Yes, they get you on the “diagnostic” part. I recently had a colonoscopy, but because I was experiencing issues beforehand, it was considered diagnostic (and there were biopsies performed). The copay wasn’t too onerous (I think $325?) but you have to wonder if every “preventative” colonoscopy in the U.S. doesn’t turn into a “diagnostic” procedure.
As far as pain, I would never in a million years consider having one done without pain meds. I was given fentanyl and Versed and it was still extremely uncomfortable.
I am amazed. The report was from 2004 so practice may have altered in the interim. When I had mine done, I spoke to three other patients who were either waiting for or had just completed the procedure and I don’t think any of us had opted for sedation.
It was uncomfortable and undignified, but not painful. The consultant removed a number of polyps and send s sample off to pathology which, to my relief, came back clear. I was on my side on a table and I could see the screen, so I can honestly say that I have seen the inside of my own arse…
It is if they had to remove anything. Did the doctor tell you that s/he had to do a biopsy while they were in there? Somebody has to examine that tissue.
My mother had colon cancer, so I’m willing to part with the $273 to have the polyps examined. The insurance company paid $1,286 to the facility, doctor and anesthesiologist for the procedure itself.
I am sorry about your mom. In your shoes I’d still call my insurance company. If you explain that you plan on not going through with the histopathology of your polyp, I’ll bet they’d offer to pay. Faced with paying $273 versus paying their share of your cancer treatments they may decide to cover their (and your) ass.
If they played hardball, I’d likely cave and pay it myself. But in similar situations I’ve played chicken with my insurance company and they’ve chosen what was in their best financial interest.
Correct me if I’m wrong, but after you’ve had polyps removed you may get a call-back appointment in three or five years rather than the standard ten years. That earlier callback won’t be considered a wellness preventive examination (but you’d be a fool to pass it up with that rationale).
Given my family history, I’ve had three, spread out by three years and then by five. All three were covered by insurance. My next is due in five years. They found small non-cancerous polyps all three times.
That’s bizarre and circular. It’s preventive, but if it turns up something it’s no longer preventive??? I could see them saying the next one isn’t preventive (if your results indicate a shorter time between screenings).
A friend’s daughter had a colonoscopy. NOT preventive in her case; she’d been having some symptoms. Their provider and facility were in-network, the anesthesiologist was not - like they had a choice.
They got a 4K bill from the anesthesiologist and were quite rightfully panicking. And that was bogus - “rack rate” for mine tended to be about 1,300 of which insurance paid maybe 250 (the rest was written off due to being in-network).
So the 4K was highway robbery.
My friend called - and the anesthesiologist had already written off the balance.
Re the OP: fight it. Contact the people billing you and contact the insurer. It might be a temporary glitch.
I do vaguely recall one colonoscopy being fully covered, INCLUDING the anesthesia, as preventive. This most recent one I had, I don’t know - they could argue it was diagnostic… but as I’d hit my out-of-pocket limit a couple weeks before, I paid nothing.
