Explanation of benefits CT scan

(Updated 2022) We’re often asked over here at ClearHealthCosts what a price means in health care. Sometimes it means next to nothing, as this piece written by our friend Peggy Zuckerman about the cost of a CT scan tells us.

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Which is better — a CT scan for $930 or $8,010? Or maybe $267?

Is there a difference? How do you choose? Do I get fries with that?

I need CT scans of my chest, pelvis and abdomen, or at least I did. Eight years ago, I was diagnosed with Stage IV cancer, got healthy, but still need pre-emptive CT scans.

Metastases were all over my lungs, and the kidney dug out of my belly, so I get “CT scans of the chest, pelvis and abdomen, with and without contrast. Compare to previous scans.”

Consistency of scans is important, so I am scanned at the same place, prepped by the same nurses, and have reports from the same radiologists. Only billing is inconsistent.

My EOB showed three scans, three CPT codes, three “retail” prices, totaling $8,010, and three insurance prices discounted by $6,613. Good so far.

Insurance pays their portion, less some amount, giving the provider $770. I am billed the balance of $626, worth $1,396 to the provider.

Before my next appointment, Medicare decided that pelvis and abdomen scans done simultaneously are one procedure. Unsure where the abdomen ends and pelvis begins, and where the kidney fits, and how low the lungs go, this made sense. It did not affect my scans nor my report.

As the three CPT codes became two, (72191 +74160= 74177) the beloved discounts didn’t accompany those codes. With the $1,000 maximum daily payout by the insurance company, my $8,010 scans were calculated to charge me $4,074! Now the scan was worth $5,074?

Not happy, and not about to pay, I asked the cash price of the scans. Just $930!

Calls to the insurance company, the third party whomever, the billing department and trips to the billing office, and subsequent calls to the state insurance office. And the letters to the collection company and the whining…

My best offers were “charitable assistance, paying the bill over two years,” and “just tell Medicare to change the codes back.” That I offered to pay my fair share and that I wasn’t a Medicare patient meant nothing. And have you ever “just told” Medicare anything?

Time for another scan: “I’ll take the cash triple CT,” and asked to be billed directly. The $930 scan was a bargain after the days spent fighting for my $626 scans.

Murphy’s Law applied, so my insurance was billed, not me. Thus, another $4,074 bill to me. And the trips and calls started again.

What does the typical CT scan really cost, per the hospital’s published reports to the American Hospital Directory? My provider states a single “CT without Contrast” to be $198, but $60 at their satellite center. With contrast, the figures go to $283 and $89, respectively. Assuming I get three of the $283 scans, it costs $849 — close to the cash price. Maybe I should get my scans from the satellite center at $89 x 3, for $267, really a deal!

Computed Tomography without Contrast cost

No wonder there is such anger and distrust with the medical system, and not only with the insurance companies. The providers play the same game with the payer — whether the individual, Medicare or Medicaid, or an insurance company. The least empowered figure is naturally the individual, but in the long run, the anger and the cynicism generated drives a wedge between the patient and his individual providers.

The doctor who prescribes a CT scan and its cost has no idea — even the provider has no idea. And who is most vulnerable, and most likely to put off the scan? Me.

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For a thoughtful conversation, see this piece, “What ‘Health Care Costs’ Really Means,” by Shannon Brownlee, Joe Colucci and Thom Walsh in Atlantic magazine, December 2012.

Do you have a similar story? We’d love to hear it; our e-mail address is info (at) clearhealthcosts (dot) com.


Related posts:

Part 1: How to find out what stuff costs in health care.

Part 2: How to argue a bill.

Part 3: Appealing a denial, or how to turn a “no” into a “yes.”

Negotiating a bill.

How to save money on prescriptions.