Thread by @AdamWeinstein

Them: Your copay for the CT scan will be $500

Me: Whaaaat? No way. Who'd you talk to at my insurance?

Them: ...

Me: What's the cash self-pay rate, if I don't use insurance?

Them: Uh, $300

Me: ...

Me: So the CT scan is $300 if I self-pay, but $500 if I use my $500-a-month insurance?

Them: ...yep

Me: Okay I guess I'll pay cash then

Them: Fine. But the radiology charge will be separate, and I don't know what their self-pay fee is

Me: Can you find out for me?

Them: ...

Them: Okay here's the number for radiology to find out their self-pay fee

Me: Wait, while you had me on hold I checked my plan info...

Them: ...

Me: It says my CT scan copay should be $300, not $500

Them: ...

Me: So... can you call my insurance

Them: ... [sighs] Fine, sure

Mind you, this is all about an hour after my ENT's office called my insurance to get the CT scan approved, then called me back and said it would cost me $100. But maybe that's just the radiology fee? WTF?

When I asked why my insurance copay on this CT scan was more than a cash self-pay rate, I was told that the self-pay matches the best negotiated rate, i.e. the Medicare rate. So... why don't we all just have Medicare, again?

Them: So, two separate reps from your insurance told me it's *actually* gonna be $500 for this CT scan, *plus* a 50% coinsurance

Me: So... you're actually not in my insurance plan, is what you're saying?

Them: ...Yes?

Me: Kthxbai

Me: Dear insurer, can you please help me find a CT scan imaging co that's in my network?

Them: Sure. So you know that's a $400 copay, right?

Me: My plan info here says $300.

Them: Is that 2020 plan info?

Me: I mean, your website gave it to me! So it's [looks] ... from 2015

Me: Dear insurer, why is your copay on my plan $100 more than the self-pay rate for a CT scan?

Them: We can only vouch for our negotiated rate. That's why I tell people, if self-pay is cheaper, don't use the insurance.

Me: ...

Them: ...

Me: That's...

Them: ... I know, right?

Me: So I guess the place I'm scheduled for -- Broward Health Imaging on Andrews -- isn't in plan, since they say it'll cost $500 plus 50% coinsurance, so can you please send me a list of in-network providers for this CT scan?

Them: Sure thing, we'll email it

Me [opens email]:

At this point I'd just pay 300 bucks for a thickly accented Austrian to tell me "Eet's naht a tumor"

Me: Dear insurer rep No. 2, can I get an in-plan CT scan at Broward Health?

Them: Well, they're in your plan

Me: Great!

Them: Buuuut they'll bill you as a hospital outpatient, so you're on the hook for coinsurance, let's find you an independent in-plan imaging office

Me: ...

Them: Whoa did someone tell you a CT scan would be $100?

Me: Yes! My ENT, when they got approval from you guys for the imaging

Them: Yeah no, $100 is for *X-rays*. Which *also* means your *CT scan* is not approved. Whew, good thing you didn't go to that appointment!

Me: ...

Me: So why should I do this for a $400 insurance copay and not just self-pay $300 around the corner?

Them: The copay covers everything at an approved imaging center. Does the $300 self-pay, or is radiology and disk space extra?

Me: I... dunno?

Them: Me neither, I'm just asking

Upshot: Scheduled a CT on Monday with someone in plan that I have been told is insurer-approved for $400. And I got this far *only* because I'm an insistent asshole with time on his hands who's been professionally trained to listen carefully, take notes and ask pointed questions!

Update to this thread: A journalist contacted me for additional thoughts on my (pretty standard, really!) situation, and on US health care in general. Sharing the latter here for max visibility.