Editor's note: In June, KQED launched PriceCheck, a crowdsourcing project on health costs. We’re working in collaboration with KPCC, public media in Los Angeles, and ClearHealthCosts.com, a New York City startup looking at health costs.
Last week in our PriceCheck project, we turned to MRIs. We asked you, the members of our audience, to share what you have paid for a back MRI. The goal is to shine a light on the notoriously opaque world of health care costs.
What we've found is even more startling than the prices we already collected on screening mammograms. Most of our results so far are from the Bay Area, so I'm focusing on that variation. For a comparison looking at the entire state, check out this post from our ClearHealthCosts.com partner.
One Facility, At Least 3 Prices for a Back MRI
The lowest rate paid by any insurer in our data set so far is Medicare. One contributor went to Health Diagnostics in San Francisco's Financial District and was charged $2,450. Medicare paid $255. The person did not indicate having to pay any additional money.
Curiously, another person went to the same facility but was charged $602.85 for the same procedure. We know it's the same because the procedure code both patients entered was identical -- CPT code 72148 "lower back MRI without contrast."
How can one facility charge two radically different rates -- $2,450 and $602.85 -- for the exact same thing? It turns out the second patient was insured through Blue Shield. This person told us in comments on the form that s/he had to pay the entire amount, "since I had not yet met my deductible."
What this tells us is that Blue Shield has negotiated a rate with Health Diagnostics -- a rate of $602.85 for an MRI. The patient gets this rate, even though insurance covers none of it, because the person has not yet met the deductible.
We launched PriceCheck because these contractually agreed upon rates between insurers and providers are generally sealed. WIth help from our community, we can see what these prices are.
What's even more curious is that the self-pay price for a back MRI at Health Diagnostics is $575. In other words, if you walk in the door, want an MRI and are uninsured or otherwise agree to pay out of your own pocket, you'll pay $575.
Other Back MRI Prices from around the Bay Area
This cash price/insured price differential played out to the benefit of one of our contributors who went to Vallejo MRI, north of San Francisco. This person was charged $580 and paid $580 out of pocket. Here's why, according to the comment: "I was told the procedure was $1,850. I have a $7,500 deductible. So I talked to (an employee) who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580."
In other words this person saved $1,270, just by asking.
Back in San Francisco, another of our contributors went to Radnet Medical Imaging on California Street in the Laurel Village area. (This is where the California Pacific Medical Center is located.) This person was charged $1,660 and paid $1,660 out of Health Savings Account funds.
I wonder if the person who went to Radnet and paid $1,660 knows that Health Diagnostics and its $575 rate was an 11-minute drive away?
Probably not. We know from this project that consumers do not have a history of shopping on price for health care tests and services -- but people are starting to. One of the most frequent questions we get is from people wondering if it makes sense to shop on price for health care -- do you really want a bargain MRI?
There's not a correlation between cost and quality in health care. So it really becomes how much you want to save money. These are personal decisions, but we believe consumers can make informed decisions only when they have all the facts.
Here are a couple more submitted prices:
Palo Alto Medical Foundation: A member of our audience received a lower back MRI and submitted a charged price of $2,650, said insurance paid $0 -- and this person paid the full cost. There was no additional comment.
Kaiser Antioch Medical Center: A member of our audience received a lower back MRI and was charged $973.25 and paid $973.25. Comment: "This price was the contracted amount through my insurance. Deductible had not been met so I was responsible for all charges. This does not include the two office visits required to obtain and analyze the results."
The $3,700 price referred to in the headline of this post -- technically $3,732.60 -- comes from UC San Francisco. It's the self-pay price as long as you pay on the day of service. If you don't pay on the day of service, it might run you $6,221.
A Couple Prices for a Different MRI
This next story from a contributor hits close to home -- literally -- because I live just blocks away from Magnetic Imaging Affiliates on Telegraph Avenue in Oakland, where this person went.
The charge for a chest MRI with dye (CPT code 72147) was $3,163 -- and insurance covered nothing. Comment: “High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it s***ed. Need to shop around assuming can even get a price quote.”
Yes, you can get a price quote. You may need to be persistent. Ask for the billing office. They may send you around, but try.
Just from this handful of prices, we can see a stunning variation. With more data, we can tell more stories. We invite you to share what you paid. It's helpful if you have your "explanation of benefits" from your insurance company (Find out more about EOBs here.)
Then visit PriceCheck and share. Help us make health costs transparent in California!