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How Much Does an MRI Cost In California: $255? $973.25? $2,925?

Jeanne PinderEarly 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.)

The Health Diagnostics website does not seem to have the Sacramento Street location. It does have one California location, in Alameda.

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 comments.

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 comments.

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.”

 

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CA Sanjeev Jain
Member

Thanks for the Information

Kaiser insurance
Guest

Healthinsuranceexchangeonline.com. online quote system can provide you with the latest rates from Kaiser health insurance, Kaiser health plans, Kaiser insurance and Kaiser insurance California.

Kivalina
Guest
Kivalina

Few years ago I was having MRI every few months on full spin e and brain done broken up not at same time,they would do 3 MRI’s total on me.Anyhow Insurance was covering it and INSURANCE payed 1250 per MRI..However after my 3rd MRI insurance decided they would drop me cause I was ‘high risk’ so here I was NO INSURANCE company would touch me.I got a few more MRI’S got bill and POTTIED Myself the 1250 that insurance was paying jumped to 7500 for a uninsured person,GREEDY GUTS Hutchinson ks hospital.

Ashley Broom
Guest

#MRI is poised to reach approximately $5.24 billion by 2018 at a #CAGR of 4.56%, Get more details at http://bit.ly/1oQMN5V

Toronto Blue Jays Jersey
Guest

that your list will get longer and longer.
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Dorothy Vargas
Guest

Thanks for sharing the cost of getting MRI done in California. We provide MRI services in West Palm Beach localities. Contact us for more information.

e-Patient Dave
Guest
e-Patient Dave

Couldn’t agree more. Everything we need to know about the lack of integrity in this area is: 1. The whole situation is summed up in Uwe Reinhardt’s 2006 paper “Hospital Pricing in America: Chaos Behind a Veil of Secrecy.” 2. In the 8 years since, nothing much has changed about it. Yes, we need regulation, as you say. But the situation is SO corrupt, SO far out of control, with the money-makers in charge, you’re right: only crowd-sourcing from the grass roots will go around the perverted structures. Prediction: watch for a move to prohibit crowd-sourcing of price data, complete… Read more »

Bob Hertz
Guest
Bob Hertz

We do need regulators, because a fair amount of medical care is involuntary.

Also, we get medical care episodically in our lives for the most part.

In other words, we cannot threaten providers with not buying care, and we cannot threaten them with never going back again if we are ripped off

It is a unique industry that needs unique regulations.

Barry Carol
Guest
Barry Carol

Bob, As you know, I’ve long called for special rules that govern how much hospitals and doctors can charge for care that must be delivered under emergency conditions, especially for patients who are either uninsured or find themselves out of network. It’s also important to note that roundly 50% of inpatient hospital admissions come through the emergency room. That’s a lot of care. I think there is room for patients to communicate bad experiences regarding both care itself and its cost through social media. Negative word of mouth commentary can be pretty powerful if there is enough of it and… Read more »

JeanneFromClearhealthcosts
Guest

Oops, sorry if I misspoke.

I completely agree, we need regulators. But I don’t know that the current regulatory system can be counted upon to solve the problems we’re discussing!

Bob Hertz
Guest
Bob Hertz

Thanks Jeanne, you have done a great job throughout the exchanges on this blog. You can call it health courts, or you can call it consumer protection, or you can call it Rumpelstiltzkin…………but some entity must rise up to slap down places like Bayonne. In way too many sectors of health care, the more you bill, the more you make. In the non-health economy, if you bill too much you cut off some of your customers. This leads to strategic decisions. If a firm decides to send huge bills to non rich customers, they go broke But in America we… Read more »

JeanneFromClearhealthcosts
Guest

Thank you, Bob. You know much more about this industry than I do, but …it’s not clear to me that we can look to legislators or regulators for the solution, as much as we might hope salvation lies there. We’re placing a bet on the people — for example, the people who have flooded to our PriceCheck app to talk about their outrage. http://blogs.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/ Power to the people, we say. My friend ePatient Dave de Bronkart talks of this as a moment at the dawn of social movement, like civil rights or feminism. It will take all of us together,… Read more »

Bob Hertz
Guest
Bob Hertz

Barry I would be delighted with the regulatory changes that you propose. At this time I do not know who will supply the political pressure to get them enacted, however. The uninsured are not a voting bloc, that has been shown over and over. Maybe a Nader-like consumer rights movement can move the dials. I still think that health courts could be like a nuclear option that is not enacted, but is threatened so that some action does take place. Rather like the situation in postwar Europe, where the Communist party was a real threat and the parties in power… Read more »

Barry Carol
Guest
Barry Carol

Bob, As many more people gain health insurance coverage under the ACA, including Medicaid expansion, I think there is a reasonable prospect that politicians, especially liberals, will turn their attention to costs and prices. There is also the possibility of state level action. Among those running for governor in Massachusetts this year, for example, is Charlie Baker, former CEO of Harvard-Pilgrim Healthcare and a strong believer in price transparency. Also, I note that the late economist, Herb Stein told us that if a trend can’t continue, it will stop. Just yesterday, I read a story on Yahoo about a man… Read more »

sribe
Guest
sribe

Here in Colorado, I went to my regular dr’s office with a painfully stubbed toe. He used a cautery needle to pierce the nail and drain the hematoma and sent me on my way. I thought the $700 price was high when I got the bill. Imagine the shock a week later when I got the bill for $2,300 for the “facility fee”. Because, you guessed it, at the time my doctor’s office was the “Family Physician” center arm of the big academic medical center, and my treatment crossed some invisible line which triggered “big greedy hospital pricing” instead of… Read more »

JeanneFromClearhealthcosts
Guest

Did you challenge the $2,300? We hear quite often that bills are sent in error, and that when people call either the provider or the insurer, the response is “Oh, never mind, you don’t have to pay that.”

