The case of the $517 chest x-ray #healthcare #prices

Part 1 in a Series.  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 (Click here for this provider's web site).

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.

Comments 32

  1. My niece has just experience the same situation. Without knowing where to go fo chest x ray, she needed 2, she went to Laurens Health Care hospital. They refused to tell her the price. She thought it would cost her $80 just like she had before at a doctor office. She was expect it would cost max 120. Now she receive a bill for 475$. Being a college student she doesnt have this much money. She asked them for cash discount but they said no. Its so inhumane. For the 2 Xray I think it would cost them max 30$. I wish all the doctor knows about this so they wouldnot send their patients to hospital for xray.

    1. Thanks for your comment, +Wildfeet.  It’s unfortunate that those who need x-rays and other services most, are often sick and unable to advocate for themselves very effectively. That’s why it’s important to find a local doctor you can communicate well with and who is savvy about health care costs, especially if you are uninsured or underinsured.  And best to see that doctor when you’re feeling well, so that the relationship is there if and when you get sick.

      Not always an easy thing to find, but well worth looking for.

  2. I’m having the hardest time getting a chest x-ray looked at. I have a high deductible PPO, and had to have a chest x-ray done. I called around, but most of the “independent” clinics in my area (New Hampshire) are now associated with hospitals, and told me they couldn’t give me pricing and I’d have to call the hospital billing department. I’ve seen radiology bills from hospitals in the area, and they aren’t pretty. I called a sports medicine place which said they charge $180, but my insurance probably has a lower rate agreement with them (it was $121 in years prior). They don’t have a radiologist though. I called a radiologist association in my area, and they don’t do x-rays but said they charge $44 to review them. But now the sports medicine place won’t send the x-rays to the radiology place because I’m not actually a patient there, and the radiology place says that a hospital or someone needs to send the x-rays to them, I can’t bring them in myself and pay to have them reviewed… so now I’m stuck with x-rays and no one to look at them! This system is impossible for a patient to navigate if they want to be mindful of cost.

    1. Thanks for your comments +Jason.  You present an unusual situation. In California x-rays are usually ordered by doctors who either interpret them or have a radiologist do so on their behalf. Once the picture-taking is done, I can see how it would be hard to have someone interpret it who isn’t actually taking care of you as a patient.  You could always have your regular primary care doctor send the films to the radiology group, but then the doctor would be responsible for helping you to interpret the report, which probably is a good thing. Best of luck!

  3. Dont even make me mention my $800 ultrasound at Lakewood Regional Medical Center… And I have health insurance! Turns out the hospital billed my insurance for $1600, which got cut down to $800 by Blue Shield because it is “in-network”. I would have to pay that out of pocket normally because I hadn’t reached my out of pocket co-pay maximum for the year (a whopping $3600). Long story short, I complained incessantly to Blue Shield and they ended up covering the $800 bill. Lesson learned though. And there are those who don’t want healthcare reform… well, something needs to change!

    1. Hi Paul. An alternative might have been to shop around for a non-hospital private ultrasound provider who probably could have done it for $250-400 if you paid up front. No need to involve Blue Shield at all if you know your deductible is high. Of course, if it was an emergency then shopping around isn’t possible. Nice to hear you got your insurance company to pay for it anyway, albeit at a cost of your time and energy. I am unsure whether health care reform as it’s currently shaping up would have helped you or not.

  4. Recently I was admitted to a hospital emergency room with heart attack symptoms (fortunately it was determined that it was not an actual heart attack) but when I tried to ascertain the cost of certain procedures that they were advocating I either got “I don’t know” or an astonishing range ($450 from one person to $3,000 from another person for the exact same procedure). I was horrified – like you said, who goes into a store and shops without asking the price of the merchandise. There should definitely be more transparency with pricing in health care so that people like me who are uninsured can make an informed decision about which services they wish to receive. I am not looking forward to getting the bill from this experience and have absolutely no idea how much it will be. That is just not acceptable nor is it necessary. They know how much to charge so why can’t they let the patient know that cost upfront.

    1. Thanks for your comments, Pamela. You’re right, it’s amazing that there isn’t price transparency in health care. The reasons for this are many-fold but that doesn’t make it acceptable.

