Streams

Help Us Find the Cost of Mammograms

Friday, May 03, 2013 - 08:43 AM

The Brian Lehrer Show is partnering with Clear Health Costs to add transparency to the cost of common medical items and procedures. We've already mapped the price of birth control pills, and now we're gathering data about the cost of mammograms. In particular, we want to know what the provider charges and what's paid by insurance. In those numbers lies a story of the true cost of health care today.

If you’ve paid cash for your mammogram, please enter the price the provider charged in the form. If you used insurance to pay for your mammogram, you will have received an explanation of benefits from your insurance company outlining the price charged by the provider, and the price paid by the insurance company. In that case, please enter the amount charged and the “negotiated price” or “insurance discount” as it appears on your explanation of benefits.

Note: The below form is tweetable, linkable, and embeddable on any site. We want to get the widest data set possible, so share widely!

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Comments [24]

maria from new york

You are incorrect when you claim that the uninsured are "subsidizing" the insured just because the uninsured pay more for the service. YOU FORGET that the insured PAY FOR HEALTHCARE whether or not they are getting the service whereas the uninsured only pay when they are getting the service. In other words, the insured continue to fund the system whether or not they are benefiting from the service, whereas the uninsured don't pay anything until they need the service.

May. 16 2013 12:29 PM
Karen

I am too late to be commenting during the show, however, it may be of some help for women who will still read these comments, that breast thermography absolutely has statistical research showing it to be safe and effective, statistics showing over 90 percent accuracy when used in combination with mammogram, that is to say the two together are more accurate than mammo alone. For women under a certain bar line thermography is a safe and effective up to a point. There are statistics, but mainstream medicine representatives are not allowed or not able to be knowledgeable or objective about this alternative form of preventive care.

May. 13 2013 11:29 AM
Mary from Fort Greene

Correcting my misspelling: asymptomatic!!

May. 13 2013 11:22 AM
Mary from Fort Greene

I am 44, asympotamic, not crazy and I am not getting routine mammograms. Will the recent studies backing me up on my decision even be mentioned on this show?

May. 13 2013 11:11 AM

This is a great endeavor, but gathering data from an online form doesn't reach a great deal of the population who don't necessarily have easy access to the internet. Some of those people may either be on Medicaid or are receiving their mammograms on either reduced cost or a sliding scale. I'm afraid there will be some bias.

There is also the topic of digital mammograms versus film/screen mammograms, where the costs are may or may not be different.

May. 11 2013 10:44 PM
Jane Kampner from Maplewood, NJ

I did some work for a group called FAIR Health..fairhealth.org. They are a non profit that is a source for transparent, current and reliable healthcare charge information.
They were "established in 2009 out of a settlement of an investigation in by Andrew Cuomo, into the health insurance industry’s methods for determining out-of-network reimbursement."

They offer fairhealthconsumer.org and an iPhone app https://itunes.apple.com/us/app/fh-healthcare-cost-estimator/id620607493?ls=1&mt=8 that allows consumers to take control and find pricing and out of pocket costs for most procedures. Consumers need to take healthcare into their own hands.

May. 10 2013 10:25 AM
Lisa from Manhattan

The year before the new health care law went into effect, before going for a mammography, I asked my insurer whether a mammogram was covered at no cost to me and the answer was yes. Then I was billed $25. When I asked about the charge, the answer I received was that the mammogram itself was free, but not the reading of the film by a physician. Since the cost was relatively low and it doesn't pay to fight city hall, I just paid the fee. My mammogram last year was free to me I'll try to see if I can see the cost on line and if so, will follow up with you.

May. 10 2013 09:19 AM
Sandy from Jersey City

The word "free" to describe costs for routine gynecological care and birth control pills under Obamacare is misleading. We are still paying high monthly rates for the insurance that covers these things. I applaud looking into the disparity in costs overall, but please, do not say that drugs and services covered under insurance that we struggle to pay for is free. We are paying through the nose for this.

May. 10 2013 08:01 AM
Lem from Upper East Side

What happens to individuals who become unemployed and collect unemployment? Medicaid is means tested, so is it possible to have no job and still be unable to get medical coverage because you earn too much?

May. 08 2013 10:19 AM
Marvin Raps from New York City

Excellent report on the radical differences in medical costs. Recently I had the need for a repeat anti-biotic while in Pennsylvania. The same drug, Augmentin, sold as a generic, was 221% more expensive at Rite Aid in Milford, PA than at CVS in Manhattan. When the Pharmacist was asked, he admitted that the cost of all prescription medication can vary by hundreds of percent from pharmacy to pharmacy. Medications are sold to people who need them like fashionable shoes are sold to customers who like them.

May. 08 2013 09:22 AM
BL Producer

@fuva - Absolutely, if you got a mammogram last year you can still post your information. We're trying to compile as big a data set as possible!

May. 06 2013 12:11 PM
fuva from harlemworld

QUESTION: Do mammograms from last year (e.g., June 2012) qualify?

