When No One Really Knows What Health Care Will Cost, Prices Skyrocket

Having spent decades as a health policy analyst, I know one thing for certain: Everyone has at least one personal story related to health care, either their own or a close relation’s, which often informs their opinions about the system.

In my case, an evolving mini-saga over the last several months confirmed my prior belief: Health care costs too much in part because no one can find out exactly what it costs — and few people have any incentive to do so.

Low-Ball Estimate

Over the summer, lingering discomfort from an ankle sprain prompted my orthopedic surgeon to suggest an MRI. I went and scheduled the imaging study at Washington Radiology, and the day before my appointment received the below text message:

Text message to author from Washington Radiology

Having done some research online into the price of ankle MRIs in the Washington area, I found the quoted cost reasonable and decided to go ahead with the procedure.

In late August, I received an Explanation of Benefits from CareFirst Blue Cross, my insurer, followed closely by a bill from Washington Radiology. Neither the amount Washington Radiology billed CareFirst ($1,503) nor the amount of out-of-pocket expense that CareFirst allowed, and which Washington Radiology billed ($518.22), matched the $466.39 estimated cost that Washington Radiology gave me ahead of the MRI. So, given my background in health policy, I decided to investigate why my charges exceeded the original estimate.

Bureaucratic Run-Around

I called Washington Radiology and asked someone to explain the discrepancy between the estimated amount and the charge on my bill. The customer service representative didn’t seem to know where the text I received had come from. She asked me to fax the information to her and pledged to get back to me.

I never heard back from the customer service rep. In early October, I received a follow-up bill from Washington Radiology, again seeking $518.22 from me, whereupon I called to ask about the status of the questions I had raised more than a month previously. This customer service representative told me Washington Radiology had finished its internal investigation over a month ago (how nice of them not to tell me).

This representative also couldn’t tell me where the $466.39 estimate that I received via text message came from. Instead, he suggested I contact CareFirst, my insurer, to inquire with them about my benefits — a suggestion that didn’t make much sense, as Washington Radiology and not CareFirst had sent me the estimate in the first place.

I followed up with several additional inquiries to Washington Radiology via their website, along with a call to the company’s corporate offices. I explained that I planned to write an article about my experiences, and what the discrepancy between the estimated cost and what I was charged said about patients’ ability to act as health care consumers.

Washington Radiology never responded to my online messages or my phone call. However, just after Thanksgiving, I received a new bill that included lines saying, “Per