The consumer heading into a medical procedure rarely knows what it will cost. Quite often, the actual out-of-pocket figure isn’t known until the insurance company is done with its calculations, and sends the consumer (and the provider) a bill.
That’s the routine, but it seems odd. The answer to “what does it cost?” might be “whatever the insurance company pays” or — increasingly – it might depend on your agreement with the doctor.
Finding out what a simple procedure like a colonoscopy costs should be fairly routine and uniform, you would think. (Also, you could argue that a preventive procedure should be free.)
Yet here’s what happened recently when I called a number of doctors and facilities in the New York City area. I told them I was self-pay, because I hadn’t met my deductible yet this year. Most of them wanted to know the name of my insurance company, even though I said it would be completely out of my pocket.
Here are the answers.
Dr. T., Mount Vernon: $800 plus any lab costs, which would need to be negotiated ($100 for initial consultation, procedure itself $600, anesthesiologist $100).
Dr. P., the Bronx: “The number you dialed is not in service.”
Dr. H., the Bronx: “That depends on what level they would bill the visit for. We wouldn’t know ahead of time.” When I asked for more information, she put me on hold, where I stayed for 20 minutes and then hung up.
Dr. J., Tuckahoe: “Around $1,100 to $1,300. That includes the facility fee, the procedure, anesthesia and pathology.”
Dr. J., Scarsdale: Somewhere between $2,450 and $4,100, depending. “We bill $2,600, but your insurance company has a contract, say they agree to pay $1,800” even though it comes out of my pocket because my deductible isn’t yet met. Anesthesia is separate (the company, a national one, said it would be between about $650 and $850, but I wouldn’t know until we were done, because it’s a “per-unit” charge at $83 per unit – and then they called back and said it would be $1,200 to $1,500 ($150 per unit) for a self-pay customer. Also, “if we need to send something to the lab, you would be responsible for that” lab charge. If they don’t remove a polyp for testing, there’s nothing to bill.
Dr. J., Bronxville: From $1,460 to $2,960, plus labs. The initial consultation would be $360; procedure itself between $800 and $1,100; anesthesia fee “probably about $300 — they charge $1,500 but work with you,” and then lab fees, if any. “Would you be better off at a clinic?” she asked. “It could be at least $2,000 without lab fees. Ask your primary care provider, or Google it.”
Dr. H., Manhattan: Between $3,288 and $3,438, without lab fees. The doctor’s charge is $1,650 to $1,800; he does it at a facility, and the combined facility fee and anesthesia fee for people with my insurance company (even if they haven’t satisfied their deductible) is $1,638, because that’s the agreed rate. “We will bill them first; and then if your deductible is not met, you will get a denial from them and we will send you a bill for $1,638.” Once the insurance company sees the claim, they apply it to the deductible. For strictly self-pay patients, the charge is not $1,638, but $1,500.
Dr. A., Manhattan: “Between the doctor’s fee and the hospital fee, it will be way over $3,000” at a New York City hospital. “It’s going to be expensive. If you’re going to be out of network, I would shop around. Go on the Internet.”
Wait, this is a fairly standard procedure. How can it be as little as $800 and as much as $4,100?
Then there is always www.cheapcolonoscopy.com, which is what I’m doing on my next vacation.
Of course, there are variations, and unexpected things happen. But still, how much does it cost?