I recently had a test done at Lenox Hill Radiology, owned by RadNet, Inc. Prior to the test, I received a written estimate of $255.82 through my insurance company. We know this was an insurance-based estimate as my co-pay and deductible were listed. My actual bill was $290.71. The bottom of the estimate says “The amount owed at time of service is subject to change if services are modified or insurance is applied or updated.” In my case, the service and my insurance were not changed.
The difference between the estimate and the bill was 13.64%. I called Lenox Hill Radiology to inquire about the difference and how the estimate was calculated. Three agents weren’t able to give me a satisfactory answer. The first agent gave me the stock answer that “it’s only an estimate.” This isn’t going to fly for two reasons. First, Lenox Hill gives an exact dollar figure, with cents. It’s either calculated or looked up in a database. Second, when using insurance, the contracted rate for the service is known in advance. (This is the allowed amount column on an explanation of benefits form.) The third agent told me the estimate should have been the insurance allowed amount.
I am providing Lenox Hill Radiology this blog post, and requesting an explanation. I will update the post after I receive a reply.
Update: I received a phone call this afternoon from a RadNet employee. Her explanation for the discrepancy was that my insurance company’s computer sent Lenox Hill Radiology the estimate, and that’s the number they use. She seemed irritated that I would raise this issue over a small discrepancy. I explained to her that 1) it’s a matter of principle, 2) my error might be indicative of a systemic issue, and 3) for many Americans, a $35 or $40 surprise bill might mean the difference between food on the table and not. She offered her apologies and said she would make an inquiry with their insurance eligibility team to see what happened in my case.
Update 9/14/24: I browsed the BBB page for Lenox Hill Radiology. It has an F rating. A common theme of the complaints revolve around discrepancies between the estimate and the actual bill. My initial impression of the written estimate was that it was provided as a courtesy to the patient. I was very wrong about this. Its primary purpose is to give the patient advance notice of the full cost-sharing due at the time of service. Lenox Hill Radiology notes this in red above the estimate.
While I wasn’t asked for any payment at my last Lenox Hill Radiology visit, it’s a fair assumption that many patients are asked for payment upfront. I would appreciate if a Lenox Hill Radiology executive could explain their policy on which visits require full cost-sharing due at the time of service. Is it at the receptionist’s discretion or is this determined using an IT system?
Earlier this year I had a scan at Lenox Hill Radiology that was not billed through insurance, i.e., self-pay. This required an upfront payment in full. Incidentally, on that visit I needed to be refunded because the scan had to be postponed. This is yet another example of why consumers shouldn’t pay for goods or services before they are delivered.
Patients should note that collecting fees at the time of service above and beyond a co-pay is not a standard practice in the American healthcare system. It’s outright greedy, much like keeping a credit card on file. Dan Weismann wrote a very informative post about paying upfront. Under most insurance contracts, the provider cannot require advance payments, other than a co-pay.
