The Wrong Approach Asking for a Cost from a Medical Provider
If you are ambitious enough to call your local hospital or MRI center billing department to ask, “What will my low back MRI cost?” The typical responses include “I don’t know” or “I don’t know until we run this through your insurance company.”
Just imagine going through the checkout line at a grocery store and asking the clerk how much your gallon of milk costs and the clerk responding, “I won’t know until I process your milk through your homeowner’s policy.” Sounds silly but this is how medical providers treat health care consumers.
So what went wrong that led to you not getting a price tag for your low back MRI? The answer is you did not use the magic word “charge” and you did not tell them that you are not interested in what the insurance company has negotiated as its price tag since you are not an insurance company. You are a consumer.
The Right Approach Asking for a Cost from a Medical Provider
Call your local hospital or MRI center billing department and ask for your low back MRI price tag as follows: “Would you please tell me your charge for a low back MRI? I am not interested in what the insurance company pays you. Please tell me your chargemaster charge for a low back MRI.” This is admittedly a mouthful but it will get you the correct answer.
If the medical provider is a hospital, and they provide you poor customer service by stating they won’t tell you the charge, tell them they must. Do the following:
1) Ask for the person’s first and last name.
2) Ask for the person’s title.
3) Tell the “customer service” person that you are demanding to know their charge master price in accordance with your right under the Affordable Care Act, Section 2718(e) that such price is to be made known and user friendly to the consumer by federal law. They will give you the price then.
At Pratter, we refer to this hospital charge as the “high” or the maximum financial risk you would have for your low back MRI given that 20% of medical claims are denied. The “charge” amount is what you are legally responsible for if your claim is denied. Pratter publishes these charges, as well as average insurance discounts, and we work hard in many ways to minimize your financial risk when you need medical care.
Next, call your health insurance company and ask what your low back MRI will cost you since you have to pay for it since you have not met your deductible. Be careful. The health insurance company representative may try to skirt the issue by stating “we won’t know until you claim is submitted as to whether or not it is a covered service.”
Re-focus your question as follows: “I have a high deductible. I have not met it. I know I will have to pay for my low back MRI. I want you to tell me the price tag for it, assuming it is a covered service. I need to know if I can afford my care. Thank you.” This is known as the negotiated discount price or the real price for care, assuming your medical claim is accepted.
We encourage you to “know before you go” when it comes to medical care pricing.