Three people shared CT scan prices here recently — one in Montana, for a CT scan of abdomen and pelvis that was charged at $2,956, when insurance paid $295.60 and the person paid $2,660.40. One-word comment: “Robbery.” (The Current Procedural Terminology or CPT code was 74176, scan without dye.)
A second person shared the same thing from Bryn Mawr, Pa. The charge was $5,982; insurance paid $934.67; the patient was asked to pay $103.85.
Another person shared around the same time a CT scan in Las Vegas; employer-sponsored insurance through Aetna. Listed as a CT angio abdomen and pelvis without and with dye (CPT code 74174 — without and with dye is more complicated), this scan had a charge of $22,420, of which the insurer paid nothing and the individual was asked to pay $3,642.
The comment: “This is robbery!! Stay away from this hospital and Valley Health System. $22,420.00 for this procedure is beyond unbelievable – it is robbery!!!!”
What’s going on here? What does a CT scan cost? We’ve written about variance in prices before: We’ve heard $340 and $1,800; we’ve heard $267 and $8,010; and we know CT scans are a fairly high-dollar item for health plans. So this seems like a continuing problem.
What’s going on here?
I asked the first person, in Montana, “Are you on a high-deductible plan? Can you tell me a little more?” Here’s his reply, lightly edited. We chose not to use his name, though he said we could, because this health issue affects not him but his wife.
“That is correct. We, like many others are in a high deductible plan. 6000$ to be exact. My wife, about three weeks prior to that CT scan was having symptoms of a UTI. After a urinalysis confirmed her suspicion she was given some medication and sent on her way. Unfortunately she was given a lower strength medication so it didn’t completely remove the infection.
“A couple weeks later the symptoms returned. Back to the doctor for another test. Unfortunately due to the antibiotics she had previously taken she tested negative this time. She wasn’t able to get any medication the second time even though she explained all her symptoms and they were textbook UTI. (A not completely uncommon thing I guess for women unfortunately that I learned after the fact).
“She tried OTC meds to no avail. Unfortunately also the symptoms were getting much worse. ( it is my understanding through my online medical degree,Lol, that prolonged UTI’s can cause kidney stones to develop.) My wife was able to get another appointment and this time they let the urinalysis sample sit a longer period of time. This time it came up positive…..again. My wife also explained her suspicion of a kidney stone. The doc ordered a CT scan, ab and pelvis w/o contrast.
“Tbh we did not immediately pull out our phones and start looking at fair market prices … we have been burned before and should have learned our lesson. In the heat of the moment with your wife in excruciating pain, one doesn’t really care I guess…..how bad could it be, right?…..sigh.
“We were not in an emergency room. We were with her doctor, who happens to be in St. Patrick’s hospital. We figured 500$ at the most as a CT scan is very common.
“Ultimately the CT scan confirmed she did have a small stone still in her kidney. A couple weeks later and you know the rest. Get a bill, wife opens it up, jaw drops, and I say…..”what, they get us for 500$ bucks or something? It’s OK, honey, you’re fine.”
‘I told them I wanted the bill reduced’
“Then I see a bill for over 2900$…..or 2600ish after our wonderful insurance applied their discounts.’ Her first visit was with a doctor affiliated with Community hospital here in Missoula. The second and third visits were with ST. Patrick’s who fall under Providence health. I called Community and paid off the bill in full and got 10% off. Providence said we could get a whole 5% off of I paid in full. I told them that I wanted the bill reduced as I felt this was well above the fair and reasonable cost for a CT scan.
“Explained that they were charging 600% higher than national average, and that Community hospital charges half what they do (we called after the fact). I was told they do not negotiate bills. I offered 1500$ on the spot, explained this was still well above fair market price. The gal was not interested. I asked her to add my offer into the remarks for our conversation and please advise her supervisor. So that’s where we are at. The call for the bill took place two days ago.
I had never heard of ClearHealthCosts or Healthcare bluebook until all this happened. I started doing research online to find out cost of these procedures, and found you both after the fact unfortunately. I’m learning a lot more now…..sigh.
“…I made sure to tell them that I would be changing doctors to someone under the Community hospital and would recommend my friends and family do the same. To which she didn’t have a reply.
“I’m literally to the point that I just want to be a thorn in their side now. Fair and transparent pricing is all I want. This whole silly thing makes me sick……sorry for the rant.”
