Budgeting for Colonoscopy- Crazy $$$

[toystory1130]

So DH had to have one, hospital out-patient tells us roughly $1200 deductible, which we pay the day of. Now we're surprised to see additional bills for the Doctor, Anestologist, and for labs. Looking at another $1000 we were not expecting. The deductible we paid at the hospital was only for "their" fees. Seriously, this bill has went to insurance for a bit over 12,000. No polyp's found (thankfully) but good grief! He was out in a few hours! I'm now terrified to even think about a upcoming hernia surgery with general anesthesia.

 

[havaneselover]

I thought these were covered under ACA??? This is absurd.

 

[robinb]

Hmmm ... I thought that screening colonoscopies did not have any deductibles or co-pays. They must have coded it as "diagnostic" instead of "preventative screening". Is this a follow-up colonoscopy?

 

[Ranger111]

My sister-in-law just went through some of this....this article explains stuff pretty well -- of course it is a California news station and they are quoting Cali prices, but the ACA applies no matter where you are..and it says preventative tests are free.

http://ww2.kqed.org/stateofhealth/2015/05/27/pricecheck-how-much-does-a-colonoscopy-cost/

Also, there is this article:
http://ww2.kqed.org/stateofhealth/2...reening-test-is-good-alternative-study-shows/

 

[TXWAC]

Have to read your policy. ACA means nothing. Most are high deductible plans. You are still getting what you pay for.

 

[robinb]

Have to read your policy. ACA means nothing. Most are high deductible plans. You are still getting what you pay for.

There is a rule as part of the ACA that screening colonoscopies are free. You're confusing the ACA rules with the insurance policies under the ACA.

 

[Sagginit]

I feel your pain. I recently had what I would say was a routine health issue and my payments quickly piled up, about $600 out of pocket in a month. I never got a bill from the ER for my visit so we have to chase it up with our insurance company to make sure I don't owe anything and it wasn't an issue with not getting a bill. I went back to the doctor for an annual visit a few weeks later, it was also a follow up to my health issue. As it was all billed as annual checkup and screenings I didn't even have a co-pay! They even did additional testing but as it all went in the system as part of my annual there was no charges, let's say I had already had my annual before the health issue, I would have had to have that as a follow up and pay much more. My doctor's office was actually really good about billing to try to save me money, they had me come in for test results and additional testing, they decided the additional testing might be a waste so they actually canceled that on the spot and instead did more blood work up. They then coded the visit as a "blood pull" (and two more after that) so I didn't have a co-pay even though I saw the dr (she talked to me in her office instead of a room so she didn't have to count it as a visit, she said it was the same to her as calling me to give me the results).

 

[Music City Mama]

I'm on a grandfathered plan through work. Some of the things covered under the ACA don't apply to me -- like free preventative services.

I'm confused about the deductible part, though. If he had to pay all of his deductible (which was $1,200), don't you only now have to pay a portion/co-insurance for the other $1,000? Like 10% or 20%?

My DH had to have his first screening done very recently. It's not subject to the deductible (per my company's plan), he just has to pay the co-insurance (10%), but that's 10% of the facility charge, the gastroenterologist charge, the anesthesiologist charge, and the pathology charges. When it's all said and done (after the discounts that our insurance company has negotiated with the providers), he'll owe about $170. However, he'll need to go back in 3 years which will be considered diagnostic and he'll have to meet the deductible first (it's $650 now, but who knows what it will be by then) and then he'll be subject to co-insurance of either 10% or 20%, so it will cost over $1,000 for sure next time.

I have to pay a co-pay for my kids' (and my own) wellness visits and the receptionists always make a big deal that we're like the only patients who pay for wellness visits. Seems weird that we're the only ones on grandfathered plans.

 

[TXWAC]

There is a rule as part of the ACA that screening colonoscopies are free. You're confusing the ACA rules with the insurance policies under the ACA.

Devil is always in the details. OP does need to call the doctors office and work with them. You will need to find out the procedure codes used and the diagnostic codes. If they don't all match the way they are supposed to it will not fall the way you want. The billing people at the doctors office will (should) work with the insurer and resubmit the claim. Good luck.

 

[crazymomof4]

Sorry to hear about these unexpected bills. sigh. Reading your OP all I can think of is that some day we will probably be in the same boat. DH's company just switched to a Medical Savings Account type insurance paired with a "high deductable" plan. Just started April 1st so no experience with it yet. I'm leary as we've always had PPO's or HMO's.

 

[AlohaNow]

I, too, have a pre-ACA grandfathered plan – bought on the open market years ago. OP needs to work with the doctor’s office to ensure the coding was correct, and the insurer to find out to what extent the procedure is covered. The ACA doesn’t matter – the only thing that matters is specifically what is contained in their contract with their insurer.

 

[havaneselover]

Have to read your policy. ACA means nothing. Most are high deductible plans. You are still getting what you pay for.

This is wrong. ACA requires all policies cover certain things. Now if they start removing polyps during a colonoscopy that is not 100% covered but I understood a diagnostic colonoscopy is.

 

[AlohaNow]

This is wrong. ACA requires all policies cover certain things.

This is wrong. A pre-ACA grandfathered plan does not have to contain ACA provisions. Now I do not know if OP has a pre- or post-ACA plan. But the blanket statement from above that this is covered by ACA may not apply to OP. OP – good luck sorting out your billing issue!

 

[jerseygal]

We have not flown SW for years. We did not purchase EBCI, and I see that our flights are now sold out. If we check in online at the 24 hour mark, are the odds good that at least 2 of us can sit together. I have a 12 year old, and she will not do well sitting alone.

Also, it is exactly 24 hours prior to flight that you can check in, no sooner?

I thought these were covered under ACA??? This is absurd.

I also thought that preventative colonoscopies were mandated to be 100% covered under ACA! Maybe there was an error? HOPING for you!

 

[havaneselover]

This is wrong. A pre-ACA grandfathered plan does not have to contain ACA provisions. Now I do not know if OP has a pre- or post-ACA plan. But the blanket statement from above that this is covered by ACA may not apply to OP. OP – good luck sorting out your billing issue!

I did not know that. Thanks for explaining.

 

[manning]

Think this is confusing wait until 2017 when everything kicks in.

 

[manning]

There is a rule as part of the ACA that screening colonoscopies are free. You're confusing the ACA rules with the insurance policies under the ACA.

Well, it's not free. You'll pay for it thru taxes and higher deductibles.

There's that magic word again. FREE!

 

[Maddie2]

I feel your pain! Both DH and I have had unexpected surgeries with general anesthesia since the first of the year and both required a one night's stay in the hospital. Suffice to say that the bills have been through the roof! We have easily met our maximum out-of-pocket for each of us. And, painful as the bills are, it makes me SO grateful for insurance! Think of it this way - it's only April. If anything else comes up, it'll be covered.

 

[kathy884]

It's one thing that my high deductible plan at work pays for 100%. Really and truly, I hate those so much, that there is almost no way I would ever do one if I had to pay for it. Unfortunately I had enough polyps that they want me to do it again in three years. I think I'll stretch it our another two at least, but my primary care physician will be on my case to do it when recommended for sure. Also, they have to give me something other than Movi Prep or there is not way I'm doing one again.

I feel your pain -- getting one is bad enough and having to pay for it out of pocket certainly adds insult to injury.

 

[DebbieB]

I had one last week, routine screening. Did have one polyp removed. Mine is covered 100%, no deductible. So far the doctor bill has hit insurance, he charged $675, insurance paid $319, I owe $0.

Update - Surgery Center charged $1,050, were paid $775, I owe $0.

Still waiting for anesthesia's bill.