It all depends on the situation, but it’s far from uncommon.

sribe
Guest
sribe

The hospital was absolutely immovable on the $2,300 facility fee. If you really want the gory details… It was billed under an incorrect procedure code. Although their billing sheet used by the doctors correctly describes it, the code used is actually for draining via incision not by cautery needle. Hospital billing of course insisted that the code was correct, because of course I could not possibly know that, could I? Neither the hospital nor the insurer would tell me what the charge would be if the correct procedure were billed. The hospital billing people actually slipped up once and referred… Read more »

Barry Carol
Guest
Barry Carol

scribe, When I’ve had disputes in the past with hospitals, insurers or large companies in general that I was unable to resolve through normal channels, I’ve written a polite letter to the CEO summarizing the facts and my preferred remedy. Usually, the letter gets forwarded to the appropriate department in the organization and it just about always gets resolved to my satisfaction on a timely basis. If you have a similar issue in the future, writing to the hospital CEO is worth a try. My favorite resolution actually involved a colleague of mine who received hospital and doctor bills totaling… Read more »

JeanneFromClearhealthcosts
Guest

Yes, Massachusetts is wrestling with price-fixing. IT will be interesting to see if they can make that happen, given the political and logistical problems.

Also, New Jersey: Ah, that hospital. That’s their business model (insert deep and gusty sigh)

http://www.nytimes.com/2013/05/17/business/bayonne-medical-center-has-highest-us-billing-rates.html?pagewanted=all&module=Search&mabReward=relbias%3Ar%2C%7B%221%22%3A%22RI%3A10%22%7D

Bob Hertz
Guest
Bob Hertz

I have proposed the creation of specialized Health Courts. These would be federally funded, placed in about 100 locations, staffed by a mix of judges and doctors and citizens. Anyone who felt cheated by a health care bill could come before such a court. They would pay a fee of $100 perhaps. All collection activity on such a bill would cease until the court had made a decision on fairness. The court’s opinion would be binding. If they set the amount at the Medicare rate plus 15%, that would be all that the health care provider could collect. The proceedings… Read more »

Peter1
Guest
Peter1

Bob, these courts would be flooded with cases if no one had any idea what constituted being “cheated”. Small claims (at least in this state) now is hard to navigate for most people as lawyers ban any guidance by filing clerks on the process.

Bob, I respect your opinions but think this one is just a wacky idea for something that should be unnecessary if these providers were regulated properly.

Barry Carol
Guest
Barry Carol

Bob, I’m inclined to agree with Peter on this one. So-called price gouging affects mainly the uninsured and people who need care under emergency conditions and find themselves out of network. I think the following regulatory changes could fix this: (1) for uninsured patients, limit charges to 115% of Medicare regardless of the patient’s income and assets and (2) if an insured patient is out of network and needs emergency care limit charges to the insurer’s in network rate. This issue of out of network providers used to come up all the time in hospitals with radiologists, anesthesiologists, pathologists and… Read more »

Kim13
Guest
Kim13

Boy, I think it is about time that people start taking back health care. I am an RN, but unfortunately for the past 7 years I have been fighting insurance companies for reasonable health care. I was pretty vocal about it and was even invited by some organizations to speak/be interviewed. IMHO, I am not the greatest speaker, however, but I do have a love for writing. I write about health care as much as i can. First off, I am under wc (workers compensation) now for my back, and although my case is moving towards settlement (finally), the third-party… Read more »

Barry Carol
Guest
Barry Carol

I’ll add that imaging lends itself especially well to reference pricing. For example, an insurer could tell its members it will pay $500 for CPT-4 code 72146 and here is a list of 10 hospitals and independent imaging centers in the region that will do the test for that price. If the patient wants to go to a more expensive facility, he or she will be responsible for any additional cost above the reference price so call ahead for firm pricing.

