After a physician ordered a breast MRI for a Pennsylvania woman, she used her insurance company's online price tool to estimate her bill. While UnitedHealthcare's tool estimated she may have to pay between $783 and $1,375, her share of the bill from an in-network facility was initially $3,237, according to The Inquirer.
Five things to know:
1. Michelle Smith, who has a family history of breast cancer, received the breast MRI at Berwyn, Pa.-based Main Line Health's imaging center at Riddle Hospital in Media, Pa. UnitedHealthcare's price tool suggested the facility.
2. Ms. Smith ended up being billed twice as much for having the procedure done at the hospital-based center instead of in a separate building across the street, according to The Inquirer. Main Line billed UnitedHealthcare $7,692 for the scan, and the insurer paid its negotiated rate of $3,463. Ms. Smith was billed nearly all of the remainder because she had not met her deductible.
3. Main Line spokesperson Megan Call told the publication that services provided in a hospital are often pricier than those performed outside of a hospital, due to fees for administrative and operating costs. When the publication asked how a patient could have known which of the health system's six imaging centers bill at hospital rates, Ms. Call said patients should contact Main Line's price estimation team.
"We do acknowledge that billing and insurance reimbursement issues can be difficult to navigate. As such, we are committed to price transparency and giving our patients the tools they need to make informed decision[s] about their care," she told The Inquirer. After a call with a reporter from the publication, Main Line lowered Ms. Smith's bill to $1,500.
4. UnitedHealthcare spokesperson Maria Gordon Shydlo told The Inquirer: "Our online and mobile quality and cost transparency resources provide estimates, which are based on actual contracted rates with healthcare providers and facilities, as well as the member's health benefits plan, offering people actionable information."
5. The incident reflects how difficult healthcare costs are to estimate, given how much prices vary within confidential agreements between providers and insurers. While health insurers and providers have invested in price estimator tools to appease growing patient demand, the tools often aren't as useful as intended, according to the report.
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