High Out-of Pocket for a Simple X-Ray?

I have an 80/20 plan. My son had a wrist pain and our PCP suggested to get an xray done. I have got an x-ray bill and I have to now pay some $500. The x-ray rates are atrocious (something like $300 for wrist xray) , $300 for elbow etc. so my insurance will pay some $100 and I will have to pay the rest (I have $500 individual deductible). Is there a way that I can negotiate with the provider to get it down. I feel the charges are ridiculous. Note: I will definitely not qualify for the assistance etc.

Insurance Pickle.com

Not if they're an in network provider. They're obligated to charge the negotiated fee.


New year just started This sounds like the deductible


You can always talk to them to see about getting the cost down. It depends on your provider though. Just remember that you pay so much out of pocket b/c your month premiums are lower than if you had most of your visit covered. For me, it's a choice I get to make at each open enrollment. Do I pay more out of each paycheck and maybe not use all the coverage, or do I pay less and have to pay out of pocket if something happens (and know that unless multiple things happen I'm still ahead of the game)?


It's a new year. Sounds like the deductible.


A way to negotiate? Sure. A way is to call or visit them and negotiate the charge.


Your son had (2) xrays, each costing $300 apiece, thus the total was $600, thus your insurance paid $100 and you paid the balance of $500 (your deductible). But with a 80/20 plan would mean that insurance would pay 80% and you pay 20%. So at 80% of $600 means that your insurance would have paid $480 and you would have paid $120. But (until) you have paid out of pocket your deductible of $500, then insurance pays nothing. They still can negotiate the contract rate. Most providers won't negotiate on the rates, but will allow you to pay it back on payments. When people who have (no) insurance, then many providers charge much more, since there is no contract, thus they charge whatever they want. You think that is high, just last month got kidney stones which is awful and extremely painful. I went to the ER for the (1st) time in my entire life (age 65) and had a CT. When I saw the bill the CT was $3,200? The ER was about $3,000 (huh). The costs for medical care or tests are through the roof, and luckily you had insurance.


Possibly, but probably not now that you've already had them submit it to your insurance. In some cases, dealing with insurance companies is over half the cost of providing medical care. You can negotiate a much better deal if you do it up front, before getting the services, and just pay the provider yourself, without having them bill your insurance.

Steve D

Probably not. But start by looking at yur EOB (explanation of Benefits) - you should see a few different numbers - the charge itself, the negotiated price (between your insurer and the provider), your portion, etc. My guess is that your plan has negotiated an x-ray price of $250 per x-ray (which adds up to $500 for two x-rays) which is your portion since you have not met your deductible (the $500). Your 80/20 does not kick in until you have fulfilled your deductible. $300 for an x-ray is not out of the realm of possibility (especially if you took your son to an urgent care of ER). As for negotiating, it is unlikely for a number of reasons - most importantly the provider has a contract with your insurer to accept whatever amount has been negotiated (which down the road works in your advantage since you will be the co-beneficiary of any future charges since your part of the price will be discounted), The provider is not going to give you a further discount now and then again the negotiated discount down the road for other service. You may be able to negotiate a payment schedule which will stretch your payments over say 6 months which will make it easier to pay compared to one lump sum payment.


@Casey - Yeah. Anyway out ?

Casey Y

Sounds like you were paying the deductible... Accepting less would put the provider in violation of their contract with the insurer...and they will get paid less anyway.