Can anyone give me a rough estimate of the typical cost billed to a participating insurance plan for an abdominal CT scan with contrast?
My daughter was recently evaluated for possible appendicitis by her family practice doctor who referred her to the local (small town) hospital for a CT scan. She was unable to tolerate oral contrast solution, and had an IV inserted for the procedure. It was pre-authorized by insurance and done on an urgent basis on a weekday afternoon. She was not seen in the ER or admitted.
We received an EOB today reflecting outpatient hospital charges of $5700. I about fainted. This doesn't include the office visit or radiologist charges, just the procedure itself.
Am I right to think this is astronomical? The provider discount was $800, leaving a balance of $4900, shared by Big Insurer and us.
I fully intend to check on this Wednesday (I have to work tomorrow.) with both the hospital and insurance company, but am curious for opinions in the meantime.
They can charge whatever they want, Your insurance has a contractual agreement on payment. You can fight any charge and ask for a reduction. There is a facility near my office that only charges 900 for CT scan with the reading. It is local docs that work at hosp where bill is like what you got...so they are just undercutting the hospitals and making money too. I have insurance, but it was cheaper to just pay cash there and they were very accommodating..
I actually got a phone call from my MD's MRI department stating that my insurance required me to call them prior to them giving the authorization because my husband's employer had bought a package where the insurance company needed to discuss with the patient what their cost for the procedure would be and where they could go instead to have a lower rate. I had never heard of this before. I was actually irritated at the time because I was in pain and just wanted to get the thing done. However, my responsibility was only $50. If it was like the OPs, I would have appreciated the heads up and a possible alternative.
The cost can vary for a variety of reasons, including how your insurance policy is worded. My husband needed to have a sinus CT done outpatient. I called the insurance company to see if it was covered (different provider then). His specialist ordered it and he had a small office with no CT machine. I was told that it would only be covered if the CT was done in the same building as the ordering physician (crazy, I know). So I asked if his PCP ordered the test (who had the equipment on site) and then consulted the specialist to review it, would it be covered. The answer was yes. Crazy red tape but a difference of paying $15 for an unnecessary PCP office visit and no cost for the CT or a few thousand dollars.
I mean, that's certainly in the ballpark of what it could cost.
When I was in the ED 5 years ago and got a stat CT to rule out brain mass, hemorrhage, etc, I think I was billed somewhere around $3000 for my CT (non contrast). I think I paid somewhere about $500 for my entire ED visit then. A few years later, when I had an abdominal CT for appendicitis (no contrast) my medical bills for that event alone totaled $35,000. I was a patient for 20 hours (four of which I'd been triaged but left to wait in the waiting area as others were sicker). A billing/coding error caused my insurer to refuse to pay which cause the hospital to bill me directly. It went back and forth, they sorted it out and my out of pocket cost was $350 (including my co-pay, ED charges, radiology, pharmacy, OR time, inpatient charges, residual charges from the radiologist, the general surgeon, and anesthesiology practice). I really miss being young enough to be on my parents' insurance!
I had a work-related injury (on the job, secondary to a fall) for which I was sent to our ED (employee health was closed at the time the charge nurse could send me). I was triaged quickly and basically sent right back to the low acuity side of our ED and seen right away. When I checked in, I specified it was a workers comp / Employee Health visit and I would not provide my insurance info. I ended up getting 4 films to see if I'd broke a bone, two tylenol and sitting on my butt in the ED for 4 hours. Three weeks later I get a bill from my hospital. Without insurance, and without billing workers comp/themselves (we're self-insured), they billed me something like $90-120 for films, ED time and tylenol. I turned the bill in to employee health, they were working on it. Somehow, though, my insurance information got attached to that bill instead. The hospital resent it, with the copay for the ED ($269) and the "revised" charges for the SAME films, ED time and tylenol WITH insurance ($720), for a total of $989 due in two weeks. I looked at that and laughed. After an extended process, I got it sorted out, paid nothing (as I shouldn't have - this never would have happened if not for me being at work). Okay, small chance it would have, but most likely it wouldn't have.
Big Blondie, ASN, BSN, MSN, APRN
500 Posts
They can charge whatever they want, Your insurance has a contractual agreement on payment. You can fight any charge and ask for a reduction. There is a facility near my office that only charges 900 for CT scan with the reading. It is local docs that work at hosp where bill is like what you got...so they are just undercutting the hospitals and making money too. I have insurance, but it was cheaper to just pay cash there and they were very accommodating..