Most people would agree that having health insurance is a good thing. Insurance can cover major medical bills that might otherwise send you into financial ruin, and it sometimes covers preventive care at zero cost. However, hospitals and healthcare facilities will often charge you more for medical tests, such as Computed Tomography (CT Scans) and MRI, if you have insurance. If you ask to pay in cash, your cost may be much lower – lower than your insurance deductible.
The Los Angeles Times recently explored this issue in an expose. While gathering information for the article, The Times discovered cash vs. insurance pricing discrepancies at many hospitals. One medical facility listed its fee for an abdominal CT Scan online at $4,423. An insurance company that works with that facility stated that their negotiated rate for an abdominal CT Scan is $2,400. A phone call to the same facility to ask the cash price for this same scan delivered a surprising answer - $250.
Why is there such a discrepancy in pricing between cash and insurance – for the same scans? And, as medical scans become used more and more for improved healthcare, what is the best way to cover the costs? Read on to find out!
Scans at Outpatient Facilities
If you have been referred for a medical scan (CT, MRI, PET) at an outpatient facility, it is likely your scan is available at a cash discount. Call the facility in advance to inquire about the cash price of your test. If the quoted price is lower than your high-deductible insurance plan, you may choose to pay for your scan out-of-pocket. However, here is where it might get tricky.
Making the Right Choice
When inquiring about a lower cash price, you will have to withhold the fact that you have health insurance. If you decide to go this route and pay the lower cash price, you will be considered an “uninsured patient” and your payment will not apply towards your annual insurance limit for out-of-pocket medical expenses. You can either pay cash and get the lower rate, or disclose that you have insurance and go through your health plan so the cost is applied toward your deductible.
Your decision should be based on factors such as the amount of your deductible and how many medical scans or other tests and procedures you anticipate undergoing during that year or billing period.
Scans at Hospitals
According to the California Hospital Association, discounted cash prices for scans and other medical tests are meant for patients who have no insurance, rather than those who do. However, most hospitals will also offer a modified discount to patients who have health insurance, but are willing to pay a portion of the cost upfront at the time of service. Typically, the discount offered to an insured patient is the rate that their insurance company has negotiated with their hospital.
Go here to learn more about medical scans or find a scanning facility!