When $625 = $2,450 = $450

Filed Under: Costs, Patients, Providers

Cancer patients have a terrible disease — and then terrible billing problems, as we’ve written before here and here. Here’s another horror story, when $625 = $2,450 = $450, as described by a cancer patient in Florida, talking about her  charges for an MRI and a biopsy treatment, and the ensuing bills.

“The woman who answered the phone at Saint Pete MRI told me the cost would be $625,” writes Robyn E. Blumner in the St. Petersburg Times of her quest to find an MRI as part of treatment for breast cancer. “The woman answering the phone at the second option had no idea. Eventually I was told they would bill a total of more than $3,000. I went to Saint Pete MRI.

“I later discovered that Saint Pete MRI actually bills insurers $2,450 for an MRI, but it charges self-paying customers $625. Under Saint Pete MRI’s contract with Cigna it would receive $650 for my MRI — except that Cigna has contracted with MedSolutions Inc. as a third-party payor. MedSolutions would be paying Saint Pete MRI and then seeking reimbursement from Cigna (and me). But I was told by Cigna that information about pricing between Cigna and MedSolutions is proprietary.

“When I received the ‘Explanation of benefits’ (the greatest misnomer in the English language) from Cigna on my MRI, it said the amount billed by MedSolutions was $1,500, of which Cigna paid zero. So I owed $1,500 to MedSolutuions. I called Saint Pete MRI to see what MedSolutions had paid it for the procedure and was told it had received only $450, or $200 less than the contracted price and $1,050 less than what I apparently owed.”

That bill, she says, is being “reprocessed.” Meanwhile, charges for a two-hour biopsy, she writes, were more than $16,700.

“I asked Bayfront for an itemized bill. I received a single page with descriptions such as these: “MA Mammotome Assist Biop” $3,244.26, “MA Breast Surgical Speci” $1,221.33. You get the idea. Or if you’re like me, you have no idea what this could possibly mean.

“Further attempts to get a breakdown of detailed costs for each item proved fruitless beyond being told that bills reflect the cost of hospital resources, including equipment, overhead, personnel, supplies, etc. At one point I was told that if I wanted more information on pricing policies I should contact the hospital’s president.

“This is why it is laughable to think that by shifting more of the financial burden for health care onto individuals they will make more economical choices. I tried. It can’t be done.”