Not necessarily a fun thing to think about—but when most people turn 50 it is time for them to go and have a colonoscopy to screen for polyps and colon cancer. There are 3 very common errors that we see at Compass as it relates to consumer understanding of the billing related to a screening colonoscopy.
Error #1 – The colonoscopy is screening and therefore will be paid for at 100%.
This is an error, because depending on what is found during the colonoscopy and how the colonoscopy is billed, it could be classified as a ‘Diagnostic Colonoscopy’ and therefore, be subject to deductible and coinsurance. Now some self-funded employers have written their plan documents such that even the diagnostic colonoscopies are covered at 100%, but across our hundreds of thousands of members at Compass, that is a rarity. Almost all full-insured plans in our experience have diagnostic colonoscopies fall to deductible and coinsurance.
Therefore, it is important to understand before your screening colonoscopy, that if the doctor finds a polyp or some other lesion during the procedure, that it is likely that the colonoscopy will be billed as diagnostic and that you will usually have to pay some out of pocket cost—which could be upwards of $4,000, but we’ll get to that later on in the post.
Error #2 – I want to be ‘knocked out,’ but not knowing if it is the gastroenterologist or an anesthesiologist performing the sedation.
This is an error, because the ‘conscious sedation’ for the procedure can be performed by either the gastroenterologist (GI doctor that performs the colonoscopy) or a separate anesthesiologist. If the gastroenterologist performs the conscious sedation, then usually you will not receive an additional bill strictly for the sedation.
However, if a separate anesthesiologist performs the conscious sedation, then you MAY receive a separate bill from the anesthesiologist for the sedation—especially (as described above) if the colonoscopy is not billed as preventive, but rather as diagnostic and therefore subject to deductible and coinsurance. That additional anesthesia bill may be upwards of $800.
The important point here is that most gastroenterologists perform their own conscious sedation for the majority of their colonoscopies and with these physicians performing your procedure, you will not run the risk of the additional bill. However, there are some gastroenterologists who routinely use a separate anesthesiologist to perform the sedation during the procedure.
So how do you know the difference?
You need to ask the gastroenterologists office. They will likely know the answer and will be able to tell you, “if you are not a high-risk patient for sedation, then Dr. So-and-So, the gastroenterologist, will perform the sedation and there will be no additional bill.”
Error #3 – Not realizing that where you schedule your colonoscopy will potentially change your cost.
This is an error because the facility fees are very different depending on which hospital, endoscopy center or ambulatory surgery center you go to. Some facilities cost over $4,000. Others cost $500. I will discuss in a future blog post why this price differential exists, but it is not necessarily because of an objective quality different among the facilities. In fact, often the same gastroenterologist will perform colonoscopies at different facilities depending on what day of the week it is. For example, he may perform procedures at the hospital on Mondays, where the facility fee is $3,800 and at the ambulatory surgery center on Tuesday, where the facility fee is $800.
This fee difference is important—again—because if your colonoscopy is billed as diagnostic, you may have to pay some or all of that cost yourself and that fee difference will affect your out-of-pocket cost.
So if you like your gastroenterologist and you do not want to change doctors, ask the doctor’s office staff if he or she performs procedures at different facilities and if he or she does, then contact the facilities to find out what their colonoscopy fee is—more on how to ask facilities for their fees in a later post as well.
Confused? Don’t worry, most people are. I hope this has at least helped a little to explain some of the nuances around colonoscopy bills and paperwork. What do you think? What are some challenges around medical bills that you have encountered?
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