Hi Bill & Jeanne, First of all, Happy Thanksgiving. I hope your holiday week is relaxing and meaningful.
Since you are my two colleagues/foot soldiers fighting for simplicity and truth in health care, I thought I would share the following. Attached, you will see a bill for MRI services. (MRI bill2) A student of mine gave me this bill for me to be a patient advocate and do some due diligence. Unfortunately for him, he is going to have to pay the $1234.38 that is due. This is because he has not met his deductible and Anthem responded back to the imaging center demanding that he pay that amount. The problem is this:
The billed charges are arbitrary and obscene. Similar to Bill’s fight with the “discounted PPO rates,” the $4367.47 that was billed is similar to the sticker price on the Toyota Camry sitting on the car lot. Thankfully, this patient’s deductible was not higher, otherwise he would have been stuck paying much more.
This is an example of why patient’s need to be better consumers. RPN charges $339.00 for CPT 70553. Mink Radiology charged $3814.00. That is a difference of $3475.00! Or in other sobering terms, RPN’s discount is 91% when compared to Mink Radiology.
This patient also had another procedure done, CPT 70544 and was billed $1740.00. RPN’s price is $249.00 resulting in a difference of $1491.00.
Now these “retail” prices that radiology companies use are artificial numbers because the insurance carriers negotiate much lower reimbursements. For instance, for the two charges above, Anthem probably has negotiated a reimbursement of $500.00 for CPT 70553 and $400.00 for CPT 70544 and the radiology firms are happy to receive that. However, if these radiology providers can inflate these charges, it impacts the patient’s wallet much greater via meeting their deductibles. The entire process is rigged and patients need to wake up.
I admire the two of you for what you are doing and quite frankly, it makes me feel less alone in this fight. For that, I am extremely thankful to have you both in my life.
Feel free to use this story, document as I blocked out the PHI.
Editor’s Note: Jeanne’s website is http://clearhealthcosts.com/