Patient Faces High Out-of-Pocket Costs for Preapproved MRI
Stephanie Halver of Vancouver, Washington, was surprised by a $1,205 bill after her insurer preapproved an annual breast MRI. Despite the approval, she ended up paying nearly all of it—$1,191.10 out-of-pocket—after insurance covered only $13.90. The procedure wasn't classified as preventive care under her employer-sponsored plan and was applied to her deductible. The issue stems from self-insured workplace health plans, which are regulated at the federal level rather than by state laws. Washington requires insurers to cover breast MRIs for high-risk patients like Halver, but this protection doesn’t apply to self-insured employer plans. This loophole leaves many Americans without key consumer protections. The case highlights broader issues in U.S. healthcare costs and coverage gaps. In 2024, average out-of-pocket health spending per person was $1,632, with deductibles averaging $1,787 for single coverage plans. Medical debt remains a significant problem, with Americans collectively owing at least $220 billion.
