Any info out there about a colonoscopy budget?

[chris31997]

OP here:
No- I DID mention it at my checkup- it just took a month to get into the gastro guy.

I am just not sure why my gyno did not do a fecal occult test and neither did the gastro...I am going to have the colonoscopy- I just want to be educated about the cost and will be calling gastro in the morning to ask if they will get pre-approval and OOP cost info from the insurance as others have suggested.

Also, my gyn is aware that I do not have these symptoms most of the time when I am drinking plenty of water, eating well and exercising...so we had agreed for quite some time that the issue may be due to constipation and/or straining and pregnancy weight gain (very graphic, I know- I am sorry).

Glad to hear that you got the hint and are going The big red flag is the blood. Because of that the DR should be able to get it covered. Not knowing exactly what you are dealing and only playing at being a dr It kinda sounds like ibs to me. Mainly because if you keep your wieght down and drink plenty of water and eat right, you have no issues. Sounds just like me. But it is also possible that there is a food intolerance also, my sis has a very severe case of ibs and certain food sends her over the edge.

Just like everyone said the worse is the prep for the colonoscopy but after that it is all good.

I hope it all turns out good for you.

 

[seashoreCM]

Preparing for the colonoscopy is not that bad.

Starting a week before you have to stop eating certain things, they give you a list. The restrictions increase as you get up to the date of the colonoscopy.

The day before, you drink a quantity of stuff they tell you to get. Typically fruit juice, or sports drink like Gatorade, mixed with some (usually) over the counter medication. So it does not taste bad.

You will need to "go" multiple times thus you may want to also stay home for the day prior to the colonoscopy. You may be able to work half the day if you don't have to start drinking the stuff until late in the day.

The purpose is to wash out the colon so the colonoscopy camera can get a better view.

 

[Jenny3]

Thank you for this- your story is what I needed to hear, thank you again...I will call for more info and have it done. I think I wigged out last night and made many excuses as to why the proceedure made no sense for me to have...I admit I am nervous and the money part scares me, but that is the fear talking and I am going to get over it.

I am glad to help and very happy to hear you are going to do it. I too was incredibly nervous, but it really will be okay. First step is getting it scheduled!

And definitely fight the insurance company if they deny the claim. Just try not to worry too much about that part right now.

Please keep me posted; I sincerely hope all is okay!!

 

[thebeesknees]

I just read an article in Reader's Digest last night about saving on medical costs and it recommended asking if the doctor will do the procedure in an outpatient center or surgery center instead of the hospital. It said that prices for a colonoscopy by managed-network patients in a Midwest city ranged from $4,481 at an "academic medical center" to $840 at a "freestanding office". I don't know if your doctor has such an office, but it might be worth asking about.

 

[griswalds]

Also, the GI drs are given bowel prep kits by the drug companies, they keep a few in their drug sample closets. When you schedule your exam ask if they have a sample you can have. I'm a RN in a colonoscopy procedure center and I've had 3 colonoscopies in the past 5 years so I've been on both sides of the stretcher so to speak. I started getting colonoscopies at age 40 because of my mom's history of colon cancer. They found a huge polyp on my first test which would have turned to cancer if I'd waited until 50 to start. Luckily the next 2 were clear and I'm scheduled again in Sept.

There are multiple preps out there and some can run $60-80 even with insurance so check on getting a free one. As a PP mentioned Miralax is a good one and it's OTC, we have found that it works better if you eat much much lighter than normal for 2-3 days prior. My personal favorite is Osmoprep which is pills versus a liquid. If you can swallow pills and don't mind taking 32 of them its the way to go. I think it is more easily tolerated because you don't have to deal with the nasty taste that a majority of the preps have.

And I agree with everyone else about setting up a payment plan, we do it everyday because the economy is tough and the MDs know it. Most will be willing to work with you if you're making an effort.

Good Luck

 

[disneybound31]

Also, the GI drs are given bowel prep kits by the drug companies, they keep a few in their drug sample closets. When you schedule your exam ask if they have a sample you can have. I'm a RN in a colonoscopy procedure center and I've had 3 colonoscopies in the past 5 years so I've been on both sides of the stretcher so to speak. I started getting colonoscopies at age 40 because of my mom's history of colon cancer. They found a huge polyp on my first test which would have turned to cancer if I'd waited until 50 to start. Luckily the next 2 were clear and I'm scheduled again in Sept.

There are multiple preps out there and some can run $60-80 even with insurance so check on getting a free one. As a PP mentioned Miralax is a good one and it's OTC, we have found that it works better if you eat much much lighter than normal for 2-3 days prior. My personal favorite is Osmoprep which is pills versus a liquid. If you can swallow pills and don't mind taking 32 of them its the way to go. I think it is more easily tolerated because you don't have to deal with the nasty taste that a majority of the preps have.

