When X-rays were invented more than 100 years ago, medicine changed forever. With the ability to see inside the body, doctors could gain all sorts of insights, and patients could be healed faster than ever.
Imaging has come a long way since then. The newest imaging devices can provide magnificent detail of the inner workings of the human body and can help physicians identify everything from cancer to Alzheimer’s disease.
But anybody who’s had an imaging exam in the past few years can name a major downside of these technological advances: They’re sometimes surprisingly expensive.
Why So Pricey?
When you pay for an imaging exam, you’re paying for more than the pictures. Many costs are built into the price, including the fee for the radiologist, the facility and the machine itself.
Imaging devices with the proper facilities can cost millions of dollars, so to recoup some of that expense, providers necessarily have to charge a certain amount. Overhead to cover the costs of administration and support staff is also built into the price.
“Most people don’t know you’re charged once for the equipment and once for the professional who reads it,” says Pat Palmer, founder and CEO of Medical Billing Advocates of America, a firm that helps patients battle insurance denials and high medical bills.
When Your Bill Is High
Billing errors are common in medicine, and imaging exams are no exception.
“In imaging exams particularly, the provider will take more views than are needed and then charge for them all,” says Jeanne Woodward, MBAA’s director of physician compliance. “It is the patient’s responsibility to ensure they’re paying for what was ordered by their physician,” she adds. You can verify this with your doctor, or by obtaining copies of your medical records.
That’s not the only error that could make your bill jump. Sometimes those charges come separately, even on separate bills, and sometimes they come bundled into one charge, Palmer says.
Always ask for an itemized medical bill before paying it, and confirm with the imaging staff how many bills you should expect. If there’s only one charge, the services have been bundled into a flat rate. A common error, Woodward says, is when the provider bundles the charges and then an extra charge appears, resulting in an overcharge.
If your bill is really high, you might not even need to know why to get it lowered — or at least covered by your insurance. Physicians usually have a good reason to order an imaging exam, and most are well-versed in justifying them to health insurers, according to Palmer. “These types of exams are usually necessary,” she says. “So if it’s not covered, you can and should make a written appeal.”
Do the Homework Before Your Exam
With today’s high-deductible health plans, out-of-pocket expenses can reach thousands of dollars. Many patients who need imaging exams will have to pay the entire cost, even with insurance. You’ll probably find that it’s in your best interest to lower costs ahead of time, right when you find out you need a costly imaging exam.
“Ask your doctor if there’s a less expensive alternative that will provide the same information,” Palmer says. For example, if your doctor orders an MRI, you can ask whether a less expensive CT scan or X-ray will do instead. While you’re at it, keep an exact copy of the doctor’s imaging orders so you have proof of what you should be billed for.
Palmer also suggests going to an independent imaging facility, rather than a large hospital.
“It will probably be less expensive, and they’re more likely to work with you on pricing,” she says. You can always ask about pricing and about any discounts they offer, such as 20 percent off for paying up front. “Tell the billing manager when you have to pay out of pocket and what you can afford,” she advises, because they are likely to be sympathetic.
“The patient is responsible for making sure the procedure is covered,” Woodward says. Call your insurer to verify coverage or to find out if the procedure needs prior authorization. Remember to make sure both the radiologist and imaging exam are covered, so you won’t face out-of-network charges later.
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Imaging Exams: Never Overpay Again originally appeared on usnews.com