Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200: The Philadelphia Inquirer

Filed Under: Costs, Health plans, Patients

“Michelle Smith knew the breast MRI her doctor ordered wouldn’t be covered in full by her insurance, so she turned to an online tool that her insurance company developed to help patients estimate prices,” Sarah Gantz writes over at The Philadelphia Inquirer. “UnitedHealthcare’s price estimator told the 51-year-old Delaware County resident that the cost for the procedure in her area ranged from $783 to $1,375. So Smith was shocked when her share of the bill — from a facility that the tool suggested — came to $3,237. ‘What good is a cost calculator if it’s not accurate? I’d be better off with no information than false information,’ she said. Health-care costs are difficult to pin down because prices vary widely and are part of confidential agreements between insurers and providers. But in response to growing demand from patients spending more out of pocket than ever before, insurers and even health systems are investing in price estimator tools that claim to offer at least a ballpark price. Still, the tools have been slow to catch on, in part because they’re clunky and, as Smith learned the hard way, not always useful. ‘It doesn’t seem like too much to ask, “How much is this going to cost? What’s a provider that’s in-network?” Those are reasonable questions and insurers need to improve their ability to answer those questions. They’re working on it, but they’re not there yet,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. Each insurance company negotiates its own set of rates with every provider in the network. The size of your health plan’s deductible (the amount you pay out of pocket before the plan pays) and how the plan splits cost between itself and its members after the deductible is met will also affect how much you owe. These complicated plan designs, with their many ways members may be footing part of the bill, have made it even more difficult to pinpoint costs in advance, Hempstead said. ‘There’s more opportunity for different types of bad surprises for consumers,’ she said.” Sarah Gantz, “Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200,” The Philadelphia Inquirer.