Insurer's price calculator severely underestimates breast MRI cost for Philadelphia woman

Although a new federal law which took effect Jan. 1 requires hospitals to post prices of all services offered online, including imaging examinations, and has encouraged many insurance providers to invest in price calculators for patients to determine out-of-pocket costs, one Philadelphia woman discovered that they may severely underestimate actual prices, according to a recent report by The Philadelphia Inquirer.   

Knowing her breast MRI wouldn’t be covered in-full by insurance, Michelle Smith used an online cost calculator from her insurance provider, UnitedHealthcare, to estimate out-of-pocket costs for the exam. The online tool—which suggested the facility Smith used to get the breast MRI—told her the cost of the procedure in her area ranged from $783 to $1,375. But Smith was shocked to discover she was billed $3,237 for the exam.

She learned she was billed double what the price calculator estimated because she had her exam at an imaging center that was inside of a hospital, as opposed to in a separate building affiliated with the hospital.  

The entire bill, therefore, expressed costs for the exam as well as fees for the administrative and operating costs associated with running a hospital. This was unknown to Smith and was not initially listed on the price calculator.   

“I do not have a problem paying the bill. It’s not a financial thing for me. It’s a principle thing. I feel like I am an informed person and can’t accurately use the cost estimator—there must be plenty of people who can’t,” Smith told the Inquirer. 

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