Which is it?

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I spoke with a woman yesterday who said our bi-annual MRI would cost $5907. Add in the 25% we pay after we’ve met our deductible, and our share of the cost would be $5227.00.

I’m sorry.  I must not have heard correctly.

Yes, the MRI costs $5907, so your share of the cost is a little more than $5,000. But you only have to pay $850 at the time of service; you can put the rest on a payment plan.

The “Oh, thank goodness” I shared was drenched in a sarcasm that barely made its way past my emerging ulcer. Might as well have asked us to sell our house for the “little” bit that this cost more that $5K.

I have, in the past four years learned a lot about how insurance works. I have, since then, moved us from Kaiser to United to Anthem.  (The latter move was to avoid having to go back to Kaiser even though that would have been the most affordable option.)

So I understand deductibles and out-of-pocket maximums, having reached both multiple times since January 24, 2013, when my life was separated into its own BC (before cancer) and AD (after diagnosis).

And yet we have never–and I mean never–paid so much for an MRI.  Sure, I understand that this procedure is highly technical and the machine that it uses is highly specialized (though probably already paid for after what they are charging).  And yes, I understand that we have changed insurance and so the costs are likely to be different (though I’m not sure why).

But the difference between $5300 and what we paid last year is more than just a few lattes.

Our explanation of benefits for our last two MRIs, albeit under a different carrier, shows that the actual cost of the procedure was somewhere between $6495.36 and $7,144.90 (depending on who was paying).  Thankfully, our previous carrier was able to apply somewhere between $4600 and $5300 in “discounts” (depending on who was paying) to bring the total we were responsible for around $2100 (if we were paying).

Did I mention that we do this dance every six months?  Yes, twice a year.  So I must be getting pretty good at this. Right?

But it never occurred to me to ask about this discrepancy: does the MRI cost $6500 or $7200?  The difference is a mortgage payment, after all.  Not our  mortgage, thanks to the insurance company’s “discounts,” however, but someone’s mortgage payment.  Because then, after applying the “discounts,” our MRI cost somewhere around two grand. The first one we pay for outright, the second one we pay up to our deductible, plus a percentage.

And please don’t misunderstand.  We would pay anything for the sense of relief that comes with sitting down with our doc just a little over an hour after each scan to hear that there are “no signs of active disease” and “no new growth.”

I get it at the level that I pray most people don’t have to.  But what I don’t understand is why, this time around we will meet our deductible on the first MRI of the year.  Is the insurance company I switched to incapable of negotiating “discounts”?  Have the MRI’s changed to somehow be valued at almost three times as much?  Have I somehow misunderstood this entire process from the very beginning?

Because, I’m sorry, an MRI is an MRI and I don’t understand how the cost for a procedure could be so fluid (depending on who is paying).  And if it is fluid, then why isn’t it to the advantage of those who do not have coverage or who spend more for coverage because they refuse to go with the only carrier left negotiating with their employer?

$6500 or $7200? Which is it? $2100 or $5300?  How much will it cost us this time? The same machine, the same injection, the same location, the same radiologist, for all I know.  But a $3200 discrepancy is something I cannot wrap my mind around.

Thankfully, Ali, the woman in the financial office, made it clear for me today: I only owe $850.

Yes, you heard that correctly this time: For the bargain price of just $850, my husband and my family can rest assured that cancer has not taken up residence in our lives again.

So, though I am relieved, I am–if possible–even more confused.  How much does an MRI actually cost?  How do insurance companies have such different “discounts”?  And why is this so complicated at a time and about a topic that so very much demands simplicity?

Even now, as I get ready to publish this post, I am tentative in my inquisition. The relief in knowing that we will be able to afford two scans AND our mortgage this year is replaced by a worry that none of this may even matter come Monday. Yes, the difference between cost and payment might well become my mortgage if our president has anything to say about it. So maybe I should be praying that–at $5300, $2100, or $850–I don’t ever have to know what an MRI actually costs without insurance.

Yeah, let’s go with that. Because between now and our next scan on Thursday, I’ve got more important things to worry about.

 

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