Mississippi man refuses CT scan until confirming insurance coverage — then gets hit with $3,878 bill

A Mississippi man went to a clinic at North Mississippi Medical Center-West Point due to intense back pain. After a urine test revealed he had kidney stones, a physician recommended an abdominal CT scan to confirm the diagnosis and size of the stones. The test cost the man $3,878.25, or 11 times more than it would have at an outpatient clinic, according to the Clarion Ledger.

Here are five takeaways from the report:

1. Jimmie Taggart was taken aback by the bill, as he first refused to undergo the CT scan until NMMC-West Point confirmed his insurance would cover the test. While his Aetna high-deductible health plan did cover the CT scan, Mr. Taggart was charged $3,878.25 because he had not met his $5,000 deductible.

2. A Clarion Ledger analysis found NMMC-West Point billed Aetna $5,171 for the CT scan. Aetna's negotiated discount with the medical center was $1,292.75, leaving Mr. Taggart on the hook for an allowable amount of $3,878.25.

3. This is more than 11 times higher than Aetna's allowable amount of $338 for the same test at Columbus Imaging Center, an outpatient diagnostic clinic roughly 30 minutes by car from NMMC-West Point.

4. Mr. Taggart has refused to pay NMMC-West Point's bill. His attorney, Tim Hudson, argues Mr. Taggart only agreed to the CT scan after hospital staff told him it would be covered. However, the hospital later told Mr. Taggart it does not verify whether a patient's deductible is met.

5. NMMC-West Point did not respond to the Clarion Ledger's request for an interview. Aetna declined to comment on why a CT scan costs significantly more at NMMC-West Point than at the outpatient clinic, citing confidential negotiations. NMMC-West Point is part of the Tupelo-based North Mississippi Medical Center system, which own 50-plus hospitals and clinics, providing the medical center more negotiating clout than an outpatient diagnostic center.

More articles on healthcare finance:
Parents charged $15,666 trauma fee after baby takes nap, drinks formula in ER
60% of Americans 50 and older have tried to avoid or minimize healthcare costs
CMS to terminate Idaho hospital's Medicare billing privileges

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Featured Content

Featured Webinars

Featured Whitepapers