A CT is a high-tech scanning tool doctors use to help diagnose illness and monitor treatment effectiveness. The CT scan creates highly detailed images of a patient’s bones, muscles, and internal organs. CT images can be used to examine any part of the body. CT scans are performed in hospitals, outpatient imaging centers, or medical offices. The price of a CT scan can vary by thousands of dollars, so it’s important to know if your insurance will cover the cost of a CT scan.
Most hospitals and standalone imaging centers—especially facilities in your insurer’s network—do take health insurance for CT scans. However, other insurance policies may influence whether or not your health insurance will approve the scan at all.
Insurance companies reserve the right to decide whether or not any procedure is medically necessary. Most insurers require what’s called a “medical necessity review” for all CT, MRI, and other imaging requests. The companies use these reviews to decide whether a given test is both appropriate and essential. They make these determinations based on three factors: the policies and clinical guidelines of the patient’s health plan and the overall standard of care. For example, suppose your primary care practitioner prescribes a breast MRI for cosmetic surgery, or an abdominal CT to strengthen a worker’s compensation case. In that case, it isn’t always deemed medically necessary and might not be covered. The safest (but not always the easiest) way to see if your test will be covered is to ask your insurance company.
If your insurance doesn’t cover your test or if you don’t have coverage in general, getting the best out-of-pocket price for a CT scan isn’t always easy.
Medical imaging is generally expensive, with or without insurance, and the price range can be wide between providers. A CT scan can run anywhere from $225 and $3,000, for instance, according to Healthcare Bluebook. When a CT scan is approved as medically necessary in the review process, the insurance will usually cover it. Still, patients typically will have to meet their deductible before the insurance covers the cost. In that scenario, you not only may have to pay the full cost of the MRI if you haven’t yet hit the annual deductible—you might also end up paying a higher price than normal depending on the pricing negotiated with the provider by your insurer.
To lower your out-of-pocket costs for expensive medical imaging procedures, including CTs, it pays to do advanced research to find pricing that works for you in the same way that you try to choose the best facility and radiologist for your needs.
A study found that patients who know how much a medical procedure will cost will save money on healthcare overall—presumably because they choose the lower-priced practitioner. The National Bureau of Economic Research found that: “patients often received care in high-priced locations when lower-priced options were available. Fewer than 1 percent of individuals used a price transparency tool to search for the price of their services in advance of care.”
With Medmo, it’s even easier to compare prices. Instead of guessing the bill (and praying there isn’t a huge surprise) or spending time cross-checking centers with insurance and availability, patients can just tell us the price they can afford. We will even tell you whether there are cheaper payment options outside of your insurance, such as cash pay discounts. To book a scan, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests – such as MRI, CT scans, PET, and more – at nearby accredited centers and identify the payment solution that works best for them.