the after 2pm CT scan, it won't count toward my deductible.

Actually, after further conversation with Aetna, the only 2 sites where I can use my insurance for complex imaging are hospital-based with a $500 deductible, one of the hospitals is my employer. That doesn't seem right to steer employees to their own expensive hospital-based imaging centers. A possible Stark law violation based on my limited knowledge. 

 

[SoBeDad]

Correction: Stark Law only applies to Medicare and Medicaid patients. So my employer-paid (partially) health insurance can steer employees wherever they want. Even if it's more expensive for the employee.

The anti-kickback statue also only applies when there is federal reimbursement involved.

Since it's the beginning of the year, probably better to just pay the $500 deductible at the more expensive insurance approved imaging center. 

 

[Gally]

Correction: Stark Law only applies to Medicare and Medicaid patients. So my employer-paid (partially) health insurance can steer employees wherever they want. Even if it's more expensive for the employee.

The anti-kickback statue also only applies when there is federal reimbursement involved.

Since it's the beginning of the year, probably better to just pay the $500 deductible at the more expensive insurance approved imaging center. 

Do you have an HSA?  I would think you could use that to pay the $300 bill and even though it doesn't count towards your deductible it seems like it could be used.  However, I guess that still doesn't really help in that you are now potentially on the hook for $800 for the year ($300 CT Scan and $500 deductible).  

I still wonder if it would be more cost effective for a relatively healthy individual to just put all the money they put into health insurance into a separate savings account and basically "self insure" and then pay cash for anything they need as a non-insured person.  I think it would likely work out to be less expensive.  

 

[CletiusMaximus]

Regardless of where the imaging is done, it will be read by someone in Korea who will be paid about $8 to spend 3-5 minutes to read and report their findings.

 

[Dez89]

Geez, wish I'd have gone to your place.  Got a CT head scan a little over a year ago and paid the hospital $1300 up front.  Insurance came back later saying it was an "unnecessary procedure" and wouldn't cover it.  The hospital has been going back and forth with them and insurance has basically said no way, so I might end up owing another $900.

 

[SoBeDad]

Do you have an HSA?  I would think you could use that to pay the $300 bill and even though it doesn't count towards your deductible it seems like it could be used.  However, I guess that still doesn't really help in that you are now potentially on the hook for $800 for the year ($300 CT Scan and $500 deductible).  

I still wonder if it would be more cost effective for a relatively healthy individual to just put all the money they put into health insurance into a separate savings account and basically "self insure" and then pay cash for anything they need as a non-insured person.  I think it would likely work out to be less expensive.  

I don't have an HSA. I did one year when my ex-wife and 2 kids were covered and it was a challenge to collect all the paperwork. And there was neglible savings. Going without insurance is an option, especially since I'm relatively healthy, but health can change quickly and there's always the possibility of an accident.

 

[DA RAIDERS]

Regardless of where the imaging is done, it will be read by someone in Korea who will be paid about $8 to spend 3-5 minutes to read and report their findings.

Wut?

 

[SoBeDad]

Regardless of where the imaging is done, it will be read by someone in Korea who will be paid about $8 to spend 3-5 minutes to read and report their findings.

I know 2 radiologists reading scans for Miami sites who live far away. One lives in Ohio, where he has family, and the other lives half the time in Finland where he has family, returning to Miami in the winter months. I'd consider Costa Rica if I were a radiologist. 

 

[Biff84]

Prices in health care are all smoke and mirrors. I know more about pharmacy side than the medical side but my understanding is it’s the same. 

In the pharmacy we set a sky-high cash price for medications because that’s the price we submit to the insurance. We do that to try and get the insurance company to reimburse us a higher amount to increase the chances that we actually make money filling that script. When you have a high deductible, that high submitted price results in a high co-pay which goes toward your deductible.

If a cash paying patient calls wanting to know our cash price, I’d never give them our true ‘cash price’ because I’d never make someone pay that. I use a discount card like GoodRX and give them that price. We make very little and often lose money on those transactions but I’m not going to make someone pay that ridiculous price.

That’s an easy example of a cash paying patient paying more than an insurance covered patient and it happens in medical billing the same way. It’s clear our insurance system is severely broken.

 

[Vanilla Guerrilla]

if you go in there and tell them their grandma is a brohan there is a good chance they will give you the grandmama brohan discount which could result in even more savings im just saying give it a shot you never know take that to the bank brohans 

Best part of that is I watched the Seinfeld episode last night where Kramer tells George to tell the eyedoctor he's friends with Kramer to get a discount.  Eye doctor totally doesn't care.