New Life Experience – The MRI

I had a new experience today.  At 7am I had my first MRI at the Boulder Community Hospital.  I was a little nervous, although I’m not entirely sure why.  I was in and out in 45 minutes – it was fascinating.

I hurt my lower back about five months ago (actually, exactly on March 13th at about 1pm at my parents house in Dallas).  I went for a two hour run and then took my dad to Fry’s for his birthday to buy him a new color printer.  As I unloaded the printer from the car, I lifted correctly, but then twisted left and immediately knew I’d screwed myself.  I rested a week and started running again in advance of a marathon in mid-April in St. Louis.  I had a great three hour run in Charlotte the first week of April and thought I was ready to roll.  Amy and I drove to Santa Fe the following weekend; when I got out of the car when we got back to Boulder I had enormous lower back pain.  I got a massage the next day (big mistake) and when I woke up Tuesday morning in a hotel room in Seattle I couldn’t get up off the toilet, nor could I completely straighten up.  Four weeks of rest and three months of intermittent running with regular recurrence of back pain in the same spot after a few days caused me to finally decide that I’m hurt and need to figure out what’s going on.

Boulder is fortunate that it has a great community hospital system.  There are plenty of new facilities and the people are very nice.  I checked in and got my paperwork.  It was already completed via my doctor’s referral.  The charge for the MRI was $3,696, my insurance plan allowed $1,078, and there was $0 co-pay or money owed by me.  I was completely stunned by this – I expected to at least have to pay a $20 co-pay.  The entire billing / checkin thing took about as long as it takes to checkin on FourSquare.  I pondered where the difference between the $3,696 and the $1,078 was coming from, or whether it simply vanished into the ether.

I went to the Imaging Center with my Dark Side of the Moon CD, ready to chill out in a tube.  I changed into hospital scrubs and was escorted to the MRI machine by a lovely nurse who talked me through everything.  The machine I was in didn’t have a CD (it had an MP3 player) but my head was in a cradle that wouldn’t fit the earphones so I punted on the music.  I got a little “panic thing” to squeeze if I freaked out and then went into the tube.

I basically had a noisy 20 minute shivasana.  They did six scans, most between three and five minutes.  The noise was loud, but rhythmic.  I had earplugs so it was more like a weird electronica thing.  I did my share of isolation tanks in college (I went through an isolation tank phase) – this was much shorter, much more comfortable, but much noisier.  As is my practice with shivasana, I dozed off near the end.

They pulled me out, I walked down the hall, and picked up a CD with my scan on it.  The software is pretty ancient, doesn’t run on my Mac, but worked fine on a PC.  I have no idea what I’m looking at – well – other than my lower back and pelvis region with all the ensuing pieces – but it’s pretty amazing to look at and ponder.

It’s fun to be a human, even when you are hurt.

  • I love that you had an isolation tank phase. I had a friend in college who used his entire bedroom to house his own personal tank, keeping his bed in the living room. It frustrated me that he wouldn't let me try it out, until he admitted that it was because he had herpes. I didn't ask again.

  • The $3696 is the cost to an uninsured patient. The $1078 is the negotiated rate between the hospital and your insurance. Your co-pay was probably paid at the doctor when you got the referral.

  • For the Mac there is a great medical imaging viewer software available called OsiriX. You can find it at: This is what most radiologists use on the Mac and should help you to look at the medical images on your Mac.

  • John Minnihan

    Medicine & medical technology is amazing.

    I recently visited the ER at the new(ish) Sky Ridge Medical Center in Lone Tree (twice in 1.5 months, I'll bore you why another time). The facility & all the equipment is brand new and the folks there can, I imagine, handle just about anything thrown at them.

    While an emergency room isn't exactly a soothing place, I'll note that this is by far the best one I've ever visited & I actually felt comfortable there.

    Oh, and my visit was $9600 each time. I'm generally a healthy guy with [normally] low annual expenses, so my yearly deductible is $2000. I paid that against the first visit, met the deductible and got the second one more or less free. (it was a two for one…)

  • John Minnihan

    WRT the uninsured – I'm now forced to alert any health care pro at the beginning of an interaction w/ them: "I have asthma, but don't write that down. My insurance co won't pay any claims related to that. If it's in your notes – at all – they'll deny the claim."

    I fired my last doctor because of this, by the way. This is how awful the system has become. The new law won't help me until 2014, and admittedly, I'm not significantly burdened by it. But it is horrible practice of insurance cos that I'm pleased to see has been made illegal.

    • Steve Bergstein

      I'm surprised, John, that you'd put that in writing in a public place, with your full name associated with it. Is there any risk that your insurance company could find it and use it against you?

      • John Minnihan

        I do what I mentioned when the visit has nothing to do w/ asthma. If the visit *is* asthma-related, I know that the insurance co. won't pay the claim, so I don't even mess w/ it.

        My former doctor got into the habit of coding my visits as asthma-related, even when they weren't and after I specifically told him to not do so. I have no idea why he (or his front office) did this. But when it continued after I specifically discussed this w/ them, I fired him. And I told him why.

        So No – I'm not the least bit concerned whether anyone associated w/ my insurance co. reads this. I simply now make sure that any health care pro *knows* I have asthma in case it affects the treatment plan, but if it isn't related to the visit (i.e. "I broke my thumb when I crashed my motorcycle"), then it shouldn't be in the notes.

