MRI Benefits

Every insurance plan is different and today I have the perfect example of just how different they can be...

Patient #1 has a commercial insurance carrier we will call A.  Patient #1 knew they would owe 20% of the allowable charges for their MRI, but had been told it was cheaper to have it done at Facility D than at Facility C where we had them scheduled.  After a phone call to insurance carrier A and to Facilities C & D I confirmed that patient #1 would in fact owe 20% of the allowable charges for the MRI.  I also learned that Facility D did bill less for the MRI as patient #1 had suspected, however the allowable charges were higher at Facility D than the allowable charges at Facility C. 

**Facility C bills more for an MRI than Facility D; however, 20% of Facility C's allowable charges was around $400 where as 20% of Facility D's allowable charges was $500.**

Patient #2 has a commercial insurance carrier we will call B. Patient #2 went for an MRI only to find out when they were there that they had to pay $4,900 out of pocket for medical services before insurance carrier B would pay anything.  This is what we would call a "major medical" policy.  Problem was patient #2 didn't realize they had a major medical policy and left without having the MRI done due to confusion about what the actual cost out of pocket would be.  After phone calls to insurance carrier B and Facility C I found out that with the insurance coverage patient #2 had they would owe the allowable charges of about $1400.  While $1400 is a lot to pay out of pocket, it sure beats the $3200 it would cost to pay out of pocket without insurance.


Questions? Comments?
deargabbyinsurance@yahoo.com