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?
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.