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Example B - Switching Facilities 

Selma gets a 3D Mammogram that is read by an "in-network" clinician and she pays $0 upfront. 


Unfortunately, Selma has a mass that needs further study, so she needs to get a Diagnostic Mammogram, but now... she wants this exam to be read by a Breast Fellowship-Trained Radiologist, so she then returns to KBC to have KBC "re-read" the images taken at the "in-network" facility.  

  • She probably won't meet her deductible yet, so she wants to reduce "out of pocket" costs, which are less at KBC 

  • KBC charges $180 to re-read another facility's images (so that needs to be considered as well). ​

    • Selma's Screening Mammogram images have to be transferred  to KBC, which could further delay her diagnosis.


Selma then needs a Biopsy:


Total Maximum Cost =  $2,000

  • Which was below Selma's deductible... so all of this is "out of pocket".

  • If Selma did not switch back to KBC, she would have paid more than twice that cost (at least).

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