colonoscopy bill for $1500??

[Anonymous]

No polyps. Very standard. I am so confused, because I thought that screening colonoscopies were 100% covered. I got a bill for $1,500 because the charges exceeded my plan's $3400 allowance.

Has this happened to anyone else? Is there anything to be done?

[Anonymous]

Did you have a deductible to meet before it's "100% covered"?

[Anonymous]

Did they find polyps last time? Because then it's probably not considered a screening this time.

[Anonymous]

Anonymous wrote:No polyps. Very standard. I am so confused, because I thought that screening colonoscopies were 100% covered. I got a bill for $1,500 because the charges exceeded my plan's $3400 allowance.

Has this happened to anyone else? Is there anything to be done?

Yes, appeal it.

Unless you went out of network or don't meet screening guidelines it should be 100% covered. This is mandated by the Affordable Care Act. Do some research and figure out how to report them to HHS if they continue to try to charge you.

https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html

[Anonymous]

First call the insurance and ask why they adjusted it that way.

Then call the provider and ask them to fix the coding they screwed up.

[Anonymous]

My husband had this fight the morning of his colonoscopy when they tried to get him to prepay. He figured out that at his pre-appointment, somebody coded it as a diagnosis rather than screening due to a misunderstanding of his family history. He wasn’t really in fighting shape, but he was able to get them to recode it and didn’t have to pay.

[Anonymous]

Anonymous wrote:My husband had this fight the morning of his colonoscopy when they tried to get him to prepay. He figured out that at his pre-appointment, somebody coded it as a diagnosis rather than screening due to a misunderstanding of his family history. He wasn’t really in fighting shape, but he was able to get them to recode it and didn’t have to pay.

Same here. They coded DH’s as diagnostic by mistake instead of screening.

[Anonymous]

Anonymous wrote:Did you have a deductible to meet before it's "100% covered"?

Not op. It doesn’t matter. If it’s a screening and you’ve never had polyps, insurance has to cover it

[Anonymous]

Did you go out of network by accident?

[Anonymous]

Either you have a history of polyps and it was a diagnostic procedure (instead of screening), you went of network, or the procedure was coded wrong.

[Anonymous]

Even if it were diagnostic that's high, no?

[Anonymous]

NP. So because I had polyps at my first one, I have to pay $1500 for the next one?

[Anonymous]

OP here. I did have a few small polyps at my last one 5 years ago. So that has now changed them forever to diagnostic? That seems crazy. Insurance is such a racket.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My husband had this fight the morning of his colonoscopy when they tried to get him to prepay. He figured out that at his pre-appointment, somebody coded it as a diagnosis rather than screening due to a misunderstanding of his family history. He wasn’t really in fighting shape, but he was able to get them to recode it and didn’t have to pay.

Same here. They coded DH’s as diagnostic by mistake instead of screening.

Starting to seem like less a mistake than a pattern.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Did you have a deductible to meet before it's "100% covered"?

Not op. It doesn’t matter. If it’s a screening and you’ve never had polyps, insurance has to cover it

I'm guessing out-of-network, too. Insurance has to cover it, but they don't have to cover it up to a million dollars, right? They can put limits, such as requiring in-network or otherwise designate as set of providers?