When the doctor gave me the scripts, he advised me that there was a good chance that one or both would not be covered by my medical insurance.
With that caveat, I decided to make some calls to schedule one or both of the tests but to also determine if my insurance covered them, and, if not, what the cost would be without insurance.
My first call was to the imaging and radiology number referred to by my doctor.
Upon connection, I asked about scheduling a coronary calcium test. The customer service representative asked for my address, then told me that the closest imaging center in their system was 40 miles away. As it turned out, it was in close proximity to a specialist whom my wife will see in January, so I made an appointment for that same day figuring we could kill two birds with one stone and have lunch somewhere in the area. Make a day of it, so to speak.
I then asked the rep if she knew what it would cost for this service, as she had already been able to determine that my insurance would not cover for it. She said no, but asked me if I could hold so she could contact the billing office and ask them. When she returned to the line, she told me that I would need to talk to someone in the financial estimate office, and then transferred me to that person.
Also a woman, this rep was very helpful. First, she told me that the cost of the test depended on which facility I went to. The one I had chosen, which was the closest to me, would charge me $336 for the test. However, there were cheaper options within their system, although a bit further away. One such option, in center city Philadelphia would only cost $129. When I asked why the big discrepancy in prices, she could not provide a reason. Since I have recently obtained a free senior Septa pass for travel on their rail and bus and trolley lines, I thought it might be nice to go into the city for a day, and spend some time seeing the sights after the test. Certainly it would be cheaper than the $217 difference between the two sites for the same test, and, again, could be a nice day for myself and Nora.
Since this rep seemed so knowledgeable, I asked her about the second test, for the peripheral vascular issue. She informed me that this was merely an ultrasound, and that my insurance would certainly cover it. She also suggested I call the insurance company (in retrospect, I probably should have called them first), and they would be able to refer me to the nearest testing facility for this test, and not be restricted to her health system, the thought being that there would be a closer provider in network but with a different provider. She also recommended that I google calcium score test near me to find a local provider since it didn't matter where I went being that my insurance wouldn't cover it. Then, if I found a more local option at a similar price as with her system, I wouldn't need to travel at all. This impressed me as she was clearly helping me first, not just her employer.
I then called my insurance company, and indeed found that the coronary test would not be covered (as I now expected), but that the leg ultrasound could be provided by an imaging facility about five miles from my house. I wrote down the address and phone number.
I next called the local imaging facility but was told that they stopped doing ultrasounds a year or so ago. Close but no cigar.
I called the insurance company again, told the rep that I had contacted an imaging provider to schedule an appointment but was told they didn't provide that service anymore, suggested he (this was the only male I encountered in this journey) adjust their referral list, and asked for another provider. He gave me two, one closer than the original suggestion, one a bit further but still relatively nearby. We strayed from the topic of my call a bit, touching on the recent election, but also on the changes that were coming to Medicare, specifically the new premium and deductible amounts. At first, he only knew the deductible change (from $240 to $257 per year) but by the end of the conversation he also informed me that the monthly premium would be rising from about $174 to about $185.
At this point I had been on the phone with these various reps for about 90 minutes, but I had learned some valuable information, both about how locations, even within the same health care system, charge different amounts for the same procedure, but also that there are people who want to help patients navigate the system, if you spend the time asking for help.
And most importantly, I was reminded that one must advocate for oneself (or family member unable to do for themselves) when navigating the health care system in America. Just as it is important to get a second opinion on any invasive procedure or surgery, it is critical to confirm information about where to go for care and what it costs, and not just assume the first response is the full truth.
I have posted numerous times under the topic Health Care, but oddly not since 2019. Here are links to the more recent entries. The third one I added because of the fear that Trump and the GOP will once again try to eliminate the Affordable Care Act.
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