In a discussion about the insurance hassles associated with ordering CAT (Computerized Axial Tomography) scans for patients with sinus disease, one of my ear, nose and throat partners told me the other day that he “doesn’t answer the phone from ‘800’ numbers and won’t call ‘800’ numbers.”  This is exactly what one insurance company, in particular, demands.  The ordering physician must call an “800” number, wait on hold until another physician comes on the phone (usually one speaking broken English) and justify the scan…basically ask permission for the scan to be “approved.”  

Let’s look at the effect his refusal has had on sinus CAT scans here in Oklahoma.  First, more physicians are refusing to jump through the insurance hoops to gain “approval” for these scans.  The patients need a CAT scan, but are insured by a company that has made the hassle too great with these doctors.  Large numbers of patients that are motivated cash buyers are looking for a reasonably priced CAT scan since having this insurance has actually prevented them from getting a scan!  Behold a market miracle!!  A bunch of doctors happen to own a CAT scanner and with  the demand for affordable scans higher than ever (with the “insured” essentially “uninsured”)……they are now offering sinus CAT scans (including the radiologist’s fee) for $150!   You can look at my blog about what a CAT scan at a “not for profit” hospital costs here.  

His decision to “not play the insurance game” resulted in a rationally priced CAT scan to make an appearance in the community.  How many times do we need to demonstrate that the absence of insurance is necessary to reveal true costs and result in rational pricing?  How many times do we need to demonstrate that “coverage doesn’t mean care?”  Relying on coverage in this case actually guarantees no access to a CAT scanner. 

“What about the poor, ” you scream!!!?  Here’s my answer:  the “not for profit,” “critical access” hospital down the street charges $4400 for a CAT scan.  These greedy doctors are charging $150.  Isn’t the logical flaw obvious in mandating that everyone have insurance?  $150 is a price that almost anyone can afford.  No one benefits from market forces more than the people who couldn’t afford something right before the market took over.  They’ll be able to soon enough.

I am giving some thought to offering sinus surgery on our website at the current price, that includes a CAT scan if the patient needs it.  At $150, these doctors are almost giving it away and yet…..they are making a profit.  How do these prices come about?  The profit motive, the absence of government interference, physician ownership and the absence of third party, insurance distortion.  Oh yeah. No “charitable hospitals.” 2014 and the full implementation of Obamacare better hurry up before information and stories like this becomes widespread.  

G. Keith Smith, M.D.