UninsuredinAmerica.org

Dr. Stephen Blythe

Picture This – X-rays and other Imaging

If you ask the hospital why they charge $3,000 for a CT scan, they will say that it is because they have staff there 24 hours a day and that the equipment is expensive. If you ask why so much money, they may tell you that they have to make up for those patients they see who do not have insurance. But the irony is that only the patients without insurance get charged $3,000 – the patients with insurance get charged about $2400 less! So to make up for the care provided that is not reimbursed, they overcharge those who are least able to pay. Makes a lot of sense….

Our local hospital charges $3,000 for either an MRI or a CT scan. They are nice and will generously reduce that by half (or on a good day by 60%) if you agree to pay at the time of service or if you work out a payment plan. It is still over twice what they get from the insurance companies for the same test – often after months of billing hassles and costs.

I tell my uninsured patients to never go to the hospital for testing unless they absolutely have to. Recently one of my uninsured patients suffered a badly fractured foot. We sent her to an orthopedist that I knew wouldn’t charge her excessively. He did send her to the hospital for a CT scan of the foot. She called our office from radiology to ask if we thought she was being treated fairly – they told her that the cost for the CT scan would be $1450, but if she paid at the time of service they would charge her only half - $725. Although on the surface that sounds awfully generous, it is still sort of like the ads that scream out “50% OFF!” – but they never say 50% off of what! We told her to wait a minute – we called one of the outpatient imaging centers that we know works with our uninsured patients, and called her right back to ask her how $225 sounded. She thought it sounded much better….  That is about what insurances pay, and that imaging center got its money without any billing hassles, so everyone had a good deal.

Understanding Imaging

It is useful to understand a little bit about imaging. Standard “plain film” x-rays – where some x-ray radiation is shot through your body to expose a piece of film – is still the gold standard for the initial evaluation some areas such as chest x-rays and looking at bones – for fractures, arthritic changes, cysts, etc.

X-rays do not show “soft tissue” – the body parts other than bone – very well. This limitation can often be overcome by using a contrast agent. Barium, which blocks x-rays, can be mixed in a heavy shake which is fed to the patient – it coats the esophagus and stomach and allows an x-ray to show the wall of the stomach – often revealing ulcers or other problems. Of course, barium can be pumped up from below as well in the form of a “barium enema”, which still has usefulness, although colonoscopy, where the GI doctor can actually look up into the colon, has largely replaced it.

 Contrast can be injected into almost any soft tissue to improve the return of information. Years ago – before there was an MRI machine in Maine – I had my sore knee evaluated. I had an “arthrogram” – my knee was injected with an iodine-based dye (which blocks x-rays) followed by three big syringes full of air! This highlighted the meniscus and cartilage surfaces of my knee. It felt like I had bubbles in my knee for the rest of the day.   Other types of contrast are concentrated in the kidney or in the liver and allow x-rays to be used to evaluate those organs.

 CT scans use information from narrow beams of x-rays coming from different directions to generate highly detailed “slices” of the body which shows bones as well as soft tissue. Sometimes contrast is used to highlight certain areas. CT scans are fast and easy, and are often used in the ER to look for appendicitis or bleeding in the skull after an injury. The downside is that they expose the patient to large amounts of radiation – something of growing concern, especially for children.

An MRI scan does not use radiation – it uses strong magnetic waves to paint a high-resolution picture representing a slice through the body. It takes longer – up to an hour – and for the “closed MRI” requires the patient to lie still in a coffin-like confined space for that time period. That can be difficult for someone in pain or who suffers from anxiety, and it is not unusual to administer pain medication, tranquilizers, or even anesthesia to patients undergoing an MRI. The magnetic field is so strong that serious injury could occur should a patient have an MRI who has any steel wires, implants, or pacemakers. Often times, especially with patients who work around grinding and welding equipment, an x-ray will be taken of the eyes to look for small pieces of steel which might be embedded in the cornea – pieces of steel which could move in response to the magnetic field of the MRI!

Below are samples of imaging studies and the amount that Medicare pays for these studies in this part of Florida. Remember that insurance companies often pay a little more than Medicare rates.

Imaging Test:

CPT Code:

Medicare Fee*:

Ankle x-ray

73610

$29.67

Hip x-ray

73510

$35.74

Chest x-ray (2 view)

71020

$31.70

Cervical spine (Neck) x-ray (3 views)

72040

$36.10

Cervical spine x-ray (complete)

72052

$63.68

Lumbar spine  x-ray (2 or 3 views)

72100

$37.80

Lumbar spine (low back) complete

72114

$68.42

CT scan foot (without contrast)

73700

$245.02

CT scan sinuses (without contrast)

70486

$247.22

CT scan abdomen w & w/o contrast

74170

$402.07

CT scan pelvis w & w/o contrast

72194

$394.62

CT scan chest w & w/o contrast

71270

$403.89

MRI neck w/o contrast

72141

$421.82

MRI knee w/o contrast

73721

$404.04

MRI shoulder w/o contrast

73221

$404.04

MRI brain w & w/o contrast

70553

$653.61

Ultrasound abdomen

76700

$133.71

Ultrasound pelvis

76856

$117.97

Ultrasound pelvis, transvaginal probe

76830

$117.30

            *Florida Region 1 2009 Fee

Mammograms:

With new technology comes new expenses! Whereas the Medicare rate for a standard mammogram is about $106, it is about $150 for the new digital mammograms. These are felt to be much better, especially for women with dense breast tissue.

Women who cannot afford yearly mammograms should call their local mammogram or women's health center and ask if there is a free mammogram service. Many areas have these, and some will also even provide follow-up imaging such as ultrasounds if needed. Some have income criteria, others do not.