kewb Posted August 16, 2016 Share Posted August 16, 2016 Let me preface by stating I am thankful I have insurance and for the most part it covers what I need. However, my dh is going for his colonoscopy tomorrow and my insurance informed me that the screening is covered 100% but if they find something and it becomes diagnostic, i.e. removing a polyp then we are responsible for a deductible. I find that so ridiculous. Like the doctor should leave the polyp so we can get pre-approval for the procedure and do it again. These are the moments that leave me shaking my head and laughing at the lunacy. 2 Quote Link to comment Share on other sites More sharing options...
Sharpie Posted August 16, 2016 Share Posted August 16, 2016 (edited) Yes, this is exactly what has happened to us. ETA: Since our deductible was very large, we would have to basically cover it in full. We then inquired a ball park figure and no matter how we phrased it or asked, no one would tell us how much it would cost us. Complete run around. Edited August 16, 2016 by Sharpie Quote Link to comment Share on other sites More sharing options...
Valley Girl Posted August 16, 2016 Share Posted August 16, 2016 Yeah, it makes no sense. After all, the purpose of the screening is to find out if the darn things are there. I could see maybe charging for the actual removal and biopsy of the polyps, but the whole procedure? That's just ridiculous. 1 Quote Link to comment Share on other sites More sharing options...
kewb Posted August 16, 2016 Author Share Posted August 16, 2016 Yes, this is exactly what has happened to us. ETA: Since our deductible was very large, we would have to basically cover it in full. We then inquired a ball park figure and no matter how we phrased it or asked, no one would tell us how much it would cost us. Complete run around. We also have a large deductible. If I have to pay it off over the next ten years, so be it. Quote Link to comment Share on other sites More sharing options...
JustEm Posted August 16, 2016 Share Posted August 16, 2016 Yep ridiculous! My dr wanted to check my vitamin D level but she had give a disclaimer that it is an expensive test and sometimes insurance will only cover if vitamin D levels are in fact low. I thought that was absolutely ridiculous. The point of the test is to determine if it is low. So either cover it or don't under the idea that it is a diagnostic tool. In the end, it turned out my insurance covered it no matter the results but the idea that some don't is silly 2 Quote Link to comment Share on other sites More sharing options...
Guest Posted August 16, 2016 Share Posted August 16, 2016 Yes, so annoying. I was having a covered procedure. I wanted to add an elective procedure (same area, same doctor, same hospital, just getting knocked out once instead of twice). Nope, then I'd have to pay for the covered procedure. But, it would have been cheaper for the insurance company to let me add it to the first procedure! Idiots. Quote Link to comment Share on other sites More sharing options...
Guest Posted August 16, 2016 Share Posted August 16, 2016 I am in appeal currently for that one. The colonoscopy does not suddenly become diagnostic...thats a misinterpretation of the law and there are several FAQs from the govt that clarify. This is a racket so the surgeon gets cash faster. You need to educate yourself, and if the surgeons office wont bill properly you need to appeal and request proper coding.http://clearhealthcosts.com/blog/2016/02/free-colonoscopies-theyre-free/ may be helpful to you. Quote Link to comment Share on other sites More sharing options...
MooCow Posted August 16, 2016 Share Posted August 16, 2016 Yes, this is exactly what has happened to us. ETA: Since our deductible was very large, we would have to basically cover it in full. We then inquired a ball park figure and no matter how we phrased it or asked, no one would tell us how much it would cost us. Complete run around. This happened to us as well. Quote Link to comment Share on other sites More sharing options...
juliebee Posted August 16, 2016 Share Posted August 16, 2016 I know what you mean. My insurance paid 100% for my mammography but paid zero for the diagnostic portion. And when I had my gall bladder removed it was considered "elective surgery" because it wasn't "immediately life threatening." Quote Link to comment Share on other sites More sharing options...
kewb Posted August 16, 2016 Author Share Posted August 16, 2016 I am in appeal currently for that one. The colonoscopy does not suddenly become diagnostic...thats a misinterpretation of the law and there are several FAQs from the govt that clarify. This is a racket so the surgeon gets cash faster. You need to educate yourself, and if the surgeons office wont bill properly you need to appeal and request proper coding.http://clearhealthcosts.com/blog/2016/02/free-colonoscopies-theyre-free/ may be helpful to you. Thank you. This is very helpful. Quote Link to comment Share on other sites More sharing options...
Valley Girl Posted August 16, 2016 Share Posted August 16, 2016 I am in appeal currently for that one. The colonoscopy does not suddenly become diagnostic...thats a misinterpretation of the law and there are several FAQs from the govt that clarify. This is a racket so the surgeon gets cash faster. You need to educate yourself, and if the surgeons office wont bill properly you need to appeal and request proper coding.http://clearhealthcosts.com/blog/2016/02/free-colonoscopies-theyre-free/ may be helpful to you. Just to muddy the water a little further... I went to that link and then to the link under the question about not being allowed to be charged for the pre-screening consult. (I was charged for that initial consult.) I then called my old health insurance company which processed the claim. The rep explained that while that is generally true, employers who self-fund the insurance aren't held to that requirement. While I don't understand all the intricacies of how companies offer/pay for health insurance, I wanted to share this because--like everything else--it apparently isn't an absolute. Quote Link to comment Share on other sites More sharing options...
Miss Tick Posted August 16, 2016 Share Posted August 16, 2016 Yep ridiculous! My dr wanted to check my vitamin D level but she had give a disclaimer that it is an expensive test and sometimes insurance will only cover if vitamin D levels are in fact low. I thought that was absolutely ridiculous. The point of the test is to determine if it is low. So either cover it or don't under the idea that it is a diagnostic tool. In the end, it turned out my insurance covered it no matter the results but the idea that some don't is silly How nice that she mentioned that before you blithely went off and had the procedure done, and then got a surprise in the mail. (grumble, grumble) Quote Link to comment Share on other sites More sharing options...
ktgrok Posted August 16, 2016 Share Posted August 16, 2016 Just to muddy the water a little further... I went to that link and then to the link under the question about not being allowed to be charged for the pre-screening consult. (I was charged for that initial consult.) I then called my old health insurance company which processed the claim. The rep explained that while that is generally true, employers who self-fund the insurance aren't held to that requirement. While I don't understand all the intricacies of how companies offer/pay for health insurance, I wanted to share this because--like everything else--it apparently isn't an absolute. Yes, self funded plans don't have to abide by MANY of the laws regarding insurance. Quote Link to comment Share on other sites More sharing options...
G5052 Posted August 16, 2016 Share Posted August 16, 2016 (edited) I am in appeal currently for that one. The colonoscopy does not suddenly become diagnostic...thats a misinterpretation of the law and there are several FAQs from the govt that clarify. This is a racket so the surgeon gets cash faster. You need to educate yourself, and if the surgeons office wont bill properly you need to appeal and request proper coding.http://clearhealthcosts.com/blog/2016/02/free-colonoscopies-theyre-free/ may be helpful to you. Exactly. I have one scheduled for next week (what joy), and they gave me a handout explaining clearly how they handle this (thankfully the correct way) and encouraging patients who have trouble with their insurance to work with the doctor's office in getting it handled properly if there's a problem. We hit our deductible early in January, and our maximum out-of-pocket in June. So either way, I won't owe because they're in network. Good thing, we're going to be paying on the earlier bills for awhile. A family member has surgery scheduled for later this month with a hospital stay. It took us several weeks to get all of the insurance approvals. Afterwards we see how the bills come out. Edited August 16, 2016 by G5052 Quote Link to comment Share on other sites More sharing options...
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