And I agree with everyone else about setting up a payment plan, we do it everyday because the economy is tough and the MDs know it. Most will be willing to work with you if you're making an effort.

Good Luck

they gave me an rx for suprep? with a coupon that said save 20percent...my insurance has NO prescription benefits...I am thinking OOP this may be very high...any info on possibly how much? I may stop into my CVS and ask them before I fill it- if it is astronomical I will get over my embarrasment and ask the gastro office if they can give me a free one if they have it...

 

[Sadie22]

I just read an article in Reader's Digest last night about saving on medical costs and it recommended asking if the doctor will do the procedure in an outpatient center or surgery center instead of the hospital. It said that prices for a colonoscopy by managed-network patients in a Midwest city ranged from $4,481 at an "academic medical center" to $840 at a "freestanding office". I don't know if your doctor has such an office, but it might be worth asking about.

MY GI specialist operates out of a freestanding center, and I thought the billed amount was under $1,000 both times I had to have colonoscopies performed. My insurance paid all costs for my tests, including the cost of prep. There was a lot less prep to be swallowed the second time I had to have the test done. It was not nasty, vile, or any of the other terms used.

 

[seashoreCM]

It is my belief that even the pills need to be accompanied by lots of water (or clear drink). You can ask about different choices of prep drinks if the instructions handed out do not mention choices. The generic versions of Mirilax will probably cost you less than $25.

 

[NorCalGal]

It sounds like you're doing the test, which is great. I just wanted to share my experience:

I had my first colonoscopy in April just before my 51st birthday. I have no family history, no obesity, exercise daily, eat well (well-ish, but not perfect, but not heavy on animal fats), no symptoms, so no reason to expect anything other than a clear result. I had stage 3 colon cancer. They were able to remove the cancer with surgery, and I'm now doing "preventive" chemo to reduce the risk of recurrance from 60% to 30%.

My best advice is call your insurance company. Mine was very helpful with options and how to reduce expenses by doing things the way they would cover the most. I have Anthem Blue Cross and they've been great.

As far as coverage, because mine was preventative they covered the colonoscopy 100%. Had it been because of symptoms it would have fallen under normal insurance rules, and I would have had to pay 20%. There are no out-patient clinics in my rural county, so I had to have it done at the hospital, and the whole procedure was $6,000, so it would have cost me $1200. In larger urban areas in California, they have clinics that specialize in this procedure and charge $1500. I will have to have them every year for the next five years, so I'll have to decide it I want to do it near home and pay $1200 or pay travel expenses to go elsewhere and pay $300 (20% of $1500.)

Seriously, though, talk to your insurance company about your concerns and see what recommendations they have.

Good luck and I hope you have great results.

 

[disneybound31]

It sounds like you're doing the test, which is great. I just wanted to share my experience:

I had my first colonoscopy in April just before my 51st birthday. I have no family history, no obesity, exercise daily, eat well (well-ish, but not perfect, but not heavy on animal fats), no symptoms, so no reason to expect anything other than a clear result. I had stage 3 colon cancer. They were able to remove the cancer with surgery, and I'm now doing "preventive" chemo to reduce the risk of recurrance from 60% to 30%.

My best advice is call your insurance company. Mine was very helpful with options and how to reduce expenses by doing things the way they would cover the most. I have Anthem Blue Cross and they've been great.

As far as coverage, because mine was preventative they covered the colonoscopy 100%. Had it been because of symptoms it would have fallen under normal insurance rules, and I would have had to pay 20%. There are no out-patient clinics in my rural county, so I had to have it done at the hospital, and the whole procedure was $6,000, so it would have cost me $1200. In larger urban areas in California, they have clinics that specialize in this procedure and charge $1500. I will have to have them every year for the next five years, so I'll have to decide it I want to do it near home and pay $1200 or pay travel expenses to go elsewhere and pay $300 (20% of $1500.)

Seriously, though, talk to your insurance company about your concerns and see what recommendations they have.

Good luck and I hope you have great results.

This is very helpful- thank you!

I did call the gastro today and told them my concerns- they assured me that they do a pre-approval and will call me with the cost details. I also mentioned that I do not have rx coverage and she immediately offered me a free sample that I can pick up anytime, so that is a burden lifted.

It sounds like, because I went to gastro with the symptoms that this will not be considered preventative, will it? I think either way, whether outpatient preventative or normal proceedure, I am going to have to pay my $1k deductible and also 20% OOP...according to my benefit explanation online-if I am reading correctly.

They only use the hospital next door- no in-office or clinic and said I will have anesthesia? I may need to ask more ?s about the anesthesia as I am unsure how involved that is...totally asleep?

Very much hoping your treatment continues to go well!!

 

[Sadie22]

It's a twilight sleep type of anesthesia where you are able to obey commands but you will not remember anything about the procedure when you awaken to the staff instructing you to pass gas.

