Why does a CAT Scan cost so damn much?

I’ve passed kidney stones before, and felt some ugly renal colic last week.

So, I went to the ER, the gave me a shot of Dilaudid and I had a CAT scan done.

I was there maybe an hour and a half total.

I got the medical bill today, and the medication cost $500.

The CT scan cost over $8,000.

After other doctor/hospital fees, $10k all told. Holy shit!

FWIW I’m only paying a fraction of that (which is still a ton of money) but it’s stuff like this that blows my mind. Why a trip to the ER costs as much as decent used car?

Can anyone help break down a case like this?

Because 25% of patients in the ER don’t have insurance and pay nothing.

I thought that had a lot to do with this. So, the hospital offsets its losses in bill collections by inflating its services and resources?

That’s one vicious cycle. And of course I’m all for universal healthcare in the States, but it’s always reminders like these that raise my blood pressure again. Ironically.

I had a CAT scan done at a hospital in Central Thailand – perhaps the highest-reputation private hospital in a multi-province area. The cost including doctor’s fee was about $50. Even granting a wage differential in the 8:1 ballpark, the difference with OP’s price is stunning.

Is that what your insurance was billed or what you are actually going to pay? A an outpatient CT should run you something like $500. In an ER, they can end up being closer to $1000 and you may have had more than one at the same time. $8000+ seems out of line for the CT alone, even bundling in all the technician charges, it still seems too much.

Also, I can’t believe Dilaudid was $500. ISTM, that should have been something like $10-$20.

For the record, when went to the ER for my first stone, I think the whole thing (including a CT) was about $4000-$5000.

Looks like the answer is to hop on a plane to Thailand then.

Moderator Note

Typo in title fixed (“do” -> “so”)

The insurance company probably doesn’t pay the listed rate.

Also, the cost has to pay for the time on the CT scanner (which is basically the cost of the machine plus maintenance costs divided over how many patients they an expect to treat with it) plus the cost of the room (part of the overall building construction/maintenance costs), the time of the CT tech and the time of a qualified radiologist to read it, cost of all supplies used, etc. There’s also malpractice insurance for all involved. Most folks don’t sue, but the rare times that something goes bad, folks in the U.S. tend to sue for very high dollar amounts. And they have to cover the costs of everyone who uses all of the above without paying anything for it.

A CT machine in less wealthy countries may be a used machine from somewhere else, so the cost of the machine is lower. That country may not have malpractice insurance to pay. The salaries of trained medical professionals may be a lot lower. They may have different laws and might not treat people who can’t pay. Their hospitals might also be government owner or non-profit, unlike U.S. hospitals that are a business and need to make money off of you.

Drugs sold in other countries are also often cheap knock-offs that aren’t protected by U.S. patents. Sometimes the drug companies will sell the drugs cheaper overseas to prevent knock-offs. They know they’ll make their R&D costs back in the U.S. and they know that folks in less wealthy countries can’t afford U.S. prices, so they’ll sell at a huge discount rather than not sell at all.

When you get your EOBs, note how much of those charges actually gets paid at all. Typically, it’s only a very small fraction. The astronomical stated charges are used for very obscure purposes (certain rare Medicare reimbursements used to be calculated via a formula that depended partly upon stated charges, for instance), but very few people pay those amounts.

It’s like with hotel rooms; the little sign inside the door stating the maximum possible charge for the room has little or nothing to do with what anyone actually pays for it.

All American health care is expensive; we have the most expensive care in the world (and quality of care is worse than most industrialized countries).

There are many reasons. One is administrative costs, which are 25% of health care (other countries top out at 10-15%). Doctors are paid more and drug prices are ridiculously high.

The people involved in giving the CAT scan are paid more in the US than in other countries. The machines themselves probably cost more.

Then there are insurance issues. Instead of setting a price for everyone, providers negotiate with many insurance companies. It may cost them, say, $2000 to pay all their expenses for a CAT scan, but Insurer A says, “We’ll pay you $1000.” Insurer A has 30% of the patients in the area, which means if you don’t agree to charge $1000, you don’t get them as referrals. So you bite the bullet and take that as payment. But that means you’re losing money on every scan. So you tell Insurer B, your cost is $3000. Insurer B is smaller and is willing to pay $2000. It helps, but you’re still in the hole. So you have to charge the uninsured a high rate to cover your costs (and profit, if you’re a profit-making hospital).

It’s actually cheaper to be uninsured at this moment in my life. I have supplemental insurance for accidental stuff and other things, so things like this aren’t unexpected.

