Here’s an interesting story about how a person’s plans can diverge from a provider’s plans.
Here are a few paragraphs from an excellent piece by Doug Thompson on iHealthBeat.com, a service of the California HealthCare Foundation, on Thompson’s colonoscopy experience, from a customer service point of view.
“Later, my wife and I were directed to a registration room, where we met with a financial counselor and ran into a small problem. My wife had called our insurance company the day before and was told that screening colonoscopies were 100% covered, but the counselor asked for a 10% copayment and the rest of my deductible — about $800. It turned out the gastroenterologist had written CPT code xxxx5 for a screening colonoscopy with removal of polyps. If he had used code xxxx0 for a screening colonoscopy alone it would have been fully covered. The hospital could not change the code the doctor had submitted but agreed to waive our pre-payment pending a conversation with the doctor’s office.
“We called the doctor’s office while the registration clerk waited. The clerk explained the doctor’s standard policy was to submit the higher code in case something needed to be removed during the procedure. If they did not find anything, they would change the code and refund our pre-payment. However, since the hospital had already made an exception and waived our pre-payment, we finished registering and went down the hall to the waiting room.
“Sitting in the waiting room we began wondering about the doctor’s incentives. No doubt he was paid a lot more for a procedure with polyp removal. Did that mean he would look really hard for something to take out, whether I needed it or not? Since I had only met the gastroenterologist once (for 15 minutes during the pre-procedure exam), I could not imagine how to raise that question with him.”
Thompson concludes that “The physician has an interest in covering the possibility of finding polyps in my colon, but I have an interest in not making him an interest-free loan of $800. Since most routine screening procedures don’t find anything, up-front collection of a large copay is unjustified from a customer service perspective, creates frequent rework to refund the patient’s money and change billing codes, and increases the risk of billing errors.”
Do you have a similar story? Email: info [at] clearhealthcosts [dot] com.
Here are colonoscopy price lists for the New York area, and here are colonoscopy price lists for the Los Angeles area. Here are colonoscopy price lists for the San Francisco area. And here are Texas cities: colonoscopy price lists for the Houston area, the Dallas-Fort Worth area, the San Antonio area and the Austin area.