So, according to the ACA, preventive screenings, including colonoscopy, are supposed to be covered with no cost-sharing to the member.
I now have a $900 bill that would indicate otherwise. Apparently insurance companies think that the only part the have to cover with no cost-sharing is the fee from the physician for actually looking up your bunghole, but that the facility charges, the anesthesia…they can pass those right on to you with no problem.
Obviously this is not what was intended by the law, but finding the relevant sections of it is proving difficult for me. I’m also trying to find out if there have been any lawsuits centered around this issue, as I’d be really interested in heading one up.
So my questions are 2:
Can someone help me find the relevant sections of the ACA that discuss this?
Have there been lawsuits filed trying to get a more favorable result for the patient?
I have also read situations where the hospital where you get the testing done accepts your insurance, but the anesthesiologist is not technically part of the hospital and is not covered by your insurance. Thus you get a huge bill for the anesthesiologist.
While that’s true, usually if you call the practice or the hospital the bill goes away.
My son ended up at the hospital ER after an assault and needed a lot of stitches on his face, so we called in plastics to the ER. The hospital took our insurance, but the plastic surgeon didn’t, in his private practice. We received a bill for over 15K for his services. However after receiving our (much lower) insurance payment, since he was working as an agent of the hostipal ER, they accepted that as payment in full.
Anytime I have anything done in a medical setting, I ask about $$$. When I had a stent placed in a coronary artery two years ago, they brought my morning meds to me as I was checking out to go home. I asked about price, then declined the three pills, saving $55 by waiting 90 minutes until I got home.
I believe some sort of sedation is commonly used. I think it was propofol the last time I went. You may be in the minority with having nothing administered.
Last time I went, I think it was, I got a fat bill and called the doc. Apparently the law pertains to the exam itself only, but one of the polyps or whatever they removed appeared suspicious to them and they sent it off for biopsy. Which meant my preventative checkup now moved into a diagnostic realm, which cost me money. I appealed, to no good result for me.
Call your insurance company about the charges. I had the same thing happen this year, and my insurance company immediately straightened it out and had my cost removed. It all comes down to the codes entered by the providers.
This also happened to me. I had to pay for the pathology charges, but not the colonoscopy itself. That’s the way it’s supposed to work. A pathologist isn’t part of the colonoscopy procedure.
I believe here there may be a difference between UK and US practice. When I had an endoscopy (UK), I was offered mild sedation or a simple local anaesthetic - the latter of which they strongly recommended. Whereas I think in the US, they vere more towards sedation.
When my sister had [planned] surgery, after all the expected bills, she got another one for $900. My dad called and asked about it and was told that was for the surgical assistant in the room and presented him with her signature okaying the presence of the assistant who literally sat in the corner and did nothing at all. It took her a day or two to even remember signing the paper. When her memory about it came back, she recalled being asked about having an assistant (that worked for the doc, not the hospital) on hand in case something went wrong. Not sure what to do and literally on the way to the OR, she signed off on it.
My dad got the fee reduced (or waived) when he explained that you really can’t/shouldn’t ask a 20 year old kid to sign something thing like that under duress.
This was nothing more than a money grab. I’ve since seen other people on the internet mention the exact same scenario.
It seems like a colonoscopy without a pathology report is little more than someone looking in your butt because the enjoy it.
OTOH, it could be a case of ‘we didn’t see anything so it’s coded as preventative’ vs ‘there was something (ie polyp) so it’s coded as diagnostic’.
My dad once got a $600 bill from his GP after a ‘free’ annual visit. When he called about it, it turns out that at some point he said ‘it hurts here once in a while’ and the doc said ‘might be diverticulitis, make follow up appointment and we’ll talk about it’. And suddenly it wasn’t an ‘annual visit’ but a ‘diagnosis’.
For my first colonoscopy, I went without. The doc was an old grey haired gentleman, and it was an uncomfortable experience, completely lacking in dignity. But I jumped off the table and drove my self home, and said ”I’m glad that’s over, let’s eat”.
The second time around, I had a much younger doc, the first having retired. What a difference. The second doc was faster, but much rougher. The discomfort was replaced by pain, and plenty of it. I came close to calling it off mid-procedure. A couple of times I came close to passing out. I was 15 or 20 minutes in the recovery room catching my breath. I drove myself home, and instead of food, I just wanted to have a bit of a lay down.
Should I be around long enough for a 3rd, I will insist on either an old doctor or new, fresh drugs. I want old people driving my ‘scope and my airplanes.
There are a number of ways to screen for colon cancer; colonoscopy is just one of them. So it may be that different insurance companies cover one particular screening method but not another.
I believe that colonoscopies are always paid by insurance that is ACA compliant. But the “free” preventative screening only covers the main procedure, not subsequent pathology or treatment work.