When I scheduled my CT Scan I was self-paying patient. The price was $500. I now have healthcare insurance, but the cost for the scan rose to $1,250. With my Blue Shield Platinum Plan, my copayment is $125. I wonder what explains the huge difference between the two prices.

-Mark-

Insurance companies make contracts with hospitals and doctors. For each procedure, there is an official price, and then there is a lower price that the hospital (etc.) has agreed to accept from the insurance company.

In other words, the official price means nothing, and the hospitals know this. So when you are a self-paying patient, the hospital will often give you a discount, so you don't end up paying the fake, inflated price; instead, you pay what the insurance company pays.

So the official cost of your scan may be $1250, but the insurance company doesn't pay that much.

Abby

Thanks Abby,

That makes a lost of sense. Seeing the higher price that one might pay without insurance, also has the effect of making one appreciating his or her insurance company even more. Had I not known the cash price, I would have assumed that I would be on the hook for the full charge. The same holds for primary care doctor visits. I was paying $95, a very good price. Now they bill $290, $20 of which is my copayment.

-Mark-

Let me give you all a recent example for myself.

I needed to have an echocardiogram. I've had one before years ago, given by a ultrasound provided by my doctor...by a company that traveled from office to office. It was about $300 give or take.

I needed a new one following a toxic drug reaction to see if there was heart damage... so because my doctor discontinued her ultrasound contract --she is partly retired but still sees patients 3 x a week ----
----I went to our local hospital...where I often go for tests. Now I have Medicare A and my husband's insurance. The letter of cost that arrived was $3500 dollars. And the hospital billed Medicare A by a process where they now "admit" the patient before the test. The drug they used to visualize the inside measurements of the heart cost $1000 of this bill. When I showed it to my doctor she was horrified.

This is how the medical machine bloats itself with money.
I find this greedy practice very obscene myself.

Now that my husband is near retirement, we are both signing up for Medicare B as well. For those who know, Medicare A pays only for hospitalization, and Medicare B for doctor visits, and tests.
The process is lengthy and we won't be activated until July. Lots of paperwork for me, that has to be sent to his employer (which is the Fed. Gov't...so the delay is typical there).

But I expect a huge shift in costs, at both the doctor's and in any future hospital bill. (his pension includes continuing our present private insurance, so that it + medicare B means as non-working elderly we pay nothing for services .. as of now. ) No telling what the future holds however.