How to avoid over-paying for tests

You can often shop around and save $$. It should be easier, and it shouldn’t be necessary.

Hey there—

As usual here, we’ve got good news and bad.

Good: When it comes to tests — x-rays, MRIs, bloodwork, etc. — there are some huge ripoffs you can avoid. 

Bad: It can take a lot of work, just to avoid an unconscionable ripoff.

Worse: Some ripoffs, you just can’t avoid.  

OK, let’s get back to that good news before we get too irritated. There’s always time to be grouchy later.

Hospitals will rip you off on tests

Everybody agrees they will. OK, maybe not hospital executives, but when medical-billing expert (and Arm and a Leg listener) Julia Nigrelli shared some tips with us, this was basically number 1 with a bullet: Don’t get tests and scans done at a hospital if you have any alternatives. 

And hospitals charge wild amounts for these tests. I have seen bills of more than $25,000 for an MRI. 

Why? It’s an easy way to turn a profit. 

My colleague and mentor Elisabeth Rosenthal¹ compares these tests – MRIs, CT scans, x-rays, echocardiograms – to booze at restaurants.  

If you’re a restaurant owner, “you can take a cheap bottle of wine, and mark it up as much as you want,” she says. 

If you’ve got a choice, avoid tests at hospitals. You may have other options.

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Research other places to go 

I want to tell you about a Giant Rockstar in the Arm and a Leg universe, Liz Salmi – a researcher and advocate for making people’s experience of the medical system less-crappy –  and how she avoided getting ripped off on testing. (Content warning: Cancer stuff in the next few paragraphs.)

Liz became an advocate and researcher after surviving a serious bout with brain cancer, experiencing the ups and downs of our medical system firsthand. To make sure the cancer wasn’t coming back, Liz needed an MRI every six months.

A few years in, she changed jobs, got new insurance, went to a new hospital for one of those scans … and got stuck with a $1,600 bill for one of those scans — yes, after insurance. 

So Liz went looking for alternatives. She called a bunch of places, reached a free-standing imaging center that quoted her $98 per scan, decided to go for it. 

And it worked. After her scan, by the time she got dressed and walked back to the front desk, they had the images ready for her on a disk. Plus a bonus: A bag with two chocolate-chip cookies. (“I was like, ‘What?!? AND COOKIES?”)  

Yep. A less-expensive MRI, and cookies. 

(Side note: Liz’s cancer came back last year. She had surgery in the fall, and she is recovering — and documenting her recovery in a blog I love and recommend. She’s a serious — and playful — force for good – follow her on Twitter, Instagram, or on her own site.) 

Liz Salmi @TheLizArmy

This probably comes as no surprise to anyone who follows me… My neurosurgeon & I are writing a paper together. 😆 I emailed to say, “Sorry I have not gotten back to you w/ those edits.” And he’s like, “It’s totally cool, boss. I know you just had brain surgery. I was there.”

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Shopping works for other kinds of tests too.

Like bloodwork. As I mentioned in a recent Arm and a Leg episode, I once got charged hundreds of dollars for a vitamin D test. My doc’s office sent it to an out-of-network lab. OUCH.

So it turns out you can — and should — shop around for bloodwork too. 

For starters, your insurance company may have a page on their site where you can look up in-network labs, and see what you’d pay. (For vitamin D tests in particular, you should also check if they pay.)

You can also Google “shop for bloodwork.” BAM. Results.  

Looking into some of them, I see options under $100. But … which one do I want? 

When your doc says, “I’d like you to get an XYZ test,” here’s what to ask:

What’s the CPT code for that test, doc?

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Wait, what’s a CPT code?  

Glad you asked! 

It’s kind of a universal language for medical providers and insurers. It’s how one doc knows exactly what another doc ordered, how the billing office knows exactly what to charge, and how the insurance company knows exactly what they’re being asked to pay for.  

Any test, any procedure — an hour of physical therapy, a vitamin D test, an MRI — has a specific five-digit CPT² code.

Very specific. For instance: 

Code 82306 is “Vitamin D; 25 hydroxy, includes fraction(s), if performed” 

Code 82652 is “Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed”

I don’t know the difference. But if my doc ever encourages me to get a vitamin D test again, I’m going to find out which one of these they mean, and I’m going to get the code, so I can shop around for a cheaper test. And so can you.  

CPT codes are a core piece of First Aid Kit vocab. We will come back to them in a big way: If you ever get a medical bill that you want to fight, you’re going to use those codes to look up the prices that Medicare and others pay for each code on your bill. 

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Seriously-advanced shopping (and money-saving)

This strategy comes from Marshall Allen, a former ProPublica reporter who wrote a book called Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. 

He’s a kindred spirit. If you’ve got the stamina for a whole volume of First-Aid Kit-type hacks, Marshall’s got you. 

