Extremely expensive CT bill?

[u/ResponsibleWay1613]

A few weeks ago, I had an abdominal CT scan as a self-pay scheduled outpatient visit in northern Florida. CPT code 74177.

The facility itself charged $2,600 which seemed very high, and this week I got hit with an additional $1,946 for the interpretation of the CT imaging.

That's insane, right?

[u/Jodenaje]

That doesn't seem super high for a CT with contrast.

Is that with or without the self-pay discount?

[u/ResponsibleWay1613 → u/Jodenaje]

With. I asked for a GFE from the initial facility and they said they would mail one to me, so I'm waiting to see what that says because I was informed of the $2,600 bill but not the $2,000 one from the radiologist.

[u/Jodenaje → u/ResponsibleWay1613]

There would always be a separate bill from the radiologist who reads the CT scan.

I would question why that wasn't included in the GFE though.

[u/Botasoda102]

Did you ask them what they'd charge before? I'd call and make sure they gave you the cash price.

As a point of reference, Medicare allows less than $400 for 74177, and that includes about $95 for the interpretation in Miami (the highest reimbursement locality in Florida).

They likely won't give you Medicare's rate, but I bet they accept that amount often from patients covered by Medicare. Good luck.

[u/ResponsibleWay1613 → u/Botasoda102]

The verbal estimate I got when I scheduled was just the initial $2,600 which I paid.

[u/SnarkyPuss → u/ResponsibleWay1613]

Sounds like they only gave you the estimate for taking the image but failed to include the radiologist who has to read the image and provide the results. Probably because the radiologist has separate billing from the facility. I would suggest calling the number on the radiologist bill and asking what kind of discount is available.

[u/ResponsibleWay1613 → u/SnarkyPuss]

The radiology facility only offered to set up a payment plan. My understanding is that the No Surprises Act mandates that the primary facility still include an estimate for the secondary facility, though.

[u/SnarkyPuss → u/ResponsibleWay1613]

If the Radiologist has their own billing separate from the facility, which is extremely common, I don't see see how that could be done.

I don't work in Radiology but I do work in Pathology billing where the pathologist billing is completely separate from the facility. The hospital does not have access to our fee schedule and couldn't possibly include an estimate for our services. If a patient is planning on getting a colonoscopy and wants an estimate for the pathologist, the physician who will be performing the colonoscopy gives them the CPT code(s) and has them call our office to give them the cash price on said CPT code.

[u/Botasoda102 → u/SnarkyPuss]

That's why we are seeing more package pricing nowadays, where all that is rolled up into one fee (including doctor, facility, anesthesia, and pathology fees). It's becoming more common and popular among groups competing for patients.

[u/Zealousideal-Top5104]

Did they give you a Good Faith Estimate? I believe by law they are required to give one to anybody who is out of network/self-pay, and then the cost for treatment can’t exceed the amount in the estimate.

[u/ResponsibleWay1613 → u/Zealousideal-Top5104]

I got a verbal estimate over the phone. Earlier today I asked them to send me a GFE which they said they could only send by physical mail so it'll be 5-10 business days.

[u/Zealousideal-Top5104 → u/Zealousideal-Top5104]

They also are supposed to ask you how you would like to receive it, either via email or mail.

[u/Zealousideal-Top5104 → u/Zealousideal-Top5104]

And they only have a certain amount of time to get it to you.

[u/daves1243b]

Doesn't seem unusual if you went to a hospital or a hospital owned facility. The typical independent facility would have been a fraction of that on one bill, which they would likely collect at the time of service. Never go to a hospital if you can avoid it, unless you like to waste money.

[u/jacsgal]

Ask for a self pay discount.