 

[snarlingcoyote]

One note. I've known some people who've gone to Mexico, Costa Rica etc. to have colonoscopies done. It's about $400 for the procedure at a clinic with the stame standards as those in the US, I understand, but, of course, you either have to have family there or already plan on a vacation for it to work out moneywise in most cases.

 

[Jenny3]

They only use the hospital next door- no in-office or clinic and said I will have anesthesia? I may need to ask more ?s about the anesthesia as I am unsure how involved that is...totally asleep?

Mine was done in an outpatient facility and yes, I was totally asleep. I remember being in the room, being told to lay on my side and that was it. Woke up in recovery and went home in a few hours. Easy peasy

 

[dawnball]

They had to wake me up toward the end of both of my colonoscopies. It wasn't the most comfortable thing in the world, but it was less painful than my arm when they hit a nerve giving me an IV.

You're unlikely to remember anything. I have distinct memories of what I was thinking when I woke up, but they're pretty disconnected from the experience, if that makes sense. I was in and out of the surgical center in a couple of hours (I want to say 2. They were -fast-), but needed someone to take me home, and I was out of it enough that my husband decided to stay home for the day to keep an eye on me.

I had immediate findings (which I was too groggy to remember, but it came with pretty pictures!) and then pathology took another week.

 

[Styx Fan]

Preparing for the colonoscopy is not that bad.

Starting a week before you have to stop eating certain things, they give you a list. The restrictions increase as you get up to the date of the colonoscopy.

The day before, you drink a quantity of stuff they tell you to get. Typically fruit juice, or sports drink like Gatorade, mixed with some (usually) over the counter medication. So it does not taste bad.

You will need to "go" multiple times thus you may want to also stay home for the day prior to the colonoscopy. You may be able to work half the day if you don't have to start drinking the stuff until late in the day.

The purpose is to wash out the colon so the colonoscopy camera can get a better view.

This must be a case of different doctors having different rules for prep...or different patients needing different prep due to health issues.

I just had a colonoscopy and edoscopy yesterday and the colon prep was much easier for me. I had NO restrictions on diet until after midnight the day before the test. Then it was a clear liquid diet. (but you could have tea, coffee or cola!). Around 2 or 3pm took 2 over the counter Dulcolax laxative pills. 2 hours later started drinking 128ish grams of Miralax in 64 oz of a liquid of my choice. Had a couple of hours to drink it all. 2 hours after finishing, 2 more Dulcolax. No flavor to Miralax, but it did make the drink a bit thicker.

If I suffered from constipation, the directions were to exclude all raw fruits and veggies from my diet for 3 days prior and start some laxative prep sooner.

After I began drinking the 64 oz, I started to make frequent bathroom trips. I just lounged on my bed with the olympics in between trips. After about 5 hours the worst was over and I slept through the night.

I am 49 and this was my 2nd colonoscopy. The last one 8 years ago was much harder to prep for. This I could deal with!

 

[KigerKat]

First of all, I am so sorry to hear that you are having health issues. I read a post by one of my friends on FB the other day that applies to you: The best thing you can do for your children is keep their parents healthy. Do not hesitate about this procedure. You are having some serious symptoms that need to be diagnosed!

I suffered from some similar symptoms 3 years ago. The worst part was the week we were at Disney in August, with free dining, and I had absolutely no appetite. I was tired a lot during the trip and could not eat. I would eat 2-3 bites of something and just want to vomit. And then there was the other "stuff" like you described.

There are GI issues in my family history, so my doc ordered a colonoscopy right away and discovered I have Crohn's. He put me on Asocol, and I have been much better ever since. I've actually been in remission for almost a year now!

I had a difficult time with the prep, and kept gagging every time I tried to drink that vile prep liquid. My doc told us to get an OTC liquid (I can't remember what is was called) from CVS and mix it with ginger ale. This was much better and didn't taste bad at all. It was a clear, fizzy liquid that only cost about $5. It wouldn't hurt to ask your doc about that option.

As for the budget issue here, I'm thinking the rep you spoke to at your insurance company must have misunderstood you. This should definitely be a covered procedure, since you are having serious symptoms and your doctor is ordering it. I would do as others suggested, and have your doctor's office get the procedure per-approved. They will know exactly which department to speak to and exactly how to word the request. I also have BCBC (GA), and my procedure was done when I was 34.

Good luck to you and keep us updated on the results!

 

[dhardawa]

This is very helpful- thank you!

I did call the gastro today and told them my concerns- they assured me that they do a pre-approval and will call me with the cost details. I also mentioned that I do not have rx coverage and she immediately offered me a free sample that I can pick up anytime, so that is a burden lifted.

It sounds like, because I went to gastro with the symptoms that this will not be considered preventative, will it? I think either way, whether outpatient preventative or normal proceedure, I am going to have to pay my $1k deductible and also 20% OOP...according to my benefit explanation online-if I am reading correctly.