      For emergency things (like your situation above) we’re all pretty much at the mercy of hospitals, which are generally opaque financially. Sad, but true for now. However, for non-emergency labs and imaging, a savvy doctor can often help obtain services for a fraction of the hospital price.

      By the way, the “squeaky wheel” often gets the grease – the more you complain and make it clear that you’re extremely unhappy with their services and business practices, the more likely the hospital is to write off your bill.

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  6. And I’m going to the hospital tomorrow for a chest xray, after a referral today. I have no idea of the price. That’s because I live in the UK. Lucky me.

  7. Its not really all that suprising that a hospital would charge more than a clinic. I work at both. The clinic has 2 xray techs and old, old equipment. The equipment is still functioning fine, as there are maybe 5 to 10 exams a day done on it. The hospital has 4 xray machines, 2 portable xray machines, 3 OR c-arms, 2 CT machines, an MRI machine, 2 ultrasound machines, and a portable ultrasound, and all of the equipment gets replaced every 5 or so years due to high usage. 20 xray techs 8 ct techs, 8 ultrasound techs, 3 shift team leads, an xray manager, a CT/MRI/Ultrasound manager, 3 patient transporters, 5 office personnel, and a director of imaging. On top of that 50 plus percent of the patients that come in the ER are not going to pay their bill. So, yes, if you have no insurance, get your imaging exams done at a clinic if you can, it will be much less expensive.

    1. Post

      Trev: You are correct, hospitals do have much higher cost structures than outpatient x-ray facilities. But around here the outpatient facilities are pretty good, and are much easier to access, so there often isn’t much benefit to using the hospital even for those with insurance. Of course, it all depends on your local market.

    2. Presumably, a hospital has more equipment because they are seeing many more patients. If they have more equipment than they need, or more staff than they need, then they need better management. I am not paying for that.

      Anyway, I went to an “outpatient center” but it was really part of the hospital and they are trying to charge me $868 facility charge for use of their x-ray machine on my son’s foot. With insurance, this was reduced to 711.76… wow, what a savings! I could have used a podiatrist’s x-ray machine for $50. Wish I would have known before hand.

  8. Good post, Dr. Paul! As a small healthcare provider I see not knowing the price a function of being a “larger” entity like a hospital. Most smaller providers, like myself may even enter the charges themselves so they should know what they are and if there is a time of service discount, etc…Sure the insurance companies may reduce the fee, but if they are a network provider the provider should even know the fee schedule. However, in a larger group practice – the individuals may not know their actual charges as you pointed out. It’s a bit ridiculous to see the large difference in price in your example, however! To your point about knowing the cost, this is where partially self-funded health plans like HSA’s seem to shine. It invests the patient (consumer) in the decision making process and gives them some choice on how and where the $$ are spent. Probably a win-win by both ensuring the providers aren’t taken advantage of by the insurance companies and charge a fair fee to their patients.

  9. This is not the only pricing difficulty. A pulley-operated lumbar support (step up from Home Depot!) I found for $75 on Amazon would have cost me the discounted rate of $200 had I bought from the medical equipment company (which charges [or tries to, I dunno] Medicare $700, I was told). Some years back I opted to buy direct an oxygenator, finding a smaller/quieter/more attractive model than among those offered by the medical equipment company contracted with my insurer. I bought outright rather than rent indefinitely (saving ton$) but my insurer wouldn’t let me log the purchase (which required and for which I had an Rx) against my high deductible.

    Lastly, the lesson from Jason’s scene below, and something I learned and wrote about in my advocacy book, is that before deciding and embarking on a course of action we must find and discuss all sorts of things with all the links in the chain. We’ve got to ask all manner of things, wildly imagining what craziness could go wrong and stymie us. Until, that is what e-Patient Dave deBronkart says, becomes a reality: Gimme my damn data, it’s all about me so it’s mine.”

  10. I had a lower lumbar x-ray done. Total cost was $732.00. Insurance did not pay because I have not reach my deductible. The hospital did deduct $252.54 bringing my bill to $479.46. They did not send an itemized bill, which I am going to request. I am assuming (??) that the Radiologist was including. We shall see, but still is way to expensive!!

