Learning institutions vs MRI's R Us

I used to get my 6 month MRI's at UCSF. The price, which started at $3000, rose to $10,000 in the span if 3 years. My 15% co-pay was getting ridiculously expensive. I looked at the breakdown of the price, which included abdomen, pelvis, with and without contrast, the radiologist fee and gadolinium, the constrast. The gadolinium price had quintupled and the radiologist fee was tripled from one year to the next!

I called to complain. First, I was told that those market prices for on those components can vary wildly. Secondly I was told that learning instititions are much more expensive for some tests such as MRI's than an an outpatient clinic. The reason was that learning institutions need to make money from somewhere. 

Indeed I checked a local clinic that specialized in MRI's and they were a lot cheaper. I don't regret my earlier MRI's being done at the hospital that saved my life, but if you are willing to shop around for a procedure, you'll find a wide variation on price of these procedures.

When A Clinic Is Still A Hospital Visit

I hurt my finger rock climbing and looked up the Hand Clinic at Stanford. The doc signed me up for therapy, which was right there. They gave me a buddy strap (a velcro strap to tie the injured finger to an adjacent healthy one) and a litte massage by a hand therapist.

The doctor's visit was the requisite doctor's visit co-pay. The therapy got billed as a hospital visit, which my health plan paid at 85% with a $300 deductible for the year. That buddy strap and a little finger rubbing cost me $500. If the Hand Clinic were not "inside" Stanford hospital, but rather a freestanding "clinic", it would have cost me only a $20 co-pay for physical therapy. 

Sometimes going to a hospital is cheaper than a clinic (see previous post), sometimes the clinic is cheaper than going to the hospital. Do your homework!

The Blood Test Conundrum

I used to get all my blood tests at UCSF hospital while undergoing cancer treatment. As diagnostic tests are free in my health plan, they didn't cost me anything!

Later, when I moved into the burbs and settled into a healthy life with just a primary care physician, I'd get my blood tests downstairs from my primary care physician. And I started to get $20 invoices from that clinic.

What gives? Some sleuthing led to this: a clinic at a doctors office often bills under a doctors name, in my case a doctor I had never heard of or met. Once associated with a doctor, it becomes a doctor's visit, subject to the co-pay of a doctor's visit. Never mind the fact that the blood test cost the insurer a lot less when done at a clinic versus a hospital, the incentive of having a blood test downstairs did not beat driving another mile or two to the closest hospital to get that same blood draw for free out of my pocket.

Deductible Changes

One change to watch for is when the in-plan deductible and out of plan deductible. I used to have an overlapping deductible, meaning my $300 in-plan deductible was shared with the $500 out-of-plan deductible. Once I hit my $300 in-plan deductible I only had another $200 to fulfill my out-of-plan deductible. 

Then, one year I neglected to read the fine print, and discovered to my horror that the deductibles became separate. If you had expenses in both categories, you were liable for a total of $800 in deductibles

Read and review those year over year plan changes!

Year to year changes

As the cost of healthcare skyrockets, plans change more often than ever. During the enrollment period, typically november or december, is a time when you sign up for the following year's health plan. Hopefully, you'll get a summary of the benefit changes for the year, and I highly recommend you actually read it carefully, because the fine print can change considerably. It's easy and a fallacy to assume that if your health and family situation is expected to stay the same, that you should just leave everything the same with your health plan.

Introduction

I've spent a lot of time dealing with health insurance and thought it would be useful to share my experiences with a PPO. Remember that everyone's health plan may be different, so take these posts as examples only. In the end, and an important thing that I've learned, is that you have to take responsibility for yourself and be vigilant about your insurance coverage.