Marshall looked up the CPT codes for a couple of common blood tests, then called an independent lab near his home, and asked how much he would pay with his insurance — and how much he’d pay if he didn’t use his insurance.

The answers were wild. With insurance, Test #1 was $64. Without, $19.20. 

Test #2, same deal: $73 with insurance, $21.90 without.

Both tests were more than three times as expensive with insurance.

(Why? As we’ve mentioned before, health insurance actually sucks: Insurance companies often do a lousy job at negotiating prices, because ultimately we’re the ones who pay those prices. Either upfront or through jacked-up premiums.) 

So that’s the next-level shopping experience: Ask for the cash price. While you’re at it, ask if they might give you a discount. Because, why not? 

(We did a whole Arm and a Leg episode on Marshall’s hacks. Listen here.)

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There’s a catch, right?

What, you mean besides the fact that this is a ridiculous amount of time to spend, just to avoid a massive ripoff?

Well, yes. Because you also need to shop for quality, not just price.

For instance, when I Googled “MRI center Chicago”, I got lots of results and noticed that some included reviews.

It turns into one of those exercises where you’ve gotta read all of them. Here’s one:  

Time to hit Yelp, because there weren’t a ton more Google reviews. Oh, look:

These complaints echo ace reporter Sarah Kliff’s experience when she chose a less-expensive MRI:  The scan wasn’t top quality, and even though Sarah’s insurance company did all the shopping for her, the whole experience was more of a hassle. 

So: Budget time to find the best place for you. Get recommendations from your group texts, your book club, your colleagues at work. Find out where you can get a decent price and get the service you need, done right.  

And then … there’s the truly sucky part.

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You don’t always get to shop around.

Here’s Liz Salmi again, the badass who found the $98 MRI-plus-cookies. She’s here to tell us: Her situation, and ability to shop around, is unusual.

Most people facing a cancer diagnosis, it's suddenly like: Oh, right, you're going into brain surgery tomorrow. And there's no shopping around. There's no time. It is an emergency. I'm in a really unique situation: I know a lot of shit at this point. And I have the luxury of time. So I am coming from a place of, I would say, privilege. But it still took ME lots of work. 

And there are situations — even non-emergencies — where you might need a scan that’s not exactly routine. 

For instance, here’s my deal: I’ve got a congenital heart defect that needs monitoring — a scan every couple of years. Which costs thousands of dollars, sticker price. 

I’ve asked my cardiologist, Couldn’t I just find a cheaper place?  And she’s said, Um, no. I give the techs at our facility very specific instructions. We’ve worked together for a long time, so I know they’re giving me exactly what I need. 

Medical-billing expert Julia Nigrelli — who advised us all to avoid in-hospital tests whenever we can — said she agrees with my doc: In my case, I’ve gotta stick with the hospital.

There are other instances too. That $25,000+ MRI bill I saw? The patient was a newborn in the hospital NICU. It’s not like the parents were gonna take their baby to MRIs ‘R’ Us. 

So, even if you are willing to shop around, to read all the Yelp reviews, ask for the cash price, ask for the good-guy discount … you may be stuck with the hospital ripoff machine. 

However, if you’ve got a choice, there’s one more thing you should know about scheduling. 

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Get it done early (in the year)

This advice comes from an Arm and a Leg listener named Rebecca, in New York City. It’s a little grisly. (So, another content warning: Cancer stuff in the next few paragraphs.) 

Rebecca used to get her annual mammogram in August, because that was a convenient time for her to see the doc. 

This means August was when they diagnosed her with breast cancer. That meant surgery in October, and radiation … in January. Of the following year.

”Like most Americans I had a really high deductible: $6,000. And then a couple months into treatment, the clock rolled over. It was January 1st. I passed ‘Go,’ and it was another $6,000 out of pocket.” 

So, Rebecca’s advice: You’ve got annual stuff you do? A checkup, a pap smear, a mammogram? Do it as close as you can to the beginning of your policy year. So if they find anything ominous, you at least don’t have to pay your deductible twice. She says:

“Sure, shit happens and you can get sick. But if you're going to go through routine diagnostic tests, do it as close to the beginning of your coverage period as possible.”

Geez, that was fun. 

We’ll be back soon with another First Aid Kit. In the An Arm and a Leg pod feed, we just hosted an episode of a show we love, Last Day, made by Stephanie Wittels Wachs, the heroine of a favorite Arm and a Leg episode:   

I’ll catch you here in a couple of weeks.

Till then, take care of yourself. 

Dan

1. Elisabeth Rosenthal is an expert on ripoffs in health care. She wrote the book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. She’s also Editor-in-Chief at Kaiser Health News, my co-producers on An Arm and a Leg. Reminder: KHN, and their parent org, the Kaiser Family Foundation, are not affiliated with the health care giant Kaiser Permanente. They share an ancestor. It’s a fun story, and you can read about it here. 

2. CPT stands for “Current Procedural Terminology”