Posts Tagged - ‘mri’

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When Health Insurers Pay For Overtreatment

Monday, June 7th, 2010

Image: Photos8.com

Overtreatment is commonly considered as health care services that are provided when they aren’t necessary. It has been criticized as one of the factors that made healthcare reform a serious priority.

For example, MRI scans are often performed on people with low risk. Since such tests aren’t completely accurate, some people have back surgeries that could’ve been avoided. Those individuals, whose conditions may have improved through other means, may then require more surgery in a decade.

Other examples abound, including the cumulative levels of radiation absorbed through a high number of CT scans–which is linked to increased risk of cancer. Affordable health insurance becomes harder to find due to this overspending. The worst part is that there have been few studies that determine which common procedures are needed and which ones could be scaled back without hurting health outcomes or creating fears of rationed care.

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Health Insurance Rates Go Up With Medical Imaging

Thursday, March 11th, 2010

(Image: anolobb under CC 3.0)

Medical imaging tests are an innovation that have helped many people catch diseases before they spread and improve their health. However, they have caused health insurance rates to skyrocket over the past two years.

There are several factors responsible for the 20% increase:

  • Investment in expensive new machines, such as digital mammography machines
  • More imaging tests being performed in hospitals, instead of cheaper freestanding clinics, which are up to twice as expensive
  • An increase in the number of tests performed by doctors
  • Hospitals substituting tests with higher reimbursement rates (e.g. CT scans) for ones with lower reimbursement (e.g. X-rays)
  • Hospitals increasing prices for the same treatments

Health insurance companies often require pre-authorization before paying for medical imaging, but they often pay high rates when it is approved.  They pay significantly higher amounts to hospitals that perform digital mammograms as opposed to standard film mammograms, even though the former have not yet proven to be more effective. Doing so encourages hospitals to encourage such tests, even when it may be wasteful.

The cost is then passed onto patients through their health insurance plans.

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