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Comment by cascom | Hacker News Reader

I actually had this experience for an MRI, I called billing at the hospital at which my doctor was affiliated/recommended I take my MRI - I was floored to learn that if I paid cash, it was ~$1k and if I ran it through insurance it was $1.5k

I actually ended up running it through insurance as I wanted the amount to be applied to my deductible…

When I asked the (very nice) woman in billing how this made any sense - she told me (paraphrasing) that it’s basically a super complex optimization problem where several thousand products/services are being simultaneously negotiated, such that the hospital can maximize its gross margin, and the insurer can minimize its payments under insurance.

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getting anything done at a hospital is 2-3x as expensive as a dedicated clinic.

an MRI is typically a ~$500 cash / out of pocket diagnostic without insurance, outside a hospital.

Just spent 1.85K USD on TMJ(tooth joint) MRI with cash, forgot to negotiate the price. it's truly expensive to me though.

If you do have an MRI, skip the contrast. They describe it as a harmless dye when in fact it’s a toxic heavy metal known as Gadolinium injected straight into your bloodstream, and is retained indefinitely by your body and deposited in your bones and skull: https://www.fda.gov/drugs/drug-safety-and-availability/fda-d...

Upside: there are very few indications for an MRI with contrast, and epidemiological studies have shown current gadolinium-based contrast appears to be well-tolerated (i.e. very low risk of nephrogenic systemic fibrosis in patients with renal failure). Downside: if an MRI protocol calls for contrast, then it’s necessary to use contrast to obtain the information desired (i.e. there’s often little use getting a non-contrasted MRI of the protocol calls for contrast but there is a contraindication).

As someone with experience with the process, she’s basically right. People complain about the $20 tablet of Tylenol that insurance pays $0.50 for, the gross-net game has been played for decades. It’s just got ridiculous in the last 20 years or so.

Insurers have little interest in negotiating for every single procedure code, and why would they when it’s a handful of codes that drive most of the cost - more efficient to spend time on those.

And on the hospital side, they leverage what the can - if you’re the only acute trauma center in a 100 mile radius you’re dam right the insurer is going to pay whatever you ask - they don’t really have a choice.

So areas with multiple MRI providers often see pretty reasonable rate (not always though). The ones where there aren’t multiple provides see the 5x charges.

Could part of the reason that the cash price is often cheaper be that dealing with the insurance company for pre-approval and claims is time consuming and expensive?

I had an MRI a little while ago. Then I ended up having to go in for minor brain surgery, and then a checkup with some high-precision head X-rays later.

I paid... about $100 for the hospital bed and food while recovering for two days, and about $15 for the taxi they arranged to take me home. Another $10 or so for some painkillers for the headache while recovering at home.

Where was that?

I hope you're doing ok now.

Which country did this happen in? If the USA, what sort of insurance was it under?

Definitely not the USA, was my point here. Health care in the USA is absolutely and completely insane, to any outsider.

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