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  12. Experienced the same thing today. My husband needs a chest x-ray and we don’t have insurance, it took an hour to call two different hospitals and ended up walking into one of them for the price. Confirmed one hospital charged $99 and the other $224 ( Idaho) this does not include the fee for a Radiologist to READ it and report it to DR. However neither hospital could give me the prices for the Radiologist to read report. They said they didn’t have those prices as they are not told. I was told to contact the radiology company that does the billing and was told they could give me price for one of the hospitals which it is $28 ( that charged the $224) but they don’t service the other hospital. I just don’t get how there are so many people without insurance and yes want to know what they are going to be charged and billed for before they get the service. This country’s health care services is not only in danger because Insurance companies, but the prices medical offices/hospitals charge and don’t care to have patients informed of what they need to pay for and how much it costs.

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  14. This just happened to me. Got aq bill for $509 for a chest X-ray for my 2 year old. They just wanted to rule out pneumonia. The clinic sent us to the local hospital to get it done.

    It is outrageous. So much for healthcare reform. And the Affordable in the ACA isn’t really working out that way.

    Hospitals doing this are criminal, no better than the mafia.

  15. Had a wet sidewalk fall walking out of a business. Did the split as I went down and heard a pop in my hip. Couldn’t lift my leg. The business drove me to the local Hosp ER as they were concerned about a broken hip. (Recently had another customer fall on their recently painted sidewalk). I walked into the ER and sat at three different desks filling out forms. Was walked into the ER and sat on a chair. I wasn’t able to lift my leg to get onto the bed. Seen by a nurse (RN) and then a DR. Wheel chaired to x-ray and back. Short time later DR advised nothing broken and Rx a pain med. I took one tab and walked out. Hospital wanted $1995. Doctor’s billing company sent bill for $1352 and the Radiology sent bill for $230. $3577 for a simple x-ray exam!!!! Criminal. I am a 64 year old without a job and no insurance. Exactly how do they expect me to pay this? If it were a sensible bill, reasonably priced for the services rendered I would not gripe. But, this is outrageous and excessive!

  16. I experienced a similar situation. Dr ordered me an MRI. Hospital said my high deductible insurance would not cover so would need to pay in advance on day of service. I asked how much and after great delay between $4000 and $5000. I contacted a local imaging facility who after receiving the details from my doctors office priced it at $1400 but would be $700 if paid at time of service and not put through insurance. What I learned was the providers do not get the full amount from the insurance companies of what the patient is billed. The patients copay however is based on the higher amount. In my case a 20 percent copay of $4000 to $5000 would have been $800 to $1000 yet I paid only $700 directly to the imaging lab. In effect the patient is getting fleeced in a system that is designed to be confusing and opaque. I no longer have health insurance and shop for care. If more common, this would be the most effective way to control health care costs. I have difficulty understanding why it is even legal to base a patients copay on a phony amount already negotiated by the insurance company and provider.

    Health “insurance” cannot be sustained IMHO without a major redesign. It has only really existed since WWII and functioned well due to many factors especially a younger age demographic that has been growing older (requiring more health care). Home/car insurance works because you try to avoid using it. Health care on the other hand is something virtually everyone will require especially as they age. Typical lifetime costs continue to rise as the baby boomers live longer and place unprecedented demands on system. I would like to see more focus on finding ways for patients to bring competition directly to providers and have less insurance involvment

  17. I had no insurance and went to Urgicare with a bladder or kidney infection ($160 with lab work). Doctor asks if my back hurts, i tell him not really. He says not at all? Well i did twinge a muscle a little earlier in the day picking up something but it would be fine if i was careful. He said i might have a kidney stone, i tell him it has not hurt at all prior so i don’t think so, but he insists i go to the hospital for a CAT scan. I reluctantly go. I tell the hospital I have no insurance and ask what it will cost. She types a bunch of stuff into the computer and says it wont cost that much, the hospital only charges about $380. So i think hmmm that is way cheaper than I thought, costs must have came way down over the years, maybe an MRI is what was /is expensive? After all it isn’t new tech anymore so seems reasonable I presume, i guess i can afford that. So I get into this machine and it has a spinning thing that looks like a stargate and I still rationalize, wow they must have paid this off years ago to cost so little. Then weeks later i get a bill from the hospital for about $380 just like she said. Awesome! so i pay it. Then i get a bill for $3100 from radiology and another $475 for the tech to read it. so about $4000 to find out i didn’t have kidney stones just as i thought… I just needed some antibiotics to fix the infection. Which I also knew i needed before I went. Why would they do such an expensive procedure when i told them I did not have insurance and couldn’t afford much? They never offered a discount so i had to pay it with a CC which made it cost even more.

