@Skylar
Very useful advice!
So when you mention ‘insurance/PBM’ for shopping around, do you mean that most insurance plans have a department meant for this?
I understand you to say major pharmacies can check prices within their own chain.
@Brandy
Wow, that is truly shocking.
In my area, small clinics offer X-rays, MRIs, and CT scans. There are also independent centers that provide X-rays, MRIs, and CT scans, aside from the two local hospitals.
Uma said:
In my area, small clinics offer X-rays, MRIs, and CT scans. There are also independent centers that provide X-rays, MRIs, and CT scans, aside from the two local hospitals.
That’s great. Searching for facilities was a bit challenging even in a big city, especially for a 4-month-old’s imaging needs.
@Lennox
I see how that can be much more challenging. You made a great choice and got it done for a reasonable price. Your advice will undoubtedly help others.
I just wanted to add this for anyone else considering options beyond hospitals.
If a provider has a contract with your insurance, they must bill the insurance for any service. Failing to do so means they can lose that contract.
It’s not new to have separate fees for radiologists interpreting X-rays. That has been going on for years.
When you reach out to a children’s hospital, you’re getting a specialist facility with dedicated training for pediatric care, so costs reflect that. Standard hospitals charge closer to typical rates for facilities. If you go to independent radiology facilities, costs are way lower. They tend to have less overhead without expenses like paying for a full hospital staff or providing emergency room support.
Then, someone will do the X-ray (technical service) and knows how to properly position for the film and radiation levels. Next, the film is reviewed by a trained doctor for any medical issues.
Costs can be high mainly due to equipment care to prevent excessive radiation exposure, and there are plenty of good reasons behind that.
I too pay out of pocket despite having insurance because of my high deductible plan—using insurance would cost me far more. I would definitely use my insurance for major medical incidents, but for routine things, it just doesn’t make sense financially.
@Mika
Exactly! That’s my plan moving forward.
I appreciate you sharing your findings and experiences!
In November 2023, I had a colonoscopy and endoscopy done in Central Texas. I had private insurance but learned I’d have to pay around $7,000 after I met my deductible, plus 20% of the rest. The self-pay option turned out to be $1,900. Knowing exactly what I had to pay before the procedure was relieving. I paid upfront, and then I didn’t have to deal with surprise bills later. Considering self-pay for procedures is definitely worthwhile!
Remember that any service done at a hospital will include both facility and doctor fees. This isn’t just applicable to X-rays. This can range from an office visit to surgery. I agree with what you mentioned, but it’s also good to acknowledge all services provided by the hospital. The facility gets paid for the X-ray, and then there is a separate fee for the doctor interpreting it.
For basic X-rays, you might want to try urgent care centers that aren’t tied to specific hospitals or doctors, like Medac or ClearChoice. My kids have had broken bones X-rayed there for just $25. They don’t treat fractures if a cast is needed, but you can take the X-rays to your orthopedic specialist.
Have you checked if your kids can qualify for Medicaid if you lack insurance?
Zan said:
Have you checked if your kids can qualify for Medicaid if you lack insurance?
I make too much for that. My Marketplace insurance kicks in on March 1. My wife has quit her W2 job to look after our child while I’m self-employed.
Every medical facility is required by federal law to have a cash or self-pay rate available. Even surgical offices can provide this.
You can call and simply ask, “What is the cash/self-pay price for X?”
You are also able to transfer your referral to any other provider or facility you wish. It’s essentially shopping around.
Absolutely! I learned this lesson myself while in Houston.
Major hospitals were aiming for thousands for a neck ultrasound, but independent options were available for only $200.
When I didn’t have insurance, I always told the hospital I was self-pay to ask for a discount. My husband went to the ER for chest pains, and after contacting them, his hefty bill got knocked down to about $300. Self-pay can make a big difference! It rarely works for regular doctor visits, though.
totally agree
The US health system is a total scam. It feels cruel and uncaring.