Price Shopping for a Medical Procedure – Part 2

When we last saw our hero, he was (not) pining by the phone awaiting a call from ProScan, which finally came in the form of a voicemail.  Thanks to Nicole from MIlwaukee, I shall continue.  Unpolished, and nearly incoherent…

Next, I finally figured out the anthem.com cost estimating tool.  The same one the people on the phone use.  I found a place on the north side of Indianapolis, much closer than ProScan, for around $400. I called Northwest Radiology Network.  Having learned my lesson on the OpenSided strangeness, I asked for confirmation of the price before scheduling an appointment.  The strange conversation follows:

ME: Hi. I need an MRI on my left knee, without contrast.  I am with Anthem and I would like to confirm pricing.

Lady on Phone (LoP): Of course, sir, I would love to help with that.

ME: Fantastic

LoP: But, we are currently renegotiating our contract with Anthem so I do not have the updated pricing.

ME: Is it going to go up?

LoP: I don’t know.

ME: Ummm… What’s your regular price?

LoP: Around $1,200.  But it will not be that much.  It won’t be more than the self pay price, which is $800.

ME: I can get it at ProScan for $400.

LoP: If you would like to make your appointment now with us, we will have the pricing later

ME: How much later?

LoP: Well your appointment could be as early as tomorrow morning.  We won’t know the price by then.

ME: I’ll go someplace else.

LoP: Ok.

ME: Ok. Bye.

Now what?  I called the next closest one on the list: Meridian MRI.

Meridian MRI confirmed they were in Anthem’s network and they confirmed pricing ($450).  They also told me what was included (the image and the evaluation).  So far, so good.  Let’s make the appointment…

…flashback: OrthoIndy (remember them?) told me to call once I had an appointment so that they could do a “pre-certification”.  Whatever that is…

…back to present… Meridian MRI said they needed the order before they could make an appointment.  The following is the sequence of events from this point:

I call OrthoIndy to ask them to fax the order to Meridian MRI.  “Okie Dokie”

An hour or so later, I call Meridian MRI to make the appointment.  They tell me that now that they have the order, all we need is a pre-certification.  “Cool.  Let’s make the appointment and I’ll get that from OrthoIndy,” says I.  “Oh, sir, we can’t make the appointment until we have the precert,” says she.

Another call to OrthoIndy.

Another pining by the phone.  Should I call back? Should I keep waiting for their call?

Finally, I call Meridian.  They have not received the pre-cert.  So I call OrthoIndy back.  They have sent it.  They will call Meridian for me.

Another pining by the phone…

I can wait no longer.  I call Meridian.  They got it! Yay!  I get my appointment! Yay!

The rest of the story involves me getting an MRI (you can’t take your phone in, by the way), then having to make a few more phone calls to figure out how to get the results over to OrthoIndy.  Diagnosis: torn ACL, sprained ACL and MCL, multiple bone bruises.  Thus ended my short and not very productive sand volleyball career.  The Pike Alumni will have to go on without me.

You know what would have been much easier than going through all of the above?  Not worrying about the cost.  Just having the MRI done at OrthoIndy for about $800.  In fact, if I were not thinking about cost, I would have not known that it was $800.
It almost would have been worth the additional $350 to avoid the hassle of finding a $450 place. But $350 is $350 when it’s coming out of my pocket.  You know when $350 isn’t $350?  When it comes out of someone else’s pocket.  If I’m tempted to pay $350 extra next time to avoid the hassle, how motivated is an insured with low deductible to go through the hassle?

There.  That’s day 6.  Feel ya tomorrow…

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