They only use the hospital next door- no in-office or clinic and said I will have anesthesia? I may need to ask more ?s about the anesthesia as I am unsure how involved that is...totally asleep?

Very much hoping your treatment continues to go well!!

Make sure they to a pre-authorization and get a copy of something showing where they did it. I can't speak for BCBS, but I work for a health insurance company and in our system if there is a pre-authorization associated with a claim, it will automatically process as is outlined in the pre-authorization. (i.e. the claim won't deny based on any criteria) If there is a glitch, you have a copy of the pre-authorization with the exact amount you should have been billed (assuming the doctor actually bills the way s/he inputs the pre-authorization - if s/he doesn't, you can make them redo the claim). It just gives you a leg to stand on if something goes wrong with the claim.

 

[NorCalGal]

It sounds like, because I went to gastro with the symptoms that this will not be considered preventative, will it? I think either way, whether outpatient preventative or normal proceedure, I am going to have to pay my $1k deductible and also 20% OOP...according to my benefit explanation online-if I am reading correctly.

They only use the hospital next door- no in-office or clinic and said I will have anesthesia? I may need to ask more ?s about the anesthesia as I am unsure how involved that is...totally asleep?

Very much hoping your treatment continues to go well!!

Thank you! I am halfway thru chemo, and it's going much better than I expected. Aside from chemo days, my life is fairly normal. It ends on Oct 27th, and I'm celebrating with a trip to WDW right after Thanksgiving.

I'm not sure how much variation there is in insurance by state. In Calif, your procedure would not be covered 100% because it's not preventive, it's diagnostic. That has been the case with every insurance I've had since I've been an adult and knew about insurance issues. My first one was covered 100% because it was just routine screening ordered by my doctor because I had turned 50. In the future, they will all be considered diagnostic so I will pay 20% (plus my deductible for that year if I haven't paid it yet.) I do have a maximum annual OOP of $3K.

I was not fully under when I had my colonoscopy. I have a history of difficulty coming out of anesthesia, so they asked if I wanted to be or not and I said no. I felt wide awake for the whole thing and remember everything. It was not uncomfortable at all - well, until the MD found the growth and said "Oh, I don't like the look of that at all."

As far as prep, I did the prescription prep for the colonoscopy, and did the OTC prep for my surgery. I didn't think either one was terrible, and actually thought the OTC prep was a little easier. The OTC was Miralax from CVS, and including 64oz of Gatorade to mix it with, all my prep stuff was $23.

I do recommend that you actually call your insurance company. I thought I had all the info I needed from my coverage booklet and their website, but still learned some very valuable stuff from their customer service person.

Good luck!

 

[Pigeon]

OP, I'm so glad you have decided to get the test. I'm personally prone to being doctor-avoidant, so I understand. I was terrified about it. When I went in for the initial talk with the nurse practitioner, weeks before the actual event, my blood pressure was through the roof and I was sweating bullets, I was that nervous.

However, I'm a breast cancer survivor. Being around to raise your children is much more important than a trip to Disney, so no matter what your OOP cost is for the procedure, it needs to get done.

I had my first colonoscopy last summer, with the Miralax/Ducolax prep others have described. I found the day before, when you can only drink clear liquids sort of tough, and while the prep isn't fun, it's not all that horrible.

The procedure was nothing at all. My only complaint was a screaming caffeine withdrawal headache from not having coffee that morning. Whatever the anesthesia was, it rocks. I remember nothing at all about the event and woke up feeling great. They found one tiny polyp, and good riddance to it.

 

[disneybound31]

OP, I'm so glad you have decided to get the test. I'm personally prone to being doctor-avoidant, so I understand. I was terrified about it. When I went in for the initial talk with the nurse practitioner, weeks before the actual event, my blood pressure was through the roof and I was sweating bullets, I was that nervous.

However, I'm a breast cancer survivor. Being around to raise your children is much more important than a trip to Disney, so no matter what your OOP cost is for the procedure, it needs to get done.

I had my first colonoscopy last summer, with the Miralax/Ducolax prep others have described. I found the day before, when you can only drink clear liquids sort of tough, and while the prep isn't fun, it's not all that horrible.

The procedure was nothing at all. My only complaint was a screaming caffeine withdrawal headache from not having coffee that morning. Whatever the anesthesia was, it rocks. I remember nothing at all about the event and woke up feeling great. They found one tiny polyp, and good riddance to it.

I am also thinking I may have a screaming headache from not having my glass of tea the day of--I don't have to be at the hospital until 11am, but by then my head will be exploding off my shoulders. Usually I drink just the one glass by 9am and have no other caffeine for the day, but if I miss that 8 ounces...watch out!! Can't get it back under control and whole day is shot