Anonymous
Post 06/01/2024 09:30     Subject: colonoscopy bill for $1500??
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?
Anonymous
Post 06/01/2024 09:23     Subject: Re:colonoscopy bill for $1500??
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
Post 06/01/2024 09:20     Subject: colonoscopy bill for $1500??
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
Post 05/31/2024 22:17     Subject: colonoscopy bill for $1500??
NP. So because I had polyps at my first one, I have to pay $1500 for the next one?
Anonymous
Post 05/31/2024 22:08     Subject: colonoscopy bill for $1500??
Even if it were diagnostic that's high, no?
Anonymous
Post 05/31/2024 22:07     Subject: colonoscopy bill for $1500??
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
Post 05/31/2024 22:04     Subject: colonoscopy bill for $1500??
Did you go out of network by accident?
Anonymous
Post 05/31/2024 21:59     Subject: colonoscopy bill for $1500??
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
Post 05/31/2024 21:49     Subject: Re:colonoscopy bill for $1500??
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
Post 05/31/2024 20:19     Subject: Re:colonoscopy bill for $1500??
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
Post 05/31/2024 19:58     Subject: colonoscopy bill for $1500??
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
Post 05/31/2024 19:55     Subject: colonoscopy bill for $1500??
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
Post 05/31/2024 19:45     Subject: colonoscopy bill for $1500??
Did they find polyps last time? Because then it's probably not considered a screening this time.
Anonymous
Post 05/31/2024 19:42     Subject: colonoscopy bill for $1500??
Did you have a deductible to meet before it's "100% covered"?
Anonymous
Post 05/31/2024 19:38     Subject: colonoscopy bill for $1500??
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?