        Making it illegal to deny coverage based on pre-existing conditions is perhaps the single greatest benefit that will come out of the recent bill. Young adults under 19 get relief under the law in September, but it doesn't kick in for everyone else until 2014. Till then, I have to manage my own MIB.

        Sucks, but that's how broken the system is today.

  • Max Lybbert

    It's always bothered me as well that the uninsured get a bad deal. But of course that's what happens when insurance companies hire people to negotiate on their behalf and write contracts before patients show up. And those contracts generally require that if any insurance company gets a lower rate for a service, then other insurance companies get that lower rate as well: i.e., all insurance companies get the same, lowest, rate (or, put another way, the insurance companies effectively piggy back off of each others' negotiators).

    • Max Lybbert

      Somehow half my comment disappeared.

      "I know from experience that it's impossible to negotiate a lower rate with a provider *after* service has been rendered. Once service is rendered, you're on the hook for the full price. I suspect it would be possible to negotiate a lower price *before* service is rendered, but I haven't had any more opportunities to try that.

      • Bill

        Hospitals will very often negotiate after service is rendered. Just call them and talk about it.

        • morganwarstler

          If you are carrying an HSA policy, you shop around even more – looking for the MRI priced below what your insurance will cover, because you keep the difference.

  • MVB

    Hmmm. I've never read much discussed about the medical insurance side of running/funding a startup, but it was a significant cost and issue when I was running mine. I'd be interested if the subject of insurance ever comes up in all the startups you are involved in and how it's handled? Perhaps twenty somethings just don't get sick or worry about catastrophic medical events?

    My fat-cat corporate insurance is long gone. So I, like most other people I know, have a catastrophic only, $6k deductible "insurance" plan that pays ZERO unless I get hit by a truck, end up in cardiac arrest, or have a stroke from the pressures of running a startup in the first place. That means my MRI was about $4k too last year, except I paid cash out of my pocket for the $1k "negotiated rate" just because I had "an insurance card." And just this week, I paid the full $6k out of pocket yearly deductible (gladly) to cut the broken pieces of meniscus out of my knee so I could walk. Oh, and because of the high deductibles, my surgeon (who I've known for 10+ years) required payment upfront because so many people can't/don't pay after he performs their surgery due to these high deductible plans.

    I just feel so lucky I can afford to pay and now I can walk (yes, and maybe even snowboard this season). I don't know what I would have done if it had happened to one of my previous start-up employees. I guess I would have found the money for them from somewhere, as I would have felt so guilty that our company didn't have great health care coverage. Like Startup Visa, maybe there needs to be a startup medical health plan group pool.

  • ben

    RE: where the difference between the charged amount and the insurance plan's allowed amount, I would guess it just vanished into the ether.

    I used to work at a retail health clinic and we would have a "retail" price for all of our services, but if the insurance plan had a lower allowed amount, the price was simply changed. It was more important for the insurance claim to be processed and paid than it is to get the full amount.

  • Kelly Taylor

    My back pain struggle that began after a run at the Glue Conference this year was due to overly tight leg muscles from a lack of stretching and skipping yoga classes. My doc recommended constant stretching which I do throughout the day now and things have gotten better over time. Good Luck man, I know it sucks.

  • If only I'd had another friend with a tank! Who knows, the opportunity may arise again. Hm.

  • StartupTrekTV

    I worked on a nuclear MRI imaging venture at Bell Labs in Holmdel for a short period back in 1986 – went to the conferences, etc At the time GE was the market leader, and some guys at the Labs organized an "intrapreneurial" venture to tackle the remote imaging problem. Doctors didn't trust remote electronic MRI or X-Ray images at the time, no matter how how the resolution – they wanted FILM! 🙂 The technology was already incredible by then – I can only imagine how much it's advanced in the past 25 years.

    Best of luck with getting the back squared away.

  • John May

    BRad – Just had a similar experience with the MRI thing. However, mine ended up resulting in taking out two discs in my neck (No wonder my arm felt asleep all the time for the last two years) and surgery thereafter. Had a great Neurosurgery doc if you need. Walked out the next day without a brace or anything. Feeling pretty good.

  • I hope you're going to Dr. VanBuskirk at the BMC – she's the best. Also, Mike at Physiotherapy associates is the best PT guy for lower backs in Boulder. Doing Quandry Peak this morning and I'm sure I'll need to see her later in the week!

    Hope you feel better.

    Dave Schwartz at Return Path

  • Steve Bergstein

    Getting older sucks, Brad. As we've discussed a few times, I've had a number of issues that required medical attention – I have an appointment with an orthopedist on Tuesday. I've avoided surgery so far but I don't know how long that's going to last.

    Good luck with the back – I was diagnosed with a couple of bulging discs (through MRI as I recall) a few years ago.

  • Mark Montgomery

    Hello Brad,

    My wife had to have an MRI a few years ago and we didn't have insurance at the time, so I worked some basic consumer magic, finding one of the best in the region– according to both her Neurologist and independent research, for less than half the cost of average. The range quoted if memory serves for a very specific brain scan was between $1800 and $6000, which was only one of many experiences that demonstrate room for value improvement in what is widely considered to be among the most dysfunctional markets (least efficient doesn't seem to quite describe the phenom). A lot of room for disruption in HC, and badly needed– .02–MM