Insurer’s price calculator severely underestimates cost of breast MRI for Philadelphia woman

Although a new federal law that took effect on January 1 requires hospitals to post prices for all services offered online, including imaging exams, and has encouraged many insurers to invest in price calculators to patients in order to determine out-of-pocket costs, a Philadelphia woman discovered she may be grossly underestimating actual prices, according to a recent report by The Philadelphia Investigator.

Knowing that her breast MRI would not be fully covered by insurance, Michelle Smith used an online cost calculator from her insurer, UnitedHealthcare, to estimate out-of-pocket costs for the exam. The online tool – which suggested the facility Smith used to get the breast MRI – told her that the cost of the procedure in her area ranged from $783 to $1,375. But Smith was shocked to find she was charged $3,237 for the exam.

She learned that she had been charged double what the price calculator had estimated because she had had her exam at an imaging center located inside a hospital, as opposed to a separate building. affiliated with the hospital.

The entire invoice therefore expresses the costs of the examination as well as the administration and operating costs associated with the management of a hospital. This was unknown to Smith and did not initially appear on the price calculator.

“I have no problem paying the bill. It’s not a financial issue for me. It’s a principle thing. I feel like an informed person and I can’t use with accuracy the cost estimator – there must be a lot of people who can’t,” Smith told the Inquirer.

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Eleanor C. William