A report came from a community member about a CT scan:
70490 Ct soft tissue neck w/o dye, charged $440.92, insurance paid nothing, he paid $440.92 at Queens Medical Imaging. He noted, “Performed at NYU imaging center on Austin Street. Seemed a bit too expensive. “
The bill had a different charge, so I asked some questions and sent back some pricing links, showing the prices in the New York area for this procedure. Here are my questions and his answers:
1. You said the provider was Queens Medical Imaging, but your note said NYU Imaging Center on Austin St. I think Queens Medical Imaging is owned by NYU, is that your impression too?
Yes.
2. It looks to us like they charged $1,120 but the “member rate” is the $440.92, is that correct?
Correct. Aetna over the phone told me the $1,120 is fictitious. There was no such charge. The member rate charged to me is the only charge. Aetna paid nothing since it was below my annual deductible. And apparently the member rate is what Aetna had negotiated for this service. So I have no idea where the $1120 came from; most likely the imaging center’s inflated chargemaster.
3. Why were you asked to pay this under your deductible, but the other event on the explanation of benefits, a doctor visit? — was covered by insurance?
Good question. I forgot. Possibly some plan specific detail under which doctor visits are covered but not any imaging? I would have to check.
One more question — how did you find us?
A lot of searching (using duckduckgo, less so google) for any resource that can help me price a lipoma excision procedure.
So, how about a lipoma excision?
Our conversation continued via email:
“I am unable to get any estimate for an upcoming procedure for my doctor, insurance, nor the hospital and I’m afraid I will get ripped off to the tune of my deductible. I am going to cancel if I cannot get an estimate from anyone, perhaps the morning of the procedure.
“I’m thinking I can get someone to issue me an estimate in writing if I’m there and ready to go, else I will say I can walk out the door. I have been calling around to other doctors, but so far no estimates.
“I pitch them with the idea that I will cancel my procedure and hire them for the work if they can give me an estimate. But I just started calling around. I had no idea my own doctor, insurance, and local hospital would treat me this way, and I now have only one week — including a long holiday weekend — to find alternatives. The local hospital after much internal finger pointing and time on the phone finally did estimate a $2500 charge not including my doctor’s fee, nor fee for anesthetics, etc, other fees, etc, if I were uninsured. But that’s not my situation. And I now realize over the phone and not in writing is worthless.
“Thank you for the links. I had no idea the CT scan was a decent price. Or perhaps more accurately, it was not a total rip off as those examples. If it had been $800 it would not have been an outrageous rip off, but still overpriced.”
I answered that I’m interested in writing about this, and sent some resources and suggestions:
1. Find out what stuff costs in health care.
2. Friend of mine who issued an RFP for his skin cancer treatment.
3. A doctor’s office is bound to be less expensive than a hospital. I don’t know much about a lipoma treatment, but can it be done in an office? Can you ask 3-4 providers in your network to do the questions above?
4. We write about these experiences when we can help others. See here and here.
‘I shopped around and got a better deal’
He replied:
“Jeanne,
“Long story short: I shopped around and got a better deal. Unfortunately my approach was haphazard. I lucked out. I did lots of online searches. I finally found some online message board that included responses from doctors about various procedures, and one in which a doctor spoke about pricing and gave a significantly lower ball park estimated price range for a lipoma excision. And that doctor was in my area. I immediately called his office, made the appointment, then set the date for the excision. And today it’s been about a week since that and all is well. I just had stitches removed yesterday.
“I did some phone work as well, prior to this stroke of luck. But all the other doctors’ offices I ever called were worthless. Most never returned my calls. Those that I spoke with refused to deal with me unless I made an appointment and paid a consultation fee. I usually got attitude from the receptionists. Never mind that I already knew what I had, along with a CT scan, and knew exactly what needed to be done; I just needed an estimate. Nobody would give me an estimate. Nobody would even try to beat the estimate I already had.
“In retrospect I think the fact that my second doctor is a plastic surgeon might be significant. My first doctor was not a plastic surgeon, and this may have been a factor in his preference to do the excision in a hospital. The plastic surgeon thought going to a hospital was highly unnecessary — in his own words — and told me he could perform the excision in his office. Obviously that saved a bundle. Perhaps he had better facilities on site too. So far I have been very pleased with his work. His sutures were done very carefully, with more than one layer, which is significant in that some other doctors don’t seem to bother with more than one set of stitches. And it seems my scar will be rather small. Not that I cared much about the scar to begin with since it was not in a prominent location but it’s nice to know he was meticulous about his work. I paid cash and it was worth every penny.”
I asked him if there were any lessons to be learned, and if I could write about this event. He said yes, but please leave his name out.
The final cost was $750, including consultation, plus $90 for lab tests to assess whether it was malignant — not the $2,500 that he was quoted before. I asked if he knew the procedure code, and he answered: “I would not know the code. Insurance was not involved.”
The surgeon was Doctor Robert Kraft, who practices in Forest Hills, Queens.
The original surgeon with the higher estimate was a general surgery specialist.
He found the doctor on realself.com, after searching Duckduckgo and Google … “forgot which found it for me. Search terms included: lipoma, cost, price. And maybe my state or city. I tried so many searches.”
“I did searches over many days actually, totaling many hours. I did not keep track but I was hitting the search engines with different search terms every day for a good while each day, for some time until, I found my doctor. A lot of patience was required. And reading. “
