Some procedures cost more with insurance than for self-pay

A New York City physician with a master's degree in public health has come to the conclusion that it would have been cheaper for her to have asked for the cash-pay price for her hospital to perform a mammogram than having it billed through her insurance company, according to MedPage Today.

Kimberly Greene-Liebowitz, M.D., was billed by Phelps Memorial Hospital in Sleepy Hollow, New York, a total of $1,712 for her mammogram, which was priced at $2,480. Her insurer, Empire Blue Cross Blue Shield, paid a total of $767.13. She is supposed to undergo the procedure every six months as the result of a medical condition.

But the cash-pay rate for Phelps is 50 percent of charges, according to an investigation by MedPage Today. In Greene-Liebowitz's case, that would be $1,240--or $472 less than she would pay as an insured patient.

But Greene-Liebowitz wouldn't actually be able to pay cash if she wanted to. "If she's fully insured, she can't come in and say 'I'm fully insured but I am not going to use my insurance," Maria Malacarne, a Phelps patient accounts employee, told MedPage Today.

Scott Breidbart, M.D., chief medical officer of Empire Blue Cross Blue Shield, noted that the procedure, which included a mammogram, an ultrasound and the diagnostic, would be much less expensive if performed in a physician's office. "It's not easy for people to find out how much healthcare costs," he told MedPage Today. "But it is do-able."

Price transparency remains a chimerical quest for most patients. It continues to be the exception rather than the rule, according to TransUnion Healthcare, even though a large amount of consumers want cost estimates for their bills. And many states continue to receive failing grades for their levels of price transparency and lack of initiatives. And even though more hospitals own outpatient practices, few post prices for procedures performed at either site.

To learn more:
- read the MedPage Today article