My insurance plan only requires me to pay the copay if a diagnostic imaging is done during a doctor’s visit. But if I’m referred to a different facility for the imaging, I have to pay both the deductible and coinsurance, which is way more expensive. Why does it work this way? Does going to a doctor’s office or larger hospital that offers imaging help save money?
Anything billed through a hospital is generally expensive. There’s a big issue with price hikes when it comes to hospital systems buying up independent imaging centers that used to offer cheaper services. Now, they bill under the hospital, and prices can go up by 3x.
If you see a doctor with an office in a hospital, you might get charged for the office visit and a facility fee on top of it.
It’s common for insurance to cover just a copay for a doctor’s office visit, but for hospital-based services, you’re often out of pocket for more.
There are a few ways this could play out, so it might help to call each facility and get an estimate after they verify your benefits.
In my experience, I’ve had to pay separately for both the visit and imaging, even if it’s in the same office, like with my recent Cigna PPO visit.