Looking into the ACA/Obamacare options now.

When I was at the ER, I told the doctor all this so he assured me the rates would be “adjusted”. Riiiight… :rolleyes:

Still, even though I’ve been aware of ludicrous healthcare costs, seeing it all broken down on the bill just blew me away. I’ll be making a few phone calls come Monday…

I’m self-employed too. So Medical Insurance is astronomical for most sensible plans. I forget a lot of the details, but If I recall correctly, most of the deductibles were in the $1500 to $2500 range.

So, even if I were paying over $1k/mo for insurance, I may have had to pay out of pocket anyway.*
*Perhaps not for CT scans, they might be waived, but in other plans, perhaps not. What a mess and a sham this whole thing has become.

Here’s what I got once from a MRI facility.

The basic fee was $4,000. The Medicare Deduction brought it down to $600, of which I paid a 20% copay of $120. I asked if they really make uninsured people pay $4,000 for the same thing, and they said if the patient can pay in full right then and there, they give a 50% discount, and charge only $2,000.

In other words, they play fast and loose and charge whatever they can from uncompensated patients, and if insured, whatever the insurance company is willing to pay. It’s called Free Enterprise and we are proud of it.

OP, learn to live with your kidney stones I’ve had nine of them, and after the first couple, I never bothered to go to a doctor, I just endured it. All the CT scan can show is “Yup, there’s the stone”, and Rx pain killers don’t help at all.

The last one was 18 years ago, in a little mountain town in central Taiwan. A pharmacist gave me an envelope with one each of four different pills, within two hours I was resting comfortably, and I never had a bit of a symptom after that. My US doctor just shook his head and said “Boy, I sure wish I knew what was in those pills”.

Order some bulk ground Rosemary by the pound online, and sprinkle it into your food. It is a close member of the same family with para-para-y, a wild weed in Paraguay that leads people there to proclaim that nobody has kidney stone in Paraguay.

Except the people who have kidney stones.

It’s been reported that the incidence of kidney stones is lower in Central and South America and Africa compared to places like the U.S., Britain, Scandinavia, Mediterranean countries etc. But then are are loads of reasonable explanations (diet, genes and so on) that make a lot more sense than the Miracle Wild Weed.

Weirdly, while looking for info on the Paraguayan connection, I found a paper alleging that one factor in rising worldwide incidence of kidney stones may be global warming (if hot temps are such a compelling factor, then it’s a mystery why there isn’t more stone disease in Central America and Africa).

It’s very simple. Medical facilities charge what the market will bear, not what it costs them to run the equipment. How else can you explain the vast disparity in fees?

Sarcasm? It isn’t a free market because the medical providers are frequently a monopoly and they do not have to tell you how much something will cost ahead of time.

And why there’s plenty of kidney stones in industrialized nation where we have more than our share of air conditioning. Most people in First World countries spend, what, less than an hour a day outdoors when it’s over 80 and less than that when it gets over 90. They spend most of the year indoors at 60-70 degrees.

But, I don’t know how many more kidney stones people 3rd world countries have and I didn’t read your paper. Was it saying that Global Warming was directly causing kidney stones or indirectly causing it? I would guess directly, if you sweat more and you don’t replace the liquid, you’ll be more at risk for them.

You try herding enough CAT’S in one area to form a scan density cluster. :smiley:

Are you older and have pre-existing conditions? I’m 38, and a high-deductible health insurance plan with a corresponding HSA wasn’t all that bad. I had a $3500 deductible, with 100% covered afterwards (and an office visit copay of $20, IIRC), and it started at just under $100/month when I was 28 and finished off at around $240/month as of last year through a decent Blue Cross/Blue Shield plan (although I first started with United Healthcare.) Plus you have the tax advantages of contributing to the HSA, which ends up being another tax-deferred retirement account, if you want to use it that way. I finally switched over to my wife’s insurance this year after I was convinced that ACA–or at least the ability to get affordable insurance even if you have a pre-existing condition–wasn’t going to go away and that I was always going to have options. My fear for leaving my self-provided insurance, even though I had been married and had the option of going on my wife’s insurance, was that I find out I have a pre-existing condition and become uninsurable on my own.

There are numerous problems with health care costs. CAT scans are only one diagnostic.
According to this Forbes article, inflated health care costs are a problem that has grown worse as providers and insurers work together to compensate losses, medicare price controls, and inefficiency. All of it gets passed to the insured in the form of premiums and high deductibles.