Home care in Chattanooga, TN

  • 6016B Shallowford Road
  • Suite 1300
  • Chattanooga, TN 37421

Always ask if self-pay for a medical procedure cost less than your insurance co-pay

September 18th, 2016

When we lived in South Georgia, I could run and bike for miles on open stretches of road. Living in Lookout Mountain, GA has proved different. I traded in my running shoes and began to 'speed walk' with my dear friend. We referred to those 6 mile walks as 'therapy sessions.' Those of you who run know that the sport eventually lures
you back. So, I began trail running. It seemed easier on my joints and, on the mountain, the return was always downhill! At 9 miles, my groin muscle began to ache. It worsened and soon ended my runs....and my walks. Amy hospital gown

After my physician asked a series of questions and manipulated my legs in many awkward positions, he decided it was not my groin muscle but rather hip problems; perhaps a Labral tear. He prescribed an MRI with contrast.

Here is where the story gets interesting.
I arrive to my appointment early, check in, review the paperwork including costs. The receptionist proceeds to tell me that my co-pay for the procedure will cost $927 because our insurance deductible is $5,000.
We have only satisfied $1,800 of that this year.

I return to the waiting room in disbelief and before long I am called back to the receptionist desk. I am told that 'insurance approval was pending' for my MRI and the office will be in touch with me after insurance is approved.

I follow-up with my physician and he recommends an x-ray of my hip as a way of convincing the insurance company that we have tried a more conservative route prior to the MRI.
Keep in my, this x-ray is not free of charge nor was my return trip to the physician.

After the x-ray, I received a call from the Imaging Center and I am told that insurance finally approved the procedure. My new appointment was 8:45a the following day.
Again, I arrive early, check in, and, not long after, I am called back to the receptionist desk only to be told that 'insurance approval for the procedure was still pending.' She proceeded to explain that, 'insurance approved a cortisone injection for pain but did not approved the MRI.'
How? Why? I had just been through this a few days earlier, had an x-ray and confirmed that I had a rescheduled appointment.

My husband has worked in healthcare for 20+ years had arrived at the Imaging Center and was very miffed as well. He proceeds to the receptionist desk and asks, 'if we walked in off of the street today with no insurance and wanted to pay cash for an MRI, what would our out of pocket expense be?" The receptionist heads off behind closed doors and returns with the the office manager who told us, "if you pay cash today, your costs will be $733." How can this be when our insurance co-pay was $200 higher?
It makes absolutely no sense at all.

Of course we decided to self-pay. We saved $200 and we can still file the bill towards our insurance. If they ever decided to approve the procedure, the amount will be applied to our deductible.

So, all this to say, ALWAYS ask what the out of pocket expense will be if you opt to pay cash (or use a credit card) instead of paying your co-pay. Insurance, in and of itself, is so frustrating and complicated. Ours has worsened in the past few years so I am happy to share any advice I can offer because I can almost bet that your insurance costs have increased as well!

Topics: Lifestyle