Early results from our California crowdsourcing project on MRI prices are in. Payments range from $255 to $2,925.15. MRI pricing is a complete mystery: What should you pay? Can you ask for a discount? We’ve been looking at health-care prices for three years, so if we say it’s a mystery, we can imagine what it looks like to you.
How much should you pay? Well, one person was told the price is $1,850, but if you pay up front, you can save almost $1,300.
The note on our form, shared by our community member: “I was told procedure would be 1850. I have a 7500 deductible. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”
On our Facebook page, one contributor wrote, “I was going to be billed $830 through my PPO for an MRI. The cash price? $500.”
This is the second part of our crowdsourcing project in California with KQED public radio in San Francisco and KPCC/Southern California Public Radio in Los Angeles. We have been asking people to share pricing information for MRI’s, especially of the back; last month we collected mammogram pricing.
A note: We are often asked in this crowdsourcing prototype project if we believe what we are being told by people who fill out our online form at the PriceCheck page. The answer: yes, we do. Though some of our community members have said their bills are confusing, or the coding they see on the bills doesn’t match what we’re collecting, we believe our contributors’ shares. We have seen wide variations in health-care pricing.
So: here are early results.
Lower-back MRI: $255? $602.85? $973.25? $1,660?
Eight identical MRI’s, and eight vastly different payments.
No. 1: We heard from one Kaiser member, who received an MRI of the lower back, without contrast or dye (CPT code 72148) at the Kaiser Antioch Medical Center on Sand Creek Road in Antioch, Calif. This person was charged $973.25 and paid $973.25; insurance paid nothing.Comment: “This price was the contracted amount through my insurance. Deductible had not been met so I was responsible for all charges. This does not include the two office visits required to obtain and analyze the results.”
No. 2: Same kind of MRI, code 72148, at Radnet Medical Imaging at 3440 California St. in San Francisco. This person was charged $1,660 and paid $1,660, out of HSA funds. (Note: Our ClearHealthCosts pricing survey included that Radnet location, and they did tell our survey agent that their cash price is $1,660.)
No. 3 and No. 4: Two of our community members sent in prices for that same MRI of the lower back (CPT code 72148), both at a Health Diagnostics location at 325 Sacramento St. in San Francisco.
One a Medicare recipient, was charged $2,450, and Medicare paid $255. There was no patient payment.
The other was charged $602.85 and paid the full $602.85. Comment: “I had to pay the full price since I had not yet met my deductible. For some reason Blue Shield of CA said it would have only been $65 if I got it done in a lab instead of a center, not sure what that means.” No email was given, so we can’t follow up for comment.
Also one of our community members sent in a pricing sheet for imaging procedures from Health Diagnostics (see below). It lists a $575 cash or self-pay price for an MRI. We could not find it on the Health Diagnostics website, so we are reproducing what was scanned and sent here. We are also attaching spreadsheets for several other imaging facilities that have posted prices online or made price lists to give to patients. Cash rates here seem to range from $399 to $3,388, though the specifics are not always clear, and some providers call their posted prices “estimates.” (See a bit below for our ClearHealthCosts pricing survey information.)
No. 5: Provider, Providence St. Joseph Medical Center in Burbank: insurer, Medicare and Blue Shield Medigap.
Charged price $2,266; Medicare paid $201.07, and Blue Shield Medigap paid $133.42; you paid $0.
Comment: “The scan and 3D radiology was $2266.00. Medicare paid $201.07 and Blue Shield Medigap pays $133.42. The 3D radiographic procedure (76376) was $338.00 and included in the $2266.00 amount.”
No. 6: Provider, Vallejo MRI on Glen Cove Marina Road in Vallejo; insurer, Blue Cross.
Charged price, $580; insurance paid, $0; you paid, $580.
Comment: “I was told procedure would be 1850. I have a 7500 deductible. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”
No. 7: Provider, Palo Alto Medical Foundation; insurer not named.
Charged price, $2,650; insurance paid, $0; you paid, $2,650.
No. 8: Provider: Kaiser Permanente Medical Center on West McArthur Boulevard in Oakland; insurer, Kaiser Permanente.
Charged price, $2,785; insurance paid, $2,785; you paid, $10.
Comment: “Service delivered on 7.19.14; ‘hospital’ bill activity summary arrived on 7.29.14. charges showed as $2,785 and activity summary shows I paid $10 at time of visit. However, values listed above came with a ‘pending’ notice – pending ‘paid by insurance/adjustment’ and pending ‘amount I owe.’ so the total charges seems to be $2,785. What portion of that I owe may go up from the $10 I paid at time of service.”
Oakland prices: Two Telegraph Avenue providers
Update, 7/31/14: More recent community shares include two Oakland MRI’s. Here they are: Both paid cash.
No. 1: Provider: Magnetic Imaging Affiliates at 5730 Telegraph Ave. in Oakland. Procedure: MRI 72147, chest spine MRI with dye.
Charged price, $3,163; insurance paid $0; you paid $3,163.
Comment: “High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it sucked. Need to shop around assuming can even get a price quote.”
No. 2: Provider: Norcal Imaging at 3200 Telegraph Ave. in Oakland. Procedure: MRI 72141, upper back MRI without dye.
Charged price, $1,000; insurance paid, $0; you paid, $1,000.
Comment: “Discount for paying day of service. ”
A different MRI, but same wild price disparities
We also got reports from three lower-back MRI’s, both with and without contrast or dye: this procedure (CPT code 72158) uses an injection of contrast material to better visualize what’s going on under the skin.
No. 1: Provider, Marina del Rey (Unclear; Marina del Rey Radiology? Marina del Rey Hospital?); insurer, Anthem Blue Cross (California).
Charged price, $319.92; insurance paid, $223.72; you paid, $96.20.
No. 2: Provider, North Bay MRI Center in Pinole, Calif.; insurer, Medicare and Anthem Blue Cross (California).
Charged price, $466.69; insurance paid, $459.03; you paid, $0.
Comment: “Medicare paid 365.73 and Anthem paid 93.30. ”
No. 3: Provider, Stanford Medical Center, on Pasteur Drive in Stanford; insurer, Aetna.
Charged price, $5,647; insurance paid, $2,925.15; you paid, $0.
Comment: “Aetna did not actually pay $5,647. The Aetna adjusted member rate was $2,925.15.”
Upper-back MRI: $305? $1,984? $2,294?
Here are reports from two other very similar MRI’s, an MRI of the cervical spine or upper back without contrast or dye (CPT code 72141). This is very similar to the one coded 72148, and usually the prices are comparable.
One person, at Imaging Healthcare Specialists in San Diego, was charged $1,984, insurance paid $0, and the patient paid $305. The comment: “Insurance paid $0 because deductible not yet met.”
Another person, at Kaiser Permanente Medical Center on MacArthur Boulevard in Oakland, who is insured by Kaiser, was charged $2,294 and is being billed for $2,294. The comment: “At the time I was billed for this procedure, Kaiser Permanente did not have on record that I was covered under COBRA. I believe this is the price KP would charge an uninsured person. COBRA should pay for this eventually, once everyone’s paperwork gets caught up. (This is another issue – I’ve been covered under COBRA for nearly 6 months, but this information was not communicated to KP’s MRI Department, despite my numerous calls to KP and the COBRA insurer. It’s taken me months to sort this out! A single payer plan would eliminate all of this paperwork, wasted time, angst, and headaches.”