$1000.oo for a colonoscopy with health insurance

[otherone]

How are working people supposed to afford medical care?

I have medical coverage, how do I afford the treatment?

Very frustrating.

Single payer is the answer.

[B Calm]

1. Single payer cannot get here fast enough!

[Nuclear Unicorn]

2. How long will that be?

Now with everyone compelled to become subjects of the insurance fiefdoms they'll have more than enough money to lobby/bribe/cajole Congress to maintain the status quo. Besides, we fought so hard to get it and keep.

[Motown_Johnny]

3. it should be no copay if you are 50 years old or older

part of the free preventive care change in the ACA


I am trying to get mine scheduled even now, and because I have Aflac I expect to be paid to get it done.

[datasuspect]

4. preventive care should start in your 40s

[Motown_Johnny]

5. some does, some doesn't. this procedure is no copay for 50+

[PasadenaTrudy]

16. 50 is the age

when your first colonoscopy is recommended. I get to do it next yr, yippee.

[Sienna86]

6. Under ACA, no copay if over 50

You don't have to pay one cent. Not sure if this applies to oh her risk factors if you are under 50. Check if that's the case.

[Javaman]

7. a colonoscopy is covered under the ACA as preventative care...

I have to get one every three years to my family history of colon cancer.

Last time I went which was last year, it was completely covered.

prior, yes, it was out of pocket. No more.

[ProSense]

9. Yes, and even the discovery of a polyp

<...>

We’ve known all along that colonoscopies count as one of the preventive services that insurers must cover without copayment, as they are a screening recommended by the United States Preventive Services Task Force.

What we haven’t known though, was what would happen if, during a colonoscopy, a doctor discovered a polyp and removed it. Would that still count as a screening—or would it cross the line into a treatment that the patient would need to pay for. Harris Meyer raised the issue back in April, writing for the Los Angeles Times:

<...>

Today, the administration resolved this issue: It decided that insurance companies cannot charge patients for the removal of a polyp during a recommended colonoscopy. From an FAQ issued by the Department of Labor:

Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?
No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.

There it is: Colonoscopy patients will not wake up to a surprise, post-operative bill.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/20/heres-one-way-obamacare-changed-today/

[Javaman]

11. Even better new! thanks. :) nt

[Ichingcarpenter]

8. NYTs: The Weird World of Colonoscopy Costs

Colonoscopies are one of three standard ways to screen for colorectal cancer. So it is disturbing to learn that the cost of this routine procedure, performed on more than 10 million Americans each year, differs radically from state to state and even within the same metropolitan area.


As Elisabeth Rosenthal reported last week in The Times, the amount paid by a patient and the patient’s insurance plan for a routine colonoscopy can be as high as $8,500 in the New York area, compared with a high of $1,900 in Baltimore. The low price in New York was $740, less than a tenth of the highest price.

Variations like these are not limited to colonoscopies. Big price differentials occur in a wide range of procedures and services, including hospital stays, M.R.I. scans and artificial hips, among others. Bringing the highest prices down to more reasonable levels will be an essential ingredient in holding the nation’s health care costs to sustainable levels.

What accounts for the big differences in colonoscopy costs? Prices can depend on the particular doctor and where the procedure is done. Colonoscopies are cheaper in a doctor’s office, more expensive in an ambulatory surgical center that can tack on a facility fee, even more expensive in a hospital outpatient department and through the roof if performed in a hospital.



More: http://www.nytimes.com/2013/06/09/opinion/sunday/the-weird-world-of-colonoscopy-costs.html


Just thought I'd add this article to the discussion.

[kentauros]

13. And yet, my $1500 colonoscopy was done at a hospital,

because that's where my doctor did all of his procedures. And then my insurance company turns around and pays me back almost $1200 of my costs.

Yeah, it's nice that I didn't have to pay as much out of my deductible, but honestly, I truly don't understand why they did that at all.

[Beaverhausen]

10. High deductibles

If you still haven't met your deductible, you must pay out of pocket.

[kentauros]

12. I don't even pretend to understand how insurance works internally.

Four years ago I had my first colonoscopy. Even with insurance, it was $1500. A month after the procedure, my insurance company sent me a check for a little over $900, stating that I'd "overpaid." I think they even sent a second check for another few hundred under the same reasoning.

Thinking that they'd made a mistake and might be asking me to pay in full after all, I put it into savings. I never heard from them again about it.

It seems that, somehow, insurance companies can "discount" their coverage on some things and you either don't pay as much as it says, or you get a refund later. I hope they do the same for you

[DURHAM D]

15. Your analysis seems correct.

I had the procedure in 2011. I am on Medicare. The bill was $1476. Medicare only allowed them to charge $253 for the procedure. Of that Medicare pays 80% ($202) for the procedure and the balance left for me was $50.

I believe that the private insurance companies set the amount they will pay out for procedures the same way Medicare does. It does not matter what a hospital or doctor charges because what they get back is already determined.

What I have never been able to figure out is if someone without insurance or is not on Medicare has the same procedure are they obligated for the full $1476 or is it lowered to $253.

[NuclearDem]

14. Man, that's taking it up the...

Never mind.