May. 06 2013 12:04 PM

difference between this and

http://www.fairhealthconsumer.org/medicalcostlookup

by fairhealth.org

May. 06 2013 11:48 AM
Susannah from NYC

My mammogram was free - I went to Columbia Presbyterian and applied for their program - they even called me back for a 2nd look - got a fluffy robe, slippers and cookies and coffee - hurt like a motha.

May. 06 2013 10:48 AM
Betsy Robinson from New York, NY

Great topic. No doubt you'll get plenty of answers, but the cost of my mammogram is just the tip of the mammary gland, so to speak, so I'll go further in a comment. For women with dense tissue, an ultrasound is also a basic test, but insurance doesn't allow it. On top of my mammogram, I had to pay $80 for that. But that was just the beginning. Without ever looking at my history or meeting me, the radiologist then recommended a biopsy, that I never needed. Long story short, I've now been charged $8,400 for a 15-minute procedure. Insurance allowed $10,000 (my deductible), so the rest is my bill. I await word from financial counseling dept. There are some links that might be helpful regarding this topic:

About my Left Breast blog—http://www.betsyrobinson-writer.com/blog.htm?post=883471#.UYZ_pyqtOX1

Costs of Care—http://www.costsofcare.org/--a great org also working in this problem

A riff on inflated costs of doctor bills, correlating it to other services—http://www.betsyrobinson-writer.com/blog.htm?post=906056#.UYZ_UiqtOX0

May. 05 2013 11:57 AM
Rene from Texas

I'm a self-employed Texan where health insurance premiums are outrageous. I'm stuck with a $11,500 deductible PPO plan that I can't afford to use, but paid nothing for my yearly mammogram because of federal mandates. I would probably not be getting them otherwise because of the cost. I just hope this stupid state gets its act together and fully participates in Obamacare.

May. 03 2013 06:24 PM
Shell from NYC

Full charge was supposedly $2000. I paid $200 out of pocket. I doubt the insurance company paid more than a few hundred more, but the negotiated rate isn't made available to patients/clients. This was in Manhattan, with corporate employee group insurance.

May. 03 2013 06:03 PM
Jill from Manhattan

I have insurance and don't pay any out-of-pocket or co-pay for my annual mammogram. I also have no idea what the cost is. In fact,I never have any idea what is being charged/paid for for the medical services I receive through my HMO. Back when health insurance (pre-HMO) I would get some kind of bill/service summary whether I submitted it to my insurance copy or the doctor did. I always wonder how I can be sure that the services I am provided are the services being claimed (whether misclaim is on purpose or by mistake). In other words, where is the check in the system? Yes, this is off-topic but would love to hear your experts have to say about this...

May. 03 2013 01:04 PM
BL Show

Thanks for your stories. If you have data, be sure to share it in the form. And we'll try to answer any questions about the project in the comments as well.

-Brian Lehrer Show, Clear Health Costs-

May. 03 2013 11:25 AM
Barbara from Stamford, CT

When I had a mammogram in Texas at Solaris, I didn't pay a thing. My insurance covered it all. What a shock moving to Connecticut where I was charged $260.24 in addition to what my insurance paid, plus I had to pay the radiologist $73.91 additionally. In the future I'll fly back to Texas to have my mammograms. It's cheaper for me!

May. 03 2013 11:06 AM
Maria from Baldwin-Long Island

My insurance company paid $820 for a mamogram, I paid a copay of $ 109 and Complete Womens Imaging (the facility) sent me a bill for $ 1,713.50, which I think it was outrageous!!!

May. 03 2013 11:03 AM
Michael Carlin MD from NYC

Your segment is quite misleading in discussing negotiated rates. Insurance companies do not negotiate rates but rather set them. Unless it is a hospital or large multi specialty practice with a significant number of patients there is no negotiation.
Furthermore the range in reimbursements depends on whether it is a hospital performing the study or an independent out patient facility. As the owner and medical director of a radiology practice I am appalled at the discrepency in reimbursements. The average reimbursement for an MRI of the spine at my facility is around 375.00, which was not negotiated, but rather imposed. Yet any hospital will get more than 2000.00 for the same study. This is just another example of cost shifting by the hospitals. For a CT scan of the abdomen and pelvis I will be reimbursed approximately $250, while a hospital will get approximately $1,800. Furthermore the cost of the MRI machine is the same to both me and the hospital, roughly 1 million dollars, a price which has not significantly decreased since the 1980's when MRI's came to clinical practice.
You might want to also look at all the third party companies that are invisible to the general public but which serve as scan brokers for the insurance companies and workers compensation boards that essentially extract a "booking fee" from whatever radiology center is willing to take the lowest rate.

May. 03 2013 10:37 AM
Anne Cifu from NYC 10016

This charge is out of pocket because when a physician opts out of Medicare...
no other supplemental will pay even a percentage.

May. 03 2013 10:36 AM
sarah from nj

At the Hack Jersey conference, a team put together this app for radiology in NJ: http://pancaketheorem.com/stuff/hackjersey/

May. 03 2013 10:30 AM

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