Your Role in Driving Medical Costs Down — Healthshare

Your Role in Driving Medical Costs Down

driving medical costs downIt’s no surprise that health plans have higher deductibles today than they ever have in the past. That’s why consumers like you have to take action to reduce medical costs. That’s easier said than done, but here are a few tips.

It’s common when a doctor orders an MRI or a CT scan for a patient to have the office staff schedule this test for you. But have you ever wondered how they decide which facility to use? Are your best interests in mind? Doctors typically look at several factors when deciding which facility to send their patients:

  • How easy is it to obtain the results?
  • How quick can the test be scheduled?
  • Will the facility obtain preauthorization for the test to remove this burden from the doctor’s office staff?
  • Does the doctor prefer that imaging results be read by a particular radiologist at a specific facility?
  • Does the doctor receive any type of incentive for referring a specific volume of patients to a particular facility?

You’ll see that “patient out-of-pocket cost” is not one of those factors! Most patients simply follow the doctor’s orders and go on to the facility recommended by their physician without even considering how much their test is going to cost them. Unfortunately the cost of a simple MRI or CT can vary greatly among facilities which also means so could your out-of-pocket costs.

Each medical facility has agreed to accept a contracted amount for each procedure performed, and contracted amounts can vary quite a bit amongst facilities. So how can you find this information?

Get Help Comparing Medical Pricing

Your insurance plan can usually help determine which facility would be best for you and cost you the least out of your pocket. An article by the National Center for Policy Analysis reveals how Blue Cross Blue Shield (BCBS) has been taking action to save their patients money.

BCBS instituted a process to intercede during the authorization process. At this point they identified which facility their patients were scheduled for imaging tests and when able, offered their patients an alternate facility within the network that offered contracted rates. In the end, this not only saved the insurance company money but also reduced the patient’s out-of-pocket cost. Here’s an example of how one client saved $1,760 on an MRI:

Mark is a 46-year-old construction worker in Denver. Mark’s was scheduled for an MRI of his hip by his orthopedist at a nearby hospital. Mark’s insurance has a $5,000 deductible for imaging services provided at the hospital on an outpatient basis. Mark would be responsible for the total contracted amount of the MRI, or $1800. BCBS assisted Mark by switching his MRI to a different type of facility – a diagnostic imaging facility, Mark was then only required to pay a $40 copay. Mark saved $1760!

When the patient asked his doctor why they insisted he have his MRi at the local hospital, he was stunned by the answer – because it was easier for them to access the MRI results online from the local hospital than to view a disk from a diagnostic center. Although this may have made the process easier for the physician, this luxury almost cost this patient an additional $1760!

How Blue Cross Blue Shield Cut Imaging Costs by Almost 30 Percent!

BCBS found that by giving patients a more cost-effective option, competing facilities were forced to decrease their rates – by 30 percent in some cases. In the end the big winner is the patient – YOU!

Have you been scheduled for an imaging study and found yourself in a similar situation? What is your opinion on how facilities are selected? Do you have any other questions about medical pricing we can answer for you?


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