Two weeks ago I posted about what I thought might be rational pricing for my MRI and I ended by saying “Stay tuned.” I don’t yet have the bill and so I can’t say more about that.
But the story got more interesting. A few days after I posted, I went online with SimonMed, the local in-network (I think) MRI provider to set up an appointment. But it walked me through a whole lot of questions to which I didn’t know the answers. It was almost as if you had to be my doctor to answer them. So I stopped. It had an 866 number but I worried that I would get into the same predicament.
Then I realized that, given that SimonMed is about a block from my office, I could walk over and talk to a human. And a great human she was. I explained that because I’m not a doctor I couldn’t answer some of the questions and she nodded knowingly. I couldn’t see her facial expression because she was masked, but I sensed that she was quite willing to help.
She told me that there had a been a cancellation for the next day and so I could get in then.
Delighted, I walked back to my office and told my wife on the phone. My wife had what she and her doctor feared was a rotator cuff tear and she was in a lot of pain. I told her that maybe I could talk to them about getting her in earlier. Her doctor had sent the referral but we didn’t know where that stood. So I walked back and gave my wife’s information. It turned out that her referral wasn’t as far along for some reason. I called my wife, who was disappointed. So she called her insurer, who then sent her to something called “eviCore.” She called them and was told that someone had canceled her referral and that it “must have been” the doctor. So she called the doctor’s office but everyone must have been in a meeting.
Then I had a thought. I wondered what it would cost if we just skipped the referral and paid for it ourselves. So I went back yet again to Simon Med and asked if we could set up an appointment if we paid for it ourselves. My new friend said we could. “What would that cost us?” I asked. She looked at her computer and said “$500.”
“$500, not $5,000?” I asked, “Are you sure?”
“I’m sure,” she said.
So I set up the appointment for the day after mine.
When I came in for my appointment the next day, the same person I had been dealing with told me that because there had been a mixup about the referral and because it was possible that SimonMed had contributed to it, we would be charged only $350.
The bad news was that the day of my wife’s scheduled MRI, Simon Med called and said that the appointment was postponed by 6 days because the magnets weren’t working. In that case, I joked, maybe they could do simply an RI.
The good news is that last Friday, she got her MRI and I paid $350.
This was better than North Dakota for Canadians!
READER COMMENTS
John C Goodman
Sep 8 2021 at 4:12pm
Welcome to nonmarket health care.
David Henderson
Sep 8 2021 at 4:14pm
Alternate statement: “Welcome to market health care.” For decades now, John, you have been pushing the idea of putting the consuming patient in charge. That’s what happened here.
steve
Sep 9 2021 at 2:57pm
Did that include having it read? We have a price checker system in my network and you can find the cost of most of what we do and it is generally comprehensive. It would include having the MRI read and also anesthesia services if you are especially claustrophobic. Looking at what you paid I think our costs would be similar accounting for the more comprehensive service. ie about $500. We had high hopes this would really increase market share but did not see a big effect.
David Henderson
Sep 9 2021 at 6:52pm
You asked:
Yes.
Daniel Hill
Sep 8 2021 at 5:45pm
I injured my knee in 2016 when I was back in Australia. The walk in cash price for an MRI was USD200.
David Henderson
Sep 8 2021 at 6:01pm
Nice!
Frank
Sep 8 2021 at 7:34pm
Well, price discrimination is a good thing utilitarianly, on account it increases quantity. [Except when the costs of enforcing price discrimination eat up too much of real resources.]
The wider point is the question of where all the revenue above average or even marginal cost goes? If the institutions offering the service is profit making, it goes into profits, obviously. Most hospitals are non-profits, but they still compete. Who gets the service equivalent of the cash at their place of work? Wellness clinics [Cooking together, e.g]? Leadership training focus for employees — talent management, change management, cultural competence? VP for People and Experience? Medically unnecessary procedures?
john hare
Sep 9 2021 at 1:49am
My opinion is that the revenue far above marginal cost is mostly corruption. Not in terms f criminal, but in terms of a corrupted program. Layers of takers from management to insurance, to people dealing with insurance to government involvement. Each acting as a leech sucking the financial lifeblood out of the medical industry and its’ users. I see the same thing in schools K-12 where simple math shows most of the educational expenditure doesn’t make it to the classroom.
I get good results from cash on the barrelhead walk in clinics for tiny fractions of the cost of emergency room visits for similar problems. Similar with chiropractors with cash vs insurance.
Evan Sherman
Sep 9 2021 at 1:53pm
See also: The “Managerial Class”, or , alternatively (depending on time and place in the discourse), the “New Class”. (Burnham, or Orwell’s more popular comments on Burnham’s ideas.)
andy
Sep 9 2021 at 6:25pm
I had a similar experience with MRI here in Czech republic. Ultimately it was solved by “having good friends”, so I had the MRI in 2 weeks instead of 6 weeks. I even looked up if any MRI center has a payer option and none advertised that (the cost was probably ~$200-$250).
I didn’t ask if paying directly was an option and if I paid, if I would still face the 6 weeks waiting time. I probably should have, at least I would have gathered interesting economic data 😉
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