Most employers do not question imaging costs.
An MRI is prescribed, the employee schedules it at the nearest hospital, and the claim comes through at whatever price the hospital charges.
That hospital-based MRI just cost your plan two to four times more than the same scan at an independent facility, using the same machine and delivering the same diagnostic quality.
What Your Broker Is Not Showing You
Hospital-based imaging centers charge facility fees on top of the procedure cost, while independent imaging centers do not. Both use the same FDA-approved equipment and have their results read by board-certified radiologists, so there is no quality difference between them.
However, your plan absorbs the inflated hospital pricing while your employees pay higher deductibles. Your broker likely never mentions it because steering patients to lower-cost facilities takes work.
Unfortunately, most brokers push the easy button. They negotiate a lower increase and call it a win. Meanwhile, every MRI, CT scan, and X-ray ordered at a hospital quietly drives your plan costs higher without improving care.
Here Is What This Looks Like
A company with 150 employees was spending over $2 million annually on their health plan. Their broker told them the 9 percent increase was “competitive for the market.”
We reviewed their claims data and found that hospital-based imaging was one of the top cost drivers. Employees were getting routine MRIs at facilities charging $3,500 when the same scan at an independent center cost $850.
We implemented a plan design that incentivizes independent imaging with lower copays for employees who use high-quality, lower-cost facilities. The communication was clear about where to go, and the process was simple.
The result was imaging costs dropping by over $100,000 in the first year while employees got faster appointments. No reduction in quality, just better use of their benefits dollars.
The Math Is Simple
Hospital MRI costs between $2,500 and $4,000, while independent imaging MRI costs between $600 and $1,200. The same scan with the same quality comes with a drastically different invoice.
If you are not directing your employees to independent imaging facilities, you are funding hospital markups for services that do not require a hospital. Your broker should be showing you this, and if they are not, ask why.
What to Do About It
Start by asking your advisor how much you are spending on imaging, where employees are going for scans, and what the cost difference is between hospital-based and independent facilities.
If they cannot answer those questions with your actual data, that is a problem.
High-quality care does not require high-cost facilities. Your employees deserve better access to the same diagnostic services without the inflated pricing, and your plan should not be subsidizing hospital costs for routine imaging.
DM me for more information.