How much should a shoulder MRI cost anyway? For reasons that I'll talk about below, my wife needed an MRI quickly, and the orthopedic surgeon she saw was pretty much unwilling to write a referral for one.

I set out to see what I could do, and started by trying to figure out how much a shoulder MRI would cost in the United States if we just didn't use our insurance at all. My wife's initial guess was $7,000. My guess was $2,000 - $3,000. Both of us think of medical pricing as quite opaque and somewhat random.

Finding MRI Pricing

The internet agrees with me, but fortunately there seem to be a few start-ups trying to tackle this problem. The first one I tried was New Choice Health, who require you to submit a form and get an emailed response. Initially I assumed that this was so some bot (or even person) on their end could send out emails and/or scrape other specific sites to find out the costs and aggregate them. After quickly getting the response email, it's pretty apparent that this is not the case. Now my best guess is that they went with this design choice to prevent their site from being scraped.

The first try was pretty much a jackpot though! New Choice Health sent back the following response:

Fair price less than $600! That was way better than I expected.

The Reality of Medical Shopping

Sadly they didn't have the prices of each of the locations, and that meant that I was going to need to call each of them. They also don't have phone numbers so I was off to start hammering through Google to find phone numbers and call each and ask each of them how much it would cost.

At this point I discovered three things:

First, all of the healthcare providers had phone trees that were absolutely disastrous Not once was I able to get the right department on the first try. "Press 6 for Billing & Pricing" and the nice lady says "oh no, you needed Press 4 for MRI Results, I'll transfer you".. Each is different and totally random. Often there were several other insane requirements. At one provider I had to make an appointment for the MRI, then they would tell me how much it cost, then I could cancel it.

Second, I didn't exactly know what I wanted... Did I want contrast? How many pictures, how many directions? I took a moment to go back to do a little research and figure that out. My wife is breastfeeding, so contrast (where they inject you with a bunch of dye) is pretty much out.

Third, pricing varied wildly, and was even stranger than I thought it would be. Some prices were around $1,000. One of them, which we ended up going with, was having a sale. Seriously, who has a sale on MRIs? Where do they advertise that? Given that pricing in general is so opaque, and people are generally tied to their insurance company why would this normally motivate people?

"Health Diagnostics - San Francisco" quoted me $200 flat because they were on sale, and I decided that was a hard offer to beat, and made an appointment for my wife.

Making the Appointment

Initially their Google Maps review of 1.7 gave me pause After reading the reviews, it became clear that the low rating came from billing issues (not relevant for cash payment) and one person complaining about traffic..

A slightly larger bump in the road was that they said they did need "Doctor's Orders", which we didn't have. The orthopedic surgeon had said he wouldn't give them because he didn't think that the insurance company would be willing to pay until we had been through 6 weeks of Physical Therapy.

But I had discovered another great little startup while I was looking for MRI pricing. Cirrus Medical Network seems to basically be an online doctor who will write you a "Physician's Request" for imaging for $50 The website has some of the worst UI I've encountered, including needing to sign up 3 times for different sections of the site..

So, $50 and one Medical History form later, we had our request. The turn-around was about 40 minutes, and the orders seem to have pulled my wife's name from her Email Address rather than from the forms we filled out on the website. They did however fix it when my wife submitted a request by email.

Why Go Around Insurance?

My wife has a condition known as "Frozen Shoulder", or "Adhesive Capsulitis". It's unbelievably painful, makes it hard to sleep, and pretty much impossible for her to care for our son. It also is a very weird medical issue, in that it seems to be a blend of a bio-mechanical and an auto-immune issue. In her case there is a pretty good chance it's also hiding a muscle tear underneath it. If that muscle tear is there, then Physical Therapy would be deeply problematic.

It seems that pretty much any doctor, osteopath, chiropractor, acupuncturist, or ayurvedic practitioner who doesn't specifically specialize in frozen shoulder gets a whole lot wrong about it.