A clarification or two
I sent him our post about “how to argue a bill” and said we are unfortunately unable to do this kind of arguing for people. But I encouraged him to use our knowledge, and tell us what happens. I also asked a few more questions, and he replied:
“First, after talking to my wife, the third urinalysis she received a negative result also, but the doctor decided to give her the medication anyways. She knew my wife had a UTI just from the symptoms she described to her. …
“–we are insured by blue cross blue shield of Montana. We get our insurance through her employer, [redacted] elementary school district. She works full time as a para-professional. I am an air traffic controller. I work for a private company contracted by the FAA. My health insurance is prohibitively expensive. If I were to buy insurance through my company I wouldn’t be able to save in our 401k. … She is 42, I am 40. Our kids are insured through their real father who was in the military. I would need to look at pay stubs to find the exact costs of our insurance.
“–we did not have a conversation about the cost of a CT scan. She was there for basically another test to see if she had a UTI again. Which as I said above came back negative, but the doctor knew the test could very well come back negative due to the recent antibiotics she was on. She was given the CT scan when she advised the doc she felt she may have had a kidney stone. Just from the symptoms she was experiencing…
“–so her first doctors visit was at a … basically a walk in clinic. We always try to got to a walk in clinic first with issues as it’s usually around 200$ a visit for us. This first visit showed she did in fact have a UTI. Unfortunately for us the doctor prescribed some sort of lower strength antibiotic which didn’t clear the infection completely. This by far is the most frustrating part. If she was given the proper medication, we would have avoided this whole situation and been out only 200$ or so. … found the bill for the first visit. was paid off at a total cost of 172.25$ after the 10% pay in full discount and adjustments from the insurance.
“– the second visit was at Western Montana clinic. Inside of St. Patrick’s hospital. She was seen by the first doctor she could get in with. Not her primary doctor, which is also part of western Montana clinic. The second visit showed a negative on UTI urinalysis and the doctor would not give her antibiotics to treat her symptoms. ( further research by us found that up to 20% of UTI urinalysis results show a false negative. And that many doctors ignore the patient and use only the test result as the litmus for prescribing antibiotics).
‘UTI was finally defeated LOL’
“– third visit was again at western Montana clinic with her primary doctor. Test came back negative. Doctor knew she had UTI and prescribed proper strength antibiotics this time. UTI was finally defeated,lol. Cat scan was ordered also during this visit. Wife in severe pain. We had no idea which tests would be ordered prior to the visit, just a suspicion of a stone in the kidney. …
“–the 600% number is from a google search . Average Cost of ab and pelvis CT scan. Healthcarepricetag.com and health care blue book. The CPT code on our detailed bill was 74176.
“–on a side note we talked with her doctor after the bill for nearly 3000$ came. My wife told her the cost…..she was quite taken aback. She had no idea of the cost, which in my opinion is a big problem with our healthcare system in general. My wife advised her that if we had any idea what the cost was we would have not done it. Another problem with our system…..Americans are quite reluctant to get proper care for fear it will cost us dearly.
“–this bill will not ruin us financially, we save and live frugally. …We don’t live beyond our means. We try to live responsibly, save when we can.
“This puts a serious dent in our savings account though. That’s the biggest frustration. We work hard through the year only to see it taken by a billion dollar company that can get away with charging whatever it want behind a curtain of secrecy. ……but I rant….again….lol. Any more questions? Feel free to ask.”
How it finally ended
In a day or two, he came back with this report.
“Update and good news overall with the cat scan bill. Providence health is a ‘non profit’ (with billions in the bank….lol) My initial call to the billing department yielded nothing so I decided to visit the billing department in person at the hospital.
“I’ve always felt looking someone in the eye was the best way to go when negotiating anything. I was lucky enough to start with the supervisor, so no need to go up the ladder. She was kind and understanding about my surprise about the cost. She explained that they were a level 2 trauma center ( I think?…) and community hospital was a level three. That’s why they were authorized to charge higher.
“While I think that’s garbage in the whole grand scheme of things , it is what it is. I asked if there was any sort of discounts or programs that St Pats had in order to help. I’m guessing that was the buzz word they needed to offer help. The first woman over the phone made no reference to this at all.
“The supervisor explained that they were a non profit and could cover much of the cost if I were willing to provide proof of income and came in below their threshold. I have no idea how they get those standards for income though tbh. But if you make less that 80k there’s a decent chance you would qualify.
“I gave them three months banks statements, last years tax returns, and three months worth of pay statements from my wife and I. Two days later the called and said they were reducing the bill by 75%. If I would have made less they would have covered 100%.my initial charge of 2900+ was reduced to a bit above 650$.”
“I can’t think of much else. Hopefully this can help someone down the road. If you need any other info feel free to ask. Thanks.”
For more about how to argue a bill, here’s the post I sent him. Let us know if you use it, and what happens!