Wellness

[CelticCrafter]

I'm going through all the EOB's from my husbands recent hospital stay and gallbladder surgery.

The charge for an abdominal CT scan was more than what the surgeon charged...

[hoosieroriginal]

Not sure if I had an MRI or a CT scan when I had my kidney stone, but I don't think it was that much.  I know one is more expensive - I must have had an MRI.  Heck, my ambulance was almost as much as my entire ER visit! 

[Gracies Mom]

CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!

[Gram W]

I would also check with the insurance company.  Explain your situation and they can check the bill they received from your hospital.    I had a case where the code on my bill do not relate to the procedure that was done.   My hospital had to rebill with the correct code.  With the correct code all was as it should be.   I was very glad I had checked my bill and not automatically paid the original amount billed without question.  

[Katcat1]

The problem is hospitals and some doctors abusing the system and are medical coverage rates are sky high.  There are companies that proofread hospital bills for double entries and mistakes.  I truly wish this medical insurance system could be corrected.

[CelticCrafter]

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@Gracies Mom wrote:

CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!

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Ah, I didn't know that.  I knew if the hospital was a network provider they had an agreement as far as what would be paid to them.

I just found it strange that something done by a machine cost a lot more than something done by a human.

We are very fortunate, we have excellent pensioner benefits, no

co-insurance or deductibles and it's not an HMO plan. 

Out of the entire bill, including the surgeon, we will be responsible for less than 3% of it and that's because the surgeon was out of network. The insurance company paid him what they would normally allow to an in network doctor.

[Gracies Mom]

CelticCrafter.....

Scans are VERY expensive---that goes for CAT scans, MRI's and PET scans---plus the radiologist who reads the scan (and compares the scan to an earlier one, if need be) has to be paid aside from paying for the scan itself. The scanning machines cost a fortune--to buy and maintain. Plus the technicians who run the machines have to be paid by whomever owns the machine. That is why most insurances insist on the doctor getting prior approval for certain scans--they want to make sure the scan is medically necessary.

For example, I have cancer--I go for a PET scan every three months at Sloan-Kettering (cancer hospital). The hospital has the responsibility of getting prior approval from my insurance company--which means they agree to pay for the scan and the reading of it. According to my explanation of benefits, a PET scan cost $6,000 and the radiologist's reading costs $500--my insurance tells me I am responsible for paying nothing--I don't know what they actually pay the hospital--but whatever amount it is, it is per their agreement. I have great insurance, thank goodness!!!!

I know that CAT scans and MRI's are cheaper than PET scans--I am allergic to CAT scan dye, so I can't have that type of x-ray--I have had MRI's recently, but that's when my oncologist was looking for another issue.

I hope I answered your question as to why scans are so pricey. There's more to it than pushing buttons to take a scan--it involves many experienced people to do it properly, aside from maintenance of the machine so it stays safe and works properly.

And yes....I've worked in hospitals for many years...I worked in a radiology department years ago for a few awhile, too. And I've been a patient since acquiring cancer six years ago--I am a survivor because of those scans!!!!!!

[Moonchilde]

Many people are unaware that for any diagnostic procedure involving Radiology, including biopsies or fine needle aspirations, there is a completely separate charge for the department (to include the personnel and all equipment and supplies) and a charge for the radiologist's expertise in looking at films, interpreting them, and comparing them to previous films. 

This goes for the hospital Pathology Dept as well, for the same reasons, with additions - in a needle biopsy, the pathologist will often be the one doing the actual tissue/fluid withdrawal, and the same with a bone marrow, as two examples. And their professional interpretation charges are separate as well.

If anyone thinks this isn't needed - wait until you have a diagnosis where skill, accuracy and experience is crucial.

[chrystaltree]

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@CelticCrafter wrote:

I'm going through all the EOB's from my husbands recent hospital stay and gallbladder surgery.

The charge for an abdominal CT scan was more than what the surgeon charged...

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        That wouldn't be unusual.  Imaging is very expensive but the surgeon's charge would depend on the surgery.  Some are high dollar, some aren't.

[chrystaltree]

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@CelticCrafter wrote:

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@Gracies Mom wrote:

CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!

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Ah, I didn't know that.  I knew if the hospital was a network provider they had an agreement as far as what would be paid to them.

I just found it strange that something done by a machine cost a lot more than something done by a human.

We are very fortunate, we have excellent pensioner benefits, no

co-insurance or deductibles and it's not an HMO plan. 

Out of the entire bill, including the surgeon, we will be responsible for less than 3% of it and that's because the surgeon was out of network. The insurance company paid him what they would normally allow to an in network doctor.

The charge for the CT is not just something a "machine" did assuming that your husband's CT was not done by a robot.  The CT charge includes much more than just use of the equipment, it also includes reimbursement for radiology technician who is a person and who is the person who actually operates the equipment.  There are other things that are factored into the CT and MRI charges, that's why they are so expensive.  

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