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Colonoscopy cost in this area
Old 12-20-2014, 04:07 PM   #1
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Colonoscopy cost in this area

My recent Colonoscopy charges/allowed figures are in and I find it interesting.


"Amount Billed" includes Biopsy (2), anesthesia, Lab Work, End Procedure, Med Office = $3765

"Amount Paid" by Medicare/Tricare =$948.27.

Fortunately, my only out of pocket expense was $17 co-pay for Osmoprep.

I wonder who pays the full "retail" price?
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Old 12-20-2014, 04:56 PM   #2
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I think a colonoscopy is 'preventative', which means free. An ACA requirement is that preventive visits are covered 100%.

If you did not have insurance, maybe you pay fill price?
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Old 12-20-2014, 05:07 PM   #3
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I think once a polyp is found it is than "diagnostic" and you may be charged.

" Your doctor wants to screen for signs of colorectal cancer based on your age or family history. If a polyp is found and removed during your preventive colonoscopy, the colonoscopy and polyp removal are preventive. If the polyp is sent for lab testing, the testing is considered diagnostic."

- See more at: Preventive vs. diagnostic care | Priority Health
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Old 12-20-2014, 05:30 PM   #4
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Quote:
Originally Posted by mickeyd View Post
My recent Colonoscopy charges/allowed figures are in and I find it interesting.


"Amount Billed" includes Biopsy (2), anesthesia, Lab Work, End Procedure, Med Office = $3765

"Amount Paid" by Medicare/Tricare =$948.27.

Fortunately, my only out of pocket expense was $17 co-pay for Osmoprep.

I wonder who pays the full "retail" price?
Answer the uninsured, and those out of network. Medical pricing is a lot like hotel pricing lots of different rates for the same proceedure.
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Old 12-20-2014, 06:25 PM   #5
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For mine, about $10,000 billed, (surgical center was the biggest at $7300, Dr., Anesthesiologist, pathology were around $1000 each give or take a bit. Insurance paid about $2000. I paid 0.

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Old 12-20-2014, 07:20 PM   #6
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Originally Posted by grasshopper View Post
I think once a polyp is found it is than "diagnostic" and you may be charged.

" Your doctor wants to screen for signs of colorectal cancer based on your age or family history. If a polyp is found and removed during your preventive colonoscopy, the colonoscopy and polyp removal are preventive. If the polyp is sent for lab testing, the testing is considered diagnostic."

- See more at: Preventive vs. diagnostic care | Priority Health
Here is an interesting article by the Kaiser Family Foundation:

Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit – Report – 8351 | The Henry J. Kaiser Family Foundation

"Claims submitted to a health insurer for reimbursement must be accompanied by billing codes that identify the service provided. So far, no consistent coding methodology is used either by all private insurers or providers to identify the preventive care and screening services that must be provided without cost-sharing as a result of the ACA. As one billing expert noted, this isnít surprising if one considers that the current coding methodologies were first developed when health insurance tended not to cover preventive care."/snip

The entire article is worth a read.
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Old 12-21-2014, 07:39 AM   #7
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Originally Posted by meierlde View Post
Answer the uninsured, and those out of network. Medical pricing is a lot like hotel pricing lots of different rates for the same procedure.
They can still negotiate a discount with the provider.
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Old 12-24-2014, 03:30 PM   #8
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Yeah, this makes me nervous because I'm up for another one next year and have a $6K deductible on my HDHP. Having a history of polyps (nothing serious), I suspect it will be coded diagnostic rather than preventative.


I'm hoping that the negotiated rate with my health insurer will be something less than the sticker price but will be thoroughly researching it beforehand. I don't want to change docs; I like this one and a HS classmate died from an intestinal perforation during a colonoscopy. Don't want to get cheap.
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Old 12-24-2014, 11:00 PM   #9
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Originally Posted by athena53 View Post
Yeah, this makes me nervous because I'm up for another one next year and have a $6K deductible on my HDHP. Having a history of polyps (nothing serious), I suspect it will be coded diagnostic rather than preventative.


I'm hoping that the negotiated rate with my health insurer will be something less than the sticker price but will be thoroughly researching it beforehand. I don't want to change docs; I like this one and a HS classmate died from an intestinal perforation during a colonoscopy. Don't want to get cheap.


Check your insurance web site... Mine will give cost estimates for various docs... I was surprised on how big a difference there was in the same procedure... I am talking 5X for some when I stopped looking...
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