JeanneFromClearhealthcosts
Guest

Barry, thanks for your expertise. I am a huge fan of your work! Our heretical notion: make it possible for the people to disclose those confidential rates, without waiting for state legislators, insurers, providers and all the other parties to come to an (improbable) agreement on disclosure, making such an agreement moot. We may be crazy, but it looks to us like people are Incensed About The Prices and excited to open up their bills. Beyond that, two thoughts to your points: 1. On pricing, if it’s always someone else’s money, then will they go ahead and buy the expensive… Read more »

Barry Carol
Guest
Barry Carol

Jeanne, I applaud what you’re doing and I’m quite sure that people find it very helpful. I would still like to see the confidentiality agreements abolished so that referring doctors can identify the most cost-effective high quality providers in real time no matter what care they need and direct their patients to them. My own primary care doc is a member of an ACO. I presume he is eligible for a bonus if he can keep costs for his patient panel below a targeted level. One of the best ways for him to do that is not to withhold care… Read more »

JeanneFromClearhealthcosts
Guest

We agree about the confidentiality piece. It’s hard to defend that from any perspective, if you ask me.

Of course, we’re journalists, and so we firmly believe that sunlight is the best disinfectant!

Barry Carol
Guest
Barry Carol

The biggest impediment, by far, to true price transparency in healthcare are the confidentiality agreements between insurers and providers that preclude the disclosure of actual contract reimbursement rates. State legislators and/or insurance regulators need to stand up to the special interests and outlaw these confidentiality agreements. It would be extremely helpful if both patients and referring doctors could easily ascertain contract reimbursement rates in real time for all the regional providers of a particular service, test or procedure. That way, patients could more easily and consistently be directed to the most cost-effective high quality providers. As for the pricing of… Read more »

David Harlow
Guest

I’m guessing Paul’s experience in not being able to negotiate a discount because a bill had already been submitted to insurance was due to the now largely discredited practice of using “most favored nation” clauses (which meant that payors got the benefit of the deepest discount given to ANY other individual or organizational payor). With such clauses in place, providers couldn’t offer discounts without having the discounted price applied to a whole lot of their volume, and so they were loath to do so. Over the past few years the DOJ has brought suit against payors for using this tactic,… Read more »

Saurabh Jha
Guest
Saurabh Jha

My guess is that MFN has become a convenient pretext for providers.

“Sorry we must fleece you, otherwise we’d be breaking the law.”

JeanneFromClearhealthcosts
Guest

David, thank you so much for shedding light on this. Do you have a white paper or blog post we could refer people to when they ask this question? We know what you say anecdotally, though would love case law and/or authoritative voices like yours to point to. thanks!

David Harlow
Guest

Here’s one example: DOJ brought an antitrust action against BCBS of Michigan re: MFN clauses and then dropped it when the state legislature banned MFN clauses. — http://shrd.by/65VExK

Also, DOJ and the FYC held a joint seminar on the subject a couple of years ago: http://shrd.by/tRc7F7

As of 3 years ago, I believe about 20 states had MFN clause bans on the books.

Peter1
Guest
Peter1

“I’m guessing Paul’s experience in not being able to negotiate a discount…”

David, what would be your basis argument for wanting a “discount”? Just because, I’m poor, I have other bills due this month, you guys are making too much money?

Paul Dorio, MD
Guest

The point of the “discount request” is precisely because there is such a wide disparity between “actual cost” and “billed charges.” While this may be distasteful, it is the practice that has been in place. It is why I shake my head daily about the “line item type of cost cutting” that regulators seem to do when they attempt to “control” health care costs. They don’t understand or see the simplicity of eliminating this strange phantom billing practice that exists everywhere, in favor of a more one-to-one billing practice employed by many companies when they offer a product up for… Read more »

Barry Carol
Guest
Barry Carol

The phantom billing practice exists because the feds require providers to bill all patients and their insurers the same amount which is the artificially high full list price or chargemaster rate in the case of hospitals. So, even Medicare and Medicaid get billed at full list and then they pay their administered (dictated) rate and commercial insurers pay their contract rate if they have one. It seems that this crazy system could be fixed by allowing providers to bill patients and insurers the rate that the insurer has agreed to pay or, in the case of the public insurers, their… Read more »

Peter1
Guest
Peter1

“The main impediments, as I see them, are individual greed, insurance company middlemen,…” Hence my question above about what does it costs in other industrialized countries that have much more government control – there is no need to individually negotiate, especially based on, “just because”, the government does the negotiating and keeps costs at about half what we pay. However the insurance industry will argue they make less than 5% profit, so they’re not to blame. “…and the widespread perception that health care should be free.” At these prices it’s not free. But the “let the patient pay use reduction… Read more »

Paul Dorio, MD
Guest

Do you want the government to determine when you need an imaging study or lab test? Or would you rather discuss that issue with a physician, who is preferably free of financial attachments to said study/test? Do you think that the costs of services in other countries are good benchmarks for services and goods provided in the USA? If so, on what economic basis do you feel that way? The suggestion that physicians should make the same, lab tests or imaging studies should be similar, or goods and services such as bread, cars, toothbrushes, etc., should cost the same in… Read more »

Peter1
Guest
Peter1

@ Paul, Paul, there is a trade off for cost and access. In those countries docs determine the “need” while some restrictions on access is required for the cost. Is triage making some wait in line unethical? Do docs call for more tests when they own the lab? Am I entitled to know what you pay for supplies, overhead and labor so I can “negotiate” a better price with you? How is the costs here good “benchmarks” on the true cost of health care? The cost in other countries is reflective of more government control. As a doc I expect… Read more »