Navigating Insurance (or how bargain shopping for MRIs is not like bargain shopping for shoes)

I suspect that this is going to be longer than one post can hold - frankly, navigating the insurance system could probably be the topic of an entire blog in and of itself. But I couldn't write that blog because even thinking about insurance makes me furious, and I like being a reasonably emotionally balanced individual. Spoiler alert: if you're looking for a post about how useful and wonderful insurance is, or want to use direct quotes in insurance advertisements, move along.

 My dad was in the army for most of my childhood. I have two younger sisters. My mom didn't work until I was in middle school so she could stay home and take care of us. This isn't the family chapter of my memoir - what I'm getting at is that I grew up broke. I grew up lucky and broke - we lived on base in military housing, I never went hungry, I always had clothes and toys and never knew that we lived paycheck to paycheck. I knew my mom never went grocery shopping without her expanding case of coupons. I knew that we never shopped anywhere except the sale section. I knew that the thrift store always had the most fun things.

The fam at my dad's retirement party

 I know the value of a dollar. I understand how to comparison shop. Between my penny pinching tendencies (read: cheap ass) and perfectionist nature, for any major purchase, I typically know all of the competing products, the pros and cons, how the reviews trend, and which product has coupons or sales online. So when my surgeon put me in contact with the scheduler for a pelvic MRI on the first visit, I waved her off. I had research to do.

 The surgeon I was seeing had privileges at the fancy hospital in the city, so I reached out to several less fancy hospitals and some independent imaging centers. I started by calling, and asking operators who I needed to talk to about billing. I needed to have a pelvic MRI with contrast - I wanted to know what it would cost. I didn't think this was going to be a difficult conversation; I thought it was going to be like pointing to (very freaking expensive) shoes in the window and asking how much those cost. And that is when I learned a very important lesson about insurance.

 It's confusing AF.

 I knew about my insurance policy - I had spoken to a representative on the phone about deductibles, out of pocket maxes, out of network benefits, coinsurances, etc (More on this later.). I thought it was just a matter of applying all of those principles to the cost of a procedure. It’s not. At least, not entirely. Because the "cost" of the procedure changes with your insurance policy. So even though a pelvic MRI with Contrast is valued at $4,500 (real number, decided by the hospital) an insurance company contracts a rate with that hospital, and they decide that they are willing to pay $1,200 (also real number) for that service or procedure. Because an insurance company represents so many more people, and has "guaranteed" resources to pay bills, the hospital will play ball and accept less money.

 So anyway, I called an imaging center, they told me they couldn't tell me what the MRI cost billed would be and that I needed to speak with my insurance. I called my insurance. They told me they couldn't tell me what the MRI cost billed would be. I almost lost my mind. I asked my insurance who I needed to speak to, and they said the facility. I called the facility back, and this is when I learned a second very important lesson about insurance.

 It is run by people. And people make mistakes.

 I called the imaging center back, spoke with someone else, and they told me they would have to look up the information and could email me the quote. I had it in my email by the end of the business day.

 Some of the places I found had online web pages or email addresses that you could communicate with to get a quote for what a procedure would cost. (This is the dream. It doesn't require actual phone conversation with a human and gives you everything you need in writing.) Regardless of the method by which you are getting a quote, you need to know the CPT code of the procedure you are having. A CPT code is a Current Procedural Terminology code that is a number that corresponds to the procedure. You would find this out by asking the referring doctor for the CPT code. And you need to know your insurance information - who holds it, what type of plan it is, and your ID and group numbers, almost all of which can be found on your insurance card.

 Important terminology

 Deductible: The amount of money you have to pay before your copay or coinsurance kicks in. You will still get the rate negotiated by your insurance company, but you have to pay 100% of the cost until a specific number.

 Co-pay: A flat fee based on appointment type

 Co-insurance: A percentage of the negotiated rate that you have to pay, AFTER the deductible is met

 Out of pocket max: The largest amount of money that you will pay for your healthcare; after this much is spent, it's all free.

 Out of Network Benefits: if a plan is "in network" it means that the insurance company and the healthcare provider have a relationship, and a contracted rate. If not, it means there is no contracted rate, but you may still have any of the above; it depends on the plan.