Tuesday, May 1, 2012

The case of the $517 chest x-ray

The following anecdote is from Dr. Paul Abramson, a physician based in San Francisco, and originally appeared on his blog http://mydoctorsf.com, and is part of a series of posts on this topic

So the story goes like this.  A patient of mine needed a chest x-ray.  He doesn’t have health insurance, so rather than just give him a requisition and send him to the local hospital, I decided to do a little calling around on his behalf to find out what the damage would be… 

Vendor #1: A well-known local hospital
I called up the radiology department and asked them how much a PA and Lateral Chest X-ray would cost.  “I don’t know – we don’t have that information” I was told by the clerk.  The radiologist gave me the same answer.  They both said I should just send the patient over and he would find out the cost when he received the bill.

That seemed a little dumb.  Since when do we go into stores and buy things without knowing the price?

So after 4 additional phone calls and about 2 hours, my assistant and I finally reached Bob who is in charge of uninsured patient billing.  He was able to tell me the price: $517.

For a PA and Lateral Chest x-ray.

For cash paying patients who pay at the time of service and know to ask for the
“20-20″ discount
 by name, the price ends up being reduced to$310.20. But you have to know the secret code word.
Time to receive report in my office: 2-3 days.
Quality: Good

Vendor #2: Free-Standing Private Radiology Office (call us if you wish to know which one)
I called up and the receiptionist answered on the first ring.  I asked how much for a PA and Lateral Chest x-ray.
An immediate answer: $73.
Time to receive report in my office: 1 hour.
Quality: Just as Good

So my quesiton is this.  How can the hospital be charging 4.25 times as much as the place down the street to cash-paying patients, for the same product and actually inferior response time?   (or 7 times as much without the secret code word).  I know, “cost shifting” is a common refrain.  But that just doesn’t fly any more.

And what’s more disturbing, how can it be so difficult to find out the price when you call up and ask?

So many doctors just send their patients to the hospital x-ray department or lab without thinking that it may bankrupt them.  And many doctors have no idea that the price spread can be so great.

It’s time we developed some more price transparency in health care.  I know there are companies trying to create online price comparison databases.  That is good, but really every entity should be required to have front-line staff know the prices
for every service they offer.  That way patients and doctors can make rational decisions about how to get each patient what they need.


  1. That's been my experience as well. I can't remember exact numbers, but I needed a CT scan of my neck and chest as a former cancer patient.

    Just to get someone to tell you how much the routine procedure costs is difficult enough. But then you have to call three more departments to inquire about cash discounts. The whole time being treated as some whack-job for wanting to know how much something costs beforehand.

    The problem is compounded when trying to do price-shopping. I eventually found that my CT scans would be 1/6 of the cost at a nearby clinic, down to $500 from $3,000 at my University Hospital.

    1. Medical Imaging Center www.openmribarrington.com only charged me $350 for an MRI with contrast and $50 for a Chest X-ray. They also have CT and Ultrasound prices that are the lowest in the Chicagoland area

  2. We returned to a prior Rhumatologist at University hospital who was now out of network just to get a referral to another rhumatologist in network. The old rhumatologist billed my out of network part of the PPO for $550.00 for the office visit. My PPO applied the charge against my yearly out of network deductible which means I would pay the bill. Of course I knew this before making the appointment and was willing to pay a reasonable fee for the referral. When the doctor sent me the $550.00 bill for the office visit, I made a call to the billing department. I requested that the bill be reduced to what they accept as payment in full for the majority of patients. The billing department said no, we do not have to do that. I then offered $225.00 as payment as that is more then they usually accept as payment in full. Again the billing department insisted they would the full $550.00 even though that amount was really bloated and an amount most never pay for the same service. Because the Hospital and doctors were not for profit under HHS standards, I applied to the hospital under charity care standards under HHS guidelines. Given our income and yearly medical expenses, the hospital wrote off the entire $550.00. Federal law requires that a hospital charge patients close to what they charge most patients. Because 80% of patients get deep discounts through their insurance, that $550.00 bill for most people would have been $125.00. Some times greed gets the best of us. The $225.00 I offered was very profitable for the doctor and hospital for this visit.

  3. Every healthcare provider should switch to an EMR solution. Paper based records and prescriptions are a thing of the past now and it would be best for both doctors and patients to take advantage of their features and accessibility.

    Medical Billing I Free EMR

  4. Thank you for writing these posts. I know the greed of university hospitals because I've spent my career negotiating healthcare contracts. There are absurd differences in prices in major institutions vs community sites. It's surreal. A university can perform such advanced research and medical procedures it's practically sci-fi. Yet, they have no prices and haggle like they're selling souvenir t-shirts in a flea market.

    But it's not funny.

    While a university fights for a few more dollars on a large contract, patients are waiting to receive care, spending their own money to live in motels nearby. While a university wastes months haggling, a patients has a birthday and then is excluded for age and cannot receive the treatment.

    In defense of university physicians: this isnt their doing. They are often embarrassed by it. But they pretend not to know or look the other way or justify it. Many "drank the kool-aid" and are drunk with their institutions' arrogance. Prestige or the ability to do more research are their only benefits. Their salaries are not proportionate to the premiums their institutions charge.

    I represent companies, so I lean right politically. It would be against my own interest to do otherwise. My own job may be obsolete in 100% socialized medicine. However, even I dislike seeing capitalism taken to such an extreme that patients' physical condition deteriorates in the name of profit. One day in the future, someone will look back on this time in America and say how barbaric we were. I hope we'll make lots of progress soon, somehow.

  5. I just had a pelvic xray in a private laboratory in Mexico. It was $16.

    A CT scan last week was $120.

    How do US hospitals get away with their prices.

  6. I believe is is so very important to find a good x ray service in Mesa .

  7. I am not really sure how the system works. And I am part of the system as well. I have been a practicing physician for more than 5 years and really feeling sad with the way the system is set up. And really everyone blames the doctors and think that the doctors are making all the money. As a matter of fact most doctor visits are changed 110-150$ depending on the complexity of the patient. And insurances pay 10-80$ depending on the part of the country you practice and the health insurance the patient has. However the patients gets huge bills on ancillary services amounting to 500-1000$ per office visit / doctor visit for simple hypertension, diabetes, cholesterol visits. Amazing and outrageous that the Insurance companies and hospitals have been doing this for a long time and nothing has been done. I am scared to go see any doctor for anything even though I am a doctor myself as I do not know how much bill I'll get after the visit.
    Scary but true....this system is set up to work against both the patients and the doctors, the most important people in healthcare. And even then all the hospitals are running in losses. Not sure who is getting all the money????

  8. Hospitals and other healthcare market lacks transparent market-based pricing. Patients cannot compare prices of medical services, as medical service providers do not disclose prices prior to service.
    This is the reason why you need to have a healthcare insurance. The insurance companies will be negotiating and be paying the medical services provided.
    I found Marchionne Insurance when I was looking for a life insurance in Wakefield MA. You might wanna check their insurance policies and get a quote.

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  12. I had a x-ray. 2 views and it cost me 43 dollars. No insurance in my name

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