Question about an MRI and Cost and Second Opinions
June 28, 2015 1:28 PM   Subscribe

I'm having an MRI on my knee late Monday afternoon to see if I might need surgery on a possible cartilage problem. The cost will be a financial hardship, and I have a question about how to discuss that. Also, I got multiple opinions from doctors, and I have a question about how to handle that.

1) My ACA insurance has a $2,000 deductible, and I haven't met any of that yet, so the total cost of the MRI will be around $2,400. I have been unemployed for the last six months, and so this amount of money is substantial for me. The hospital let me know I can come early to talk to a financial counselor and the possibility that I might be able to receive some charity assistance.

They didn't tell me anything about the process, what information they need, or anything to bring. Does anyone know how this will work? Is there any particular way that I can talk about myself and my financial situation that will make them more likely to help me?

Also, will the doctor who I am seeing later this week know if they grant me some financial assistance? I'm concerned that if he knows I'm receiving a discount that he might be less likely to suggest medical options which might be very expensive, if I would need more financial support to afford future care. (i.e. surgery might be the best approach, but other less expensive approaches could also be tried.)

2) The doctor doing the MRI is Doctor B. I originally saw Doctor A, who also suggested an MRI and possibly surgery. Doctor A wanted to do an MRI with dye/contrast, but when I mentioned that to Doctor B, he said to to do it without dye. I called back Doctor A at the end of last week, and he said that dye would be better for my particular situation. I'm going to be sticking with Dr. B, who has more experience, a better reputation, and is at a better hospital, but I'm wondering if I should follow up with him again about the difference between dye or no dye.

Is there a way to handle it when doctors give two differing opinions? Should I try to talk to Dr. B again before the MRI to explain why Dr. A said to use dye to see if he has any additional thoughts?

Any thoughts or comments on how to handle this situation would be appreciated.
posted by crocodiletsunami to Health & Fitness (8 answers total)
I had to have an MRI on my back last year. My old insurance company (BCBS) was being real d**ks about approving this. I think it was going to be something like 1800 bux, but if my insurance company approved it, I'd pay only 800 because of the payment agreement between provider and insurance company.
I finally got so frustrated I called the Imaging Center up and asked "How much if I pay you cash at time of service? Answer: 800 dollars.

That (2400) sounds pretty high for a no-frills/no dye MRI of a knee. I think I'd be shopping that one around. And if this is an Insurance Company approved provider, there are usually some pretty heavy discounts... the way you describe things it sounds like the provider my not be an approved provider. Check with your Insurance Company about approved providers for this service - Mine (Humana) has it all online. You should NOT be paying retail, which is what 2400 sounds like. HIGH retail at that.

As a point of reference I paid 2400 for a lung cancer screening X-ray with dye and some sort of fancy 3D spinny Xray machine that you go through like an MRI machine.
And the Doctor doesn't "do" the MRI. They -order- the MRI. Some technician does it.
posted by rudd135 at 2:05 PM on June 28, 2015 [1 favorite]

I learned the hard way that the cost of MRIs varies a lot between faciltiies. Apparently, it's usually a lot cheaper to go to a stand-alone "imaging center" rather than a hospital. You might want to make some phone calls Monday to see if it's worth trying a different facility.

That said...$2400 does sound like a lot for an MRI. I think my neck MRI was like $800. Is $2400 the "list price" or the "contract price"? Every medical provider has a ridiculously high "price" for every procedure, but the insurance companies negotiate much lower prices.

You should definitely talk to the hospital or facility where you get the MRI about payment options. Ask about a payment plan where you pay them monthly. However, you will need to discuss finacial issues separately with your doctor, he won't hear it from the MRI people.
posted by radioamy at 2:35 PM on June 28, 2015

If there is a difference of opinions between doctors, I think the best course of action is to ask for the reason for the disagreement and see if they can provide any evidence behind their opinion, and then go with whichever doctor seems to have the better evidence to support their opinion and/or can provide you with the best/most trustworthy explanation. A lot of tests and treatments in medicine are done without much evidence to back them up, unfortunately, based on things like "expert opinion" (which isn't worth much as far as evidence goes). So in this case, rather than asking your doctor "do I need dye for this MRI?" The better question(s) would be "Why don't I need dye for this MRI? Can you explain your thought process behind ordering it without dye? I have to pay for this out of pocket so I just want to make sure I'm getting the test done right the first time." Any doc who has a problem with explaining that probably shouldn't be your doc. Ultimately, though, you have no choice but to get the MRI done the way the ordering physician orders it, of course.

Here's a resource that explains a bit more about the need for dye with a knee MRI. The standard is for them to be done without dye. The relevant section states:
"Intravenous contrast for an MRI of a joint has not proven to be very helpful, unless there is concern regarding a potential infection, tumor, or synovial pathology. However, unlike intravenous contrast, intra-articular injection of contrast, i.e. MR-Arthrography, can be very helpful... for detecting recurrent meniscal tears, loose bodies, and articular cartilage damage."
posted by treehorn+bunny at 4:45 PM on June 28, 2015 [1 favorite]

MRI costs vary enormously. You do not have to go where your doctor has pointed you. Ring around for costs.
posted by DarlingBri at 11:10 PM on June 28, 2015

Response by poster: Does anyone know how upset the hospital might be with me if I call the morning of an MRI to cancel? Looking at DarlingBri's article, it seems like MRI costs vary and the hospital that I am going to would be on the high end.

My appointment isn't until 4pm, and I could call them at 8am to cancel.
posted by crocodiletsunami at 12:03 AM on June 29, 2015

There should not be any problem calling this morning to cancel.

You are free to shop around for a MRI and I would highly recommend it. Also, as the imaging center what CPT code they are billing for the procedure and then call your insurance company and ask them what the allowed charge for that code is. Unless your insurance company is bad at negotiating the allowed charge should be substantially lower than what the facility bills.
posted by Broken Ankle at 7:13 AM on June 29, 2015

Some years ago, I had an MRI for which the bills were something like $600 for the imaging and $200 for a radiologist to read it. So $2500 seems high me.

Remember, you should pay the 'allowed charge' per your insurance.
posted by SemiSalt at 9:31 AM on June 29, 2015

Just wondering if you have tried physical therapy to deal with your knee pain. Sherry Brourman is a physical therapist who wrote a book called Walk Yourself Well that supplies stretching and strengthening exercises to help correct your gait and posture. They really helped me with my knee pain. Good luck!
posted by GregorWill at 5:37 PM on June 29, 2015

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