Capitol Imaging Services shares a news article on the unfortunate situation a medical doctor incurred when becoming a patient herself, and experiencing what many other non-medically trained people have: high hospital imaging fees.
This occurred in New York state. However, no matter the location, the principle issue raised in this article and countless others holds true here. Be aware of where you go for medical testing (and often other types of health care services) because when going to a hospital, invariably it will cost more — often much more.
In this example, it was for a mammogram and ultrasound. Because of the hospital’s higher charges, the presumption is that it was a diagnostic mammogram. A diagnostic mammogram IS NOT INCLUDED under the Affordable Care Act (ACA) as being covered in full by insurance. Other diagnostic-type tests, such as breast ultrasound and breast MRI are also not part of the ACA.
There are two very interesting and telling points in the story.
First, the doctor-patient told the author, “She said it never occurred to her to discuss price, because they were insured, and the previous summer’s mammogram had cost about $1,300.” The exams did not change in quality or type from one year to the next, so why is the charge for her latest tests double in cost?
Second, the doctor who is the chief medical officer for the insurance company is quoted after being asked about the level of expense as answering, “It depends tremendously on whether it’s done in a hospital or at a freestanding radiologist,” he said. “Had it been done at a radiologists’ office, it would be a lot less.”
Had it been done at a radiologist’s office, it would be a lot less.
The fact that the doctor-patient is well educated and experienced in the health care system did not preclude her from mega-high hospital bills. However, due to her experience, she stated that she changed her health care purchasing behavior.
“I was supposed to get an x-ray and though I was unable to get anyone in the hospital to tell me how much it would cost if I billed the x-ray through insurance, I found the out of pocket charge to be unreasonably high and I opted to look for an outpatient radiology center instead.”
Women need to understand what is covered as screening tests and what is not covered (and subject to insurance coverage and deductibles) under the ACA. Screening mammograms are covered. Diagnostic mammograms and other follow-up tests are not.
Know before you go. Remember… “had it been done at a radiologist’s office, it would be a lot less — insurance company.”
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