Issues regarding colonoscopy coverage under the PPACA

[Free To Canoe]

If we can learn one thing from Michael's initial post, it may be that we should do a lot of research before undergoing any kind of test or procedure.

The link to the PPACA information points up the reason that Healthcare is a 24,000 page package, and reading the "specifics" is so important. Naturally no one will ever "know" what's in the healthcare laws, but when it comes to the details, the time spent "Googling" the details, could pay off big time.

As a colon cancer survivor, this particular issue is very interesting.

We begin everything that has to do with health... by researching on-line. Before a doctor visit for any reason, we spend as much time as necessary (hours sometimes) researching the reason(s) we're looking for help. No one knows your body better than you do, so looking up symptoms, or following through on suspicions online, gives the doctor a jump start, and saves time.

Researching procedure costs by searching "cost of lumpectomy" (for instance) often brings up interesting results, such as whether a procedure or test can be done in a clinic or as an outpatient.

The maze of government regulations is usually there for a reason. Without regulation we are all subject to being overcharged. Those who suggest that regulation is always "too much" should consider what living in an uncontrolled society might be. We have a chance of staying ahead of the game, by looking before we spend.

+1
Well stated. After some initial surprises, we also take this approach.

 

[JoeWras]

Joe, one thing is for sure which I have learned through this forum, is on top of all of it now, you have to be an expert in understanding billing coding. I will have to make sure I know the right questions to ask and prove they answered them correctly. Punching in an unfavorable code, can evidently hit a person in the wallet hard.

I made the mistake of not asking any questions before the procedure, and being too quick to get out of there. But I got lucky...

So, it turns out the good doc's office knows what they are doing and pressed the right buttons to spit out a correct billing code to my insurance. Despite the fact that doc snipped a polyp, insurance covered it 100%. This was even after I called my insurance earlier and they warned I might get an extra charge for the snip. I am still awaiting pathology which I know I'll be charged for. That's OK.

Overall, I'm very surprised and pleased.

However, since I'll have follow-ups to deal with, I'll be paying for those under my high deductible plan. It is OK, maybe in the neighborhood of $1k. I just consider it like a car repair. Like I've said before, I see too many people put out huge bucks on their car repair but refuse to go to the doctor because they "may have to pay."

 

[perrytime]

I went for initial consult today, I have individual 10k deductible policy, and by there own admission, if they remove a polop, proceedure turns diagnostic and not 100% covered, but a call to supposedly informed person at place doing procedure got me little info, seems it is impossible to nail down what cost will be. They did say I would be billed at a percentage of agreed to rates (Aetna).
Let to me to believe will be under $1k. I had thought of waiting till next year, assuming I am forced into a more expensive better plan, but at 55 and never had it done before, i just want to get it over with.