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Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200. | The Philadelphia Inquirer

Michelle Smith knew the breast MRI her doctor ordered wouldn’t be covered in full by her insurance, so she turned to an online tool that her insurance company developed to help patients estimate prices.

UnitedHealthcare’s price estimator told the 51-year-old Delaware County resident that the cost for the procedure in her area ranged from $783 to $1,375.

Health-care costs are difficult to pin down because prices vary widely and are part of confidential agreements between insurers and providers. But in response to growing demand from patients spending more out of pocket than ever before, insurers and even health systems are investing in price estimator tools that claim to offer at least a ballpark price. Still, the tools have been slow to catch on, in part because they’re clunky and, as Smith learned the hard way, not always useful.

Little did Smith know that the imaging center at Riddle would cost her twice as much because the center is based within the hospital, as opposed to a separate building across the street.

Services provided in a hospital are often more expensive because the price includes fees for the administrative and operating costs associated with running a hospital, Megan Call, a spokesperson for Main Line, said in a statement.

When asked how a patient could have known which of the six imaging centers are billed at a hospital rate, Call said patients should call Main Line’s price estimation team for help.

“We do acknowledge that billing and insurance reimbursement issues can be difficult to navigate. As such, we are committed to price transparency and giving our patients the tools they need to make informed decision about their care,” she said in a statement.

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Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200..

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