middle age woman on phone

Summary: We are often asked “how do people use your information?” Here’s one way: I have blog post here on our site about colonoscopy prices that was also reposted on The Health Care Blog here. People often find that post via Google search, instead of finding our site, and they let us know what they think. We can see that a lot of people click on that post, and then click over to our site via the links. And they often comment. Here are some of the comments, including “Thank-you for this blog it has been very helpful.”

 


A commenter named Sharon wrote:

“Thank-you for this blog it has been very helpful. I have Blue Shield of CA EPO and recently had my 1st colonoscopy screening at age 52. I spent time making sure my provider and facility were in network. I called BS and was told it would be fully covered, as the ACApreventative screening has required by law. Just yesterday, I recieved a bill from the endoscopy center showing BS paid $2,360 for the total billed of $3,200 and I was to pay the difference of almost $600. Well BS made a mistake, processing the bill as surgical services requiring a 20% co-pay. I called BS and told them this was a screening and there was a problem with my co-pay. They said yes and they would re-process the bill and I should owe nothing. It pays to call the insurance company and remind them the covered individual should not pay even with high deductible insurance for this screening procedure. I believe the insurance companies will try to wiggle out of payment whenever possible and the unsuspe
cting consumer needs to to be diligent. I did see
a separate billing for anesthesia and BS did not pay anything for this service,but I did not recieve a bill. Hope this helps”

A commenter named Jenie wrote:

“Are these charges up to date? But it does give clear idea How it might cost. thank you. now I can reconsider my options.”

A commenter named Gary wrote:

“I went back to the same doctor that had done these procedures previously. Having had the procedure before I had in mind the costs I paid previously, about $600 with plops removed 5 years ago. So I was shocked when the EBO came and said my responsibility was $2550. Total bill from hospital $12,267 in Warwick NY. The insurance company said it was normal for the hospital to change the code from preventative to diagnostic. Why? Because they can. Reviewing the charges, the Hospital charges for the Colonoscopy with biopsy $3,485 and Colonoscopy with removal of Lesion $3,485. I asked Insurance company if this was double billing and why they would pay double billing and they gave me the same reason, it’s how the hospitals charge. There were separate charges for the Pathology lab and Anesthesiologist from rthe hospital. This does not include my doctors invoices Colonoscopy with Lesion removal $867 and Colonoscopy with Biopsy $749. All these numbers were not paid by the Insurer but were reduced. I am keeping these papers handy for my next procedure and will ask more questions of the doctor and hospital about these issues. Won’t be using the same doctor and probably not be doing it in a hospital. I will see if I can get the information about these cost before scheduling.”

A commenter named William wrote:

“I have UHC. They pay 100% for a colonoscopy coded as Preventative . If a biopsy is taken, the coding is changed to Diagnostic and they hit you for 20% of the cost, So, in reality, you are being punished for having something wrong found in your body (as if it were your own fault), which is the purpose for the procedure in the first place. This way of thinking is absurd, a Catch-22.”

A commenter named Candice wrote:

“Here is what Tx Blue Cross Blue Shield told my husband whose PCP told him to get a colonoscopy for a look see since he was over 50.
BC BS told him the procedure is no charge as preventative but if any abnormalities are found the price goes up a fair amt since the procedure has then changed to diagnostic.
I think that is the biggest insurance scam ever. If the doc takes one polyp biopsy the whole procedure is no longer routine. How did they get away with that.”

A commenter named Sandra wrote:

“MY GI doctor expects full payment up front from patient, then submit the insurance paperwork (to which I find, is now considered “a curtesy” by them to even do for ya)..WHEN/IF insurance company pays..the GI folks re-imburse us..Last time I did that kind of thing was with an emergency ORAL surgery for a bad tooth..I never did get get all my money reimbursed. the oral surgeon kept most of that money too. THAT bugger got almost 1000.00 for 1 easy emergency extraction..to which I paid over 3/4 …I got just 200 or so dollars reimbursed. Frankly, I think it is fraud/against the law to swindle people with such an expectation. Im seriously considering canceling the entire colonoscopy thing..and just let any possible cancers, etc take its course.”

A commenter named Jennyct wrote:

“I arrived at this site after opening my EOB. I have a high deductible and I met that early this year with a broken ankle. After meeting my deductible, I am responsible for 20% of negotiated rates, 40% for “non-preferred”. Note that this is NOT out of network.
I had a colonoscopy and endoscopy.
Hospital fees billed: 5025.
Member rate: 4284.
My portion: 1035.
CRNA billed: 980.
Member rate: 573.
My portion: 0
Pathology (I think) billed: 780.
Member rate: 355.
My portion: 141.
Physician: 1815.
Member rate: 428.
My portion: 285.
total billed; 8600
member rate: 5640
my portion: 1461
“Note that I have already met my dedcutible AND the colonoscopy for which I am supposed to have free (all screenings are supposed to be 100% covered).This is probably why the anesthesia was covered, but I was charged for the colonoscopy.”

