Question about cost of CT scan

[SleepyGuy]

Hello,
So the explanation of benefits from my insurance has started to roll into my mailbox. The one thing that stuck out the most was an abdominal CT scan I had. The hospital hit up my insurance for 5,216 USD. I've never heard of a CT scan costing this much.

I was curious what other people's experience was with this.


edit: Insurance paid 1,000 USD, so that leaves me with 4,216 USD left. I checked around on google and never say anything this high

edit #2 : Ok, insurance talked it down to 4,216 USD and paid 1,000 of that.. Still too high though

[SleepyGuy]

My insurance only pays 1,000. So I guess I'm just up the creek?

[tonytigre]

My previous insurance, Blue Cross Blue Shield would pay 100% after my a initial 1000 dollars out of my pocket. So with them the most I would pay out of pocket would only be a 1000 dollars in one year. So with my first CAT Scan I would pay only the first 1000 dollars and from there on it was all my insurance. I never met the total amount of coverage and I had 4 cat scans that year so I guess it is pretty high. I was also on COBRA with Blue Cross so I was paying a 500 dollar a month premium untill I started my current job. I am not covered with First Choice and I can say that the coverage is not the same. First, though my boss pays for all the premiums and my total out of pocket in a calendar year is only 2000 dollars which isn't that bad because I figure I was paying a lot more to continue coverage with Blue Cross. I just got my EOB from Quest on my AFP and HCG test that were done and the total cost billed to insurance was 197 dollars and the total amount I am responsible for is 9.49 If you have any questions about your coverage you should contact your insurace company. There could probably be a mistake, the only reason I can think of that you have such a high totat out of pocket charge to you is that you are married and have your family on your policy. Families on my policy would have a total of 4000 dollars out of pocket in a calendar year, so that might be it. Hope this helps

[tonytigre]

Because these are all diagnostic my current insurance pays 100% w/$0 copay. -chris

Rover,
Doesn't your insurance have a deductible? Mine has a 300 dollar deductible but a total out of pocket of $2000 every calendar year. No portion of the CAT scan got applied to your deductible, or had you met it already?
Tony

[SleepyGuy]

My insurance says right out that they only pay 1,000 for CT/MRI scans. I have student insurance.

[IowaBrian]

The best thing I did was to only have one ct at the hospital they will over bill and charge the max allowed that is what they do. Try to get your scan done in a onc clinic or at a private ct clinic they will be a lot cheaper. Call them and see what they can do to help keep the cost down without giving up anything that you need.
My insurance pays after my DED which doesn't take long to get to these days, but I still want to try and keep te cost down as to not max out my coverage before I get too old to care
I have a post on here I will try to bump it shows a lot of my cost for the first 6 months.

[SleepyGuy]

You can try writing some letters and maybe they'll take care of it in the interest of "good customer relations"? My insurance co said the appeals go before some kind of medical review board to determine medical necessity and review individual circumstances. Couldn't hurt to try?

Good luck
-chris

The rad onc's social worker gave me a phone number for free legal help for cancer survivors in Atlanta. So I might call them up and have a chat, to see at least what my options are with insurance.

[SleepyGuy]

Go to Grady with your student insurance. they will charge what your insurance will pay. It is a county hospital, but a very good one. it is run by Emory University. As a student you may qualify for county aid.

Do they charge what the insurance will pay regardless or is that a county aid program?

I've looked into different programs to help with the expenses, but I dont qualify. The money I get for school bumps me over the limits.

[Sans rt1]

Last fall when I started having lower pack discomfort, my oncologist ordered a full CT (chest, ab, pelvis) plus some other images to see if there was anything going on with the spine in that area. When I got the insurance statement I was stunned (even more than I had been with the earlier bills). The total was $15,300 - my insurance "negotiated savings to customer" was about $12,700, then they paid $2300 leaving me to pay about $300 (I was already well past my deductable). I was on the CT table for about 30 minutes - so it was significant, but I wonder the games that are played with these rates. I mean, the contrast solution (assume this included what I drank plus what was put in my vein) was over $600 of the original total.

I have excellent beneifts where I work, so I am lucky. My provider is Blue Cross, but recently because they have played so hardnosed with the doctors and hospitals, most in my area will not accept the basic low cost plan - so I (and many of my co-workers) have been forced to change to the alternate plan that cost us more each month, has higher co-pays and deductibles - so we can get good care in our area - use the best doctors and hospitals - have some sayso in our care. I consider myself very fortunate to be able afford to do this, but feel for those who can't. I agree our system is broken. It seems to be a game to see who can be squeezed the most.

I also wonder what rates a person without insurance pay, or what do we the taxpayers about those on assistance or medicare?

[SleepyGuy]

I also wonder what rates a person without insurance pay, or what do we the taxpayers about those on assistance or medicare?

Depends on how hard nosed you are about the thing. Many places if your using cash, will give you the insurance rate or some percentage off the bill. I imagine Medicare/Medicaid is probably the same.

But the list rate you see on your insurance papers is what many people will pay. Although seeing what the insurance pays is quite amazing. Like my preop labs were over a 100 USD. Insurance pays ~21 USD for that. I wonder how many private payers get that rate.

[SleepyGuy]

Are you at a state school? GSU, or anything like that ?

R

I'm already seeing a guy at the Emory Clinic. I'm almost done with my treatments, so changing over to Grady at this point might be a problem. Even though he works at Grady.

I go to LSU, staying here for the semester with the parents. The money I receive for college comes in as cash and not credits. So thats the main issue. They just send me a check in the mail to deposit.

So for programs that require you to have a certain income under a certain level, I typically get excluded, since tuition is so high. But if the financial aid is based on how much you have coming in and going out, then its a different story.

My first abdominal CT scan was done at Gwinnet Medical, ordered by the Urologist. Second one, chest, was done at the Emory clinic by the Rad. Onc. I'm already having to do the song and dance with Gwinnet. Theirs doesnt seem to be based on how much income you get, but by what comes in and out. So I might be ok there.

[SleepyGuy]

I got some more info. Grady is still an option for follow up care, but might not be. BUt I found out I'll probably be able to qualify for assistance from the hospital since I'm unemployed and make no money. Not even a student this semester. But I wont know anything for sure until I fill out and submit the rest of the paperwork.

On the the other hand, thats just for my CT scan. I'm still probably gonna owe 15k to Emory. Thats when I'll try the appeals in my insurance. I have 50k worth of coverage, but they dont cover anything.

[IowaBrian]

Just keep on them get a copy of the policy there should be a long plan discription that they shoud be able to send you that will really tell you what they cover. Don't ever listen to what one of the CS reps tell you on the phone I am in insurance and I will call our Health Insurance company and ask a question then call back a hour later and get a different answer. I would bet the University has someone that knows a lot about the coverage I would find out who that is and go in and talk to them they might have a contact they can call to make sure you are getting all that is due. Remember you can always call the State and ask them if they are playing fair!
Good Luck

[Steve]

Easily under $1,000 here in Ireland, you are getting fleeced

[SleepyGuy]

Easily under $1,000 here in Ireland, you are getting fleeced

Seems like as long as I never have it done at a hospital affiliated facility it will be under 1,000.