When is it appropriate to shop for healthcare services?

Much is spoken about, written about and bantered about in regard to people becoming much more engaged with healthcare services that they may need. Services have a wide and varied range from lab work to therapy to surgeries.

Within that range, of course, is medical imaging. Medical imaging is an important cog in healthcare due to its screening and diagnostic capabilities that are often crucial to a medical provider in determining a person’s overall health and/or what might be the source of an illness, discomfort or pain.

One of the most important points for people to understand is that price comparison shopping in healthcare is NOT for medical emergencies. When it is an emergency or urgent situation, that’s where the value of a hospital is found.

Price shopping is much more appropriate for what some call “discretionary” or non-urgent situations in which a person has the time to evaluate providers, to research and to make a decision.

What are examples of these situations? One would be a person who has developed soreness in a knee and a physician determines after their evaluation that an MRI would be best appropriate. Another would be for a person, who after being evaluated, receives a recommendation of a CT scan to evaluate the thyroid glands. In these cases, neither situation has been determined as emergency or urgent scenarios and people have the opportunity to evaluate choices for both types of imaging exams.

Study after study has shown that price and quality are not linked.

This means that the higher price that is most often found at local hospitals do not mean their exam services are better. They’re just more expensive. Hospitals give many reasons for their higher prices. However, people do not have to accept these reasons and agree to have testing at the hospital. In the vast majority of non-urgent, non-emergency medical situations, people will find significant savings in the hundreds and even thousands of dollars when they evaluate an independent outpatient imaging center’s fees in comparison to hospitals.

There are now numerous tools available for people to use in their comparison shopping efforts. For people with health insurance, they can call their insurance plan or check their website. Many have cost calculators that will help compare prices at different facilities. In some cases, health plans can be specific about the price of a service and other times they can’t be. This is because of contractual obligations to medical providers who don’t want price or quality data to be reported publicly.

Often times, those medical providers are the hospitals. Perhaps it’s because they know they’re more expensive? You be the judge.

If you can’t pinpoint the exact price, look for the amount that Medicare reimburses for procedures in your region, which is “the closest thing to a fixed benchmark price in the marketplace,” Pinder says. Find them at ClearHealthCosts by procedure code or by searching the Medicare Physician Fee Schedule lookup tool at www.cms.gov.

Call providers directly and ask about cash rates. They may give you a lower price if you pay up front and/or agree not to bill your insurance. To be clear, if you pay cash, your outlay may not be applied to your deductible.

In all of these cases, when you’re quoted a price, make sure you understand what the figure means. Is it the full cash price? Is it the portion you would pay if your insurance were applied? Is it an average?

And remember, this isn’t foolproof. You may come across conflicting information in your search or contend with providers who won’t tell you the exact cost of a procedure.

At Capitol Imaging Services, we do everything we can from a service perspective to be as upfront as possible about prices, fees, deductible estimates and all other financial information. In the vast majority of cases, when a person contacts us and compares DIS to area hospitals, they either see the huge difference in savings or they have our information and can’t get the information from hospitals because it is a difficult thing to do.

And, as we like to say, if a hospital can’t or won’t tell you how much an MRI or CT is going to cost you potentially, do you really want to go there blind and hope for the best?

We think not.

As the new year approaches, people with insurance deductibles have their fulfillment of that deductible set to $0. With the continued growth in offering people high deductible health plans in which deductible amounts can be in the thousands of dollars, activism in healthcare will also continue to grow.

So how do you compare prices in medical imaging? Capitol Imaging Services offers a price estimate tool that allows you to get a good faith estimate from us as to any fees that would be your responsibility to pay. With our estimate, you know before you go.

Capitol Imaging Services is doctor trusted and patient preferred.