  18. 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????

  19. It is trajic that the doctor, me, doesn’t know the cost of the test or if the medicine that I prescribe because of the hundreds of insurance companies and thousands of different policies. No 2 are alike. Only information and a free market place will cub this bear. The insurers and hospital systems and pharmaceutical companies do not want that info disseminated . There would be a patient revolt if patients knew the costs.

  20. I am a Radiologist owning a Private out patient Radiology office and have newest and stae of the art Xray machine, Mammography , Ultrasound and MRI machines. We do 3 D mammograms without additional charge. I agree that Hospitals charge a lot more. I get paid less than 300 dollor for MRI and if at second MRI is done same day, around 70 dollors. With these reimbursements from the insurance, the private out patient radiology ctrs. are having difficulty surviving. I would suggest public to call and find prices from Private radiology facilities first than just going to Hospital based radiology ctrs.

  21. I had a chest x-ray (2 views) total cost was $798 and my out of pocket was $470.97. this was at the hospital that is next door to my doctor’s office. I filed a complaint and asked the girl if she wanted a number to call me back. she wanted to know why she needs to call me; I told her so that she can let me know the outcome of the complaint. She said oh, it just gets noted that you complained but it won’t change the bill.
    I need a CT scan of my lungs now so I called the same hospital to get a price. What you have to go through to get any answers is ridiculous. She told me the cost would be $5,400 (it would be the same if it’s cash) but I didn’t need to worry about it because my insurance will pay the balance after my copay of approx. $400. I told her that I do worry because that is why insurance premiums are skyrocketing. I tried to find out how much the PPO discount was but she wouldn’t tell me.

  22. I came across this article last year and I mention it in my Healthcare Systems course to reinforce an in-class activity where I share with my pharmacy students the insurance bill for my $550 X Ray at the local hospital … They are always surprised to learn about the total cost and the variability in costs depending on where the X Ray is performed. Thanks for sharing your experiences on this issue!

  23. This looks like it needs someone from 2017. 3/4/17 went to ER for chest pains and worst heartburn of my life. I do not currently have insurance, I did right up until Obamacare passed and then I could no longer afford insurance. anyway. Into ER. I paid cash up front so the visit went from $1900 down to 1100, 40% savings. (yes that’s how much the insurance bureacracy costs us). I had 2 xrays. front and side. I didn’t have a heart attack. 2 weeks later I get a Radiology Bill for $747. 2 xrays for $747?? !!! seriously? I haven’t called yet to chat about the bill. Granted it was the ER. I did find some Cost Of Procedure websites to do comparisons for future procedures.

  24. Well, speaking from very recent, personal experience, many of the cash discount places refuse treatment if they find out you have insurance. I, like many people, have a high-deductible insurance plan. Doctor said he wanted me to have a standard 2-view chest x-ray. Finally found a place that would do it for $54. Sounds great. I PREPAY, make an appointment, and two days later I arrive to have the x-ray; except they refuse to allow me the x-ray unless I give them my insurance information. Of course, if I give them my insurance, TWO bad things happen. First, my insurance will approve a lot more than $54. Then, I will be expected to pay it. Second, the insurance company finds out I had a chest x-ray, decides I must have cancer, COPD, or some other dread disease, and raise my premiums (and yes, those of us on grandfathered insurance plans can have that happen to us). Now, I suppose if I actually have some sort of dread disease, then I’ll have to use the insurance and no avoiding the rate increase. But no need to waked up a sleeping giant over a $54 x-ray.

    I had my rates jumped 30% about 6 years ago because they got a claim (just applied it to the deductible) for a biopsy done on some warts that were taken off. Apparently, the dermatologists send off everything for testing, even if you don’t want them to. After about two months of arguing with the insurance company, and getting some records to prove that all it was was a wart, they lowered the rate back down.

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