Health Care in Real Life

Recently I have personally experienced one of the many problems with health care and why what we have now needs some repairs.

With a very painful shoulder, I went to the chiropractor and other more unconventional treatments with no relief. Finally a sports therapists said he didn’t feel safe going any further without an MRI. So I went to my MD who scheduled the MRI.

My health insurance is borderline acceptable but to save money in this difficult economy, I have a policy with a $10,000 deductible. But it is very hard to read the fine print and define what is covered and what is not.

There are two parts to the policy important to this conversation: normal and accident. If the pain is the result of an accident, then the insurance company pays more.

Anyway, I called the MRI company and they said the MRI costs $1121 each – 1 for the neck and 1 for the shoulder. But the insurance company would only be billed for $600. And if I paid cash without insurance, it would only be $700.

I know there is a $250 deductible for the MRI. So see if this makes sense to you:

The insurance company is going to be billed $1121 but only pay $600. I pay $250.

$1121 – $600 = $521 – $250 = $271

What happens tot he $271? The insurance company and the MRI company didn’t know.

But if I were to pay to cash – $700, the MRI company would make $100 more than by billing the insurance company.

Now it gets even more confusing:

My therapist believes there is a shoulder and neck problem which is 2 different MRI’s. If these 2 MRI’s are done at the same time, I would only have to pay $250. But it is impossible to get the doctor to order them both at the same time and to get the insurance to pay for 2 at the same time.

So is there some form of collusion going on here? Why can’t I get 2 MRI’s at the same time?

While waiting for the answer, the pain continues……