A commenter named Kathy wrote:

“My husband just had his 3rd colonoscopy at Stanford Hospital & Clinics (Palo Alto CA). I nearly fell over when I saw that Stanford was claiming total charges of $11,630!!! And that does not include the doctor’s charge. I called customer service for clarification learned that total charges for his 2010 (identical procedure) was $5612. We suspect coding was incorrect so we are getting copies of all documentation related to these procedures to compare codes. I am learning that if you go to a major hospital for any type of service the charges are typically uplifted by 100%+.
“Will post outcome of colonoscopy charges later.”

A commenter named Margaret wrote:

“I work in the medical insurance field and part of my job which is very unique, is when the Drs office calls for an authorization I check to see where they want to do the procedure. If the request comes in for a hospital setting I ask if the procedure can be done at a free standing surgery center. 99% of the time it can be.

“The Dr schedules the procedure at the hospital for his convenience only. He normally has special days and hours reserved at the hospital and that is the reason he wants to go to the hospital plus he may be getting some kind of financial incentive from the hospital to bring all his patients there. Most members dont read or understand their Summary Plan Description booklet.

“This is where the big mistake is made. You need to take the time to read your summary and understand the difference between having the procedure done at a hospital vs a surgery center. Anything done at a hospital is always much, much higher than having it done at the FREE STANDING SURGERY CENTER. It cannot be related to the hospital in any way.

“If it is then the billing Tax ID # will be the same and fall under the hospital contrct. If you are contracting with any of the major carriers the contracts for each Dr and facility are different. You can even have two Drs in the same building with different contracts. I always recommend to my members to stay away from the hospital for all basic tests and outpatient surgery.

“Since members dont take the time to read their SPD they panic and run to the closest ER for services. This is a very expensive decision. When I go to enrollment meetings I ask if they have a car, of course they all do. I then ask, what do you do when you are having problems with your car. They advise they take it to the shop for diagnostic testing and have the mechanic call them back with an estimate before they proceed.

“Medicine is no different. When you go to the Dr for a severe pain in your knee and the Dr writes an RX for an MRI at your local hospital, off you go without asking any questions and assumes that the Drs office is going to take care of everything.

“This is the biggest mistake that members makes. At that point if you have read your SPD you would let the Dr know that you do not want to have the test done at the hospital but rather the free standing radiology or lab site down the street where your covered will be a lot higher and very little out of your ppocket if any.

“My plan pays 100% if your use the freestanding lab and freestanding radiology sites. This is an incentive for the patient as it is a win win for both the member and the self funded Trust that I work for. We share the savings with the members by paying 100% of the negotiated rates. Even if I know that the facility is no contracting I will reach out to the facility, let them know the reduced benefits if the member goes to their facility. I am very successful at getting the facilities to accept a negotiated rate and usually ends up paying 100% of the negotiated rate. This is something that I am very passionate about and ask myself every day, why dont the members take the time to read their SPD or call and ask. I could write a book about this.”

A commenter named Barry wrote:

“I had my most recent colonoscopy at my local community hospital in central NJ four months ago. The following is a list of charges at list price followed by what was actually paid by Medicare and my Medicare supplemental insurance plan combined according to my EOB:
Drugs / Other: List price, $9.00. Paid by insurance: $0.00
Sterile Supply: List price: $245.00 Paid by insurance: $0.00
Venipuncture: List price: $17.00 Paid by insurance: $0.00
Pathology Lab Examination of Tissue: List price: $1,482.00 Paid by insurance: $115.17
Hospital Facility Charge: List price: $4,101.00 Paid by insurance: $890.34
Pathologists Fee: List price: $495.00 Paid by insurance: $109.17
Gastroenterologist Fee: List price: $800.00 Paid by insurance: $275.92
Anesthesiologist Fee: List price: $1,530.00 Paid by insurance: $165.15
Total Charges at List price: $8,679.00 Paid by insurance: $1,555.75 (17.9% of list price).

“I didn’t have to pay anything out-of-pocket. It’s also worth noting that the actual procedure took only 20 minutes to perform.

“The big impediment to price discovery in the commercial insurance sector is the confidentiality agreements that preclude disclosure of actual contract reimbursement rates. We need to get rid of those. There is also no reason why a bundled price can’t be quoted even though sometimes there will be polyps and sometimes there won’t be. Occasionally there will be complications. Those factors could easily be built into the bundled price in my opinion.

“As for out-of-network care, I’ve recently been told by an expert that most hospitals now require all doctors who practice within the hospital to be members of the same insurance networks that the hospital itself participates in.”

 

 


Jeanne Pinder

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...