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Post Colonoscopy Billing Hell
Old 11-09-2011, 09:39 AM   #1
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Post Colonoscopy Billing Hell

Ok, had my fourth of these in the middle of Oct. I item removed for biopsy which was negative. The whole thing was easy....maybe the easiest of the four.

This was my first under Medicare. Before going, I had carefully looked the the medicare.gov website which indeed says that the procedure is covered once every ten years and for those with certain family and personal history more often. It seemed to me that I qualified for the more often, else why was I getting these every 4-5 years. My father died of colon cancer, and some kind of polyp was found in the first one ten years ago.

So, you can imagine my surprise when I received notice that Medicare had declined to pay for my procedure! This would leave me with a bill for $2700.

A call to Medicare revealed that the provider had coded the procedure as "routine", and having had one 5 years earlier, it appeared that I was not eligible. Seems in 1998, after paying for a lot of "unnecessary" colonoscopies, Medicare had instituted new rules and additional coding numbers for these so that only folks who needed them more often that ten years would receive same.

I called the billing office of the provider and suggested they reexamine the coding. They agreed to do so. I also have a call into the Doctor to confirm my "status" as high risk. I mean, if I'm not high risk, why all the procedures?

This is just one more example of the huge problem we as a nation have with our healthcare system.
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Old 11-09-2011, 11:25 AM   #2
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That's awful. After all, why did they think you had the colonoscopy? For fun? I seriously doubt it.

I'm not on Medicare, but my own post-colonoscopy billing hell was enough to make me wonder if I ever want another colonoscopy. I didn't mind paying what I owed, but the insanity of their billing (demanded double payment, many many little bills, etc) was worse than the procedure.
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Old 11-09-2011, 11:35 AM   #3
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Ok, had my fourth of these in the middle of Oct. I item removed for biopsy which was negative. The whole thing was easy....maybe the easiest of the four.

This was my first under Medicare. Before going, I had carefully looked the the medicare.gov website which indeed says that the procedure is covered once every ten years and for those with certain family and personal history more often. It seemed to me that I qualified for the more often, else why was I getting these every 4-5 years. My father died of colon cancer, and some kind of polyp was found in the first one ten years ago.

So, you can imagine my surprise when I received notice that Medicare had declined to pay for my procedure! This would leave me with a bill for $2700.

A call to Medicare revealed that the provider had coded the procedure as "routine", and having had one 5 years earlier, it appeared that I was not eligible. Seems in 1998, after paying for a lot of "unnecessary" colonoscopies, Medicare had instituted new rules and additional coding numbers for these so that only folks who needed them more often that ten years would receive same.

I called the billing office of the provider and suggested they reexamine the coding. They agreed to do so. I also have a call into the Doctor to confirm my "status" as high risk. I mean, if I'm not high risk, why all the procedures?

This is just one more example of the huge problem we as a nation have with our healthcare system.
If the provider recommended you do the procedure, it was absolutely bad coding on their part.
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Old 11-09-2011, 12:32 PM   #4
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Can't blame Medicare for this one--it's your provider.
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Old 11-09-2011, 12:33 PM   #5
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I didn't mind paying what I owed, but the insanity of their billing (demanded double payment, many many little bills, etc) was worse than the procedure.
Yes, we're going through this now with Lena's parathyroid stuff. We get tons of little bills, all with different formats. We got one for $1,300 and when we went to pay it, they said there was an adjustment and now they owe us $439.
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Old 11-09-2011, 12:55 PM   #6
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That's awful. After all, why did they think you had the colonoscopy? For fun? I seriously doubt it.

I'm not on Medicare, but my own post-colonoscopy billing hell was enough to make me wonder if I ever want another colonoscopy. I didn't mind paying what I owed, but the insanity of their billing (demanded double payment, many many little bills, etc) was worse than the procedure.
Yep, you get reamed inside and out.

My first colonoscopy was when I was only 43. At an annual physical the company Doc had persuaded me to have a proctoscope examination and when I did, the colon Doc said he could see a polyp and that I should come back for a colonoscopy. (turns out he was wrong and says that what he saw was a natural shadow cast by the colon - yeah, right!!).

Even though that was 13 years ago I still remember wrangling with the insurance company and Doc's office since they coded it in a way that wasn't clear the colonoscopy was triggered by the earlier proctoscope. In those days routine colonoscopies were not covered by my insurance at that age.
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Old 11-09-2011, 01:14 PM   #7
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I had mine done at the same time as an endoscopy. The dr sent an itemized bill to the insurance co, which refused to pay for 2 prep's. They would only pay for 1. The dr explained that the 2 preps were justified because he had done 2 procedures ( I think he noted that the geographical difference between the procedure locations dictates separate preps). But the insurance co held fast and only paid for one prep since both procedures were done at the same time.
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Old 11-09-2011, 02:36 PM   #8
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.......... But the insurance co held fast and only paid for one prep since both procedures were done at the same time.
So how does that Fleet taste?
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Old 11-09-2011, 03:01 PM   #9
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So how does that Fleet taste?
Going down or coming up?
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Old 11-09-2011, 06:27 PM   #10
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So how does that Fleet taste?
Fleet tasted nasty. The prep the dr was billing for was his work to prep me when i got to the hospital - whatever that was. I already had bought and drank the fleet on my own. I don't want to go through that again, but I'm up gain in 2014.
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Old 11-09-2011, 07:03 PM   #11
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Fleet tasted nasty. The prep the dr was billing for was his work to prep me when i got to the hospital - whatever that was. I already had bought and drank the fleet on my own. I don't want to go through that again, but I'm up gain in 2014.
I've always been under the impression Fleet went in the other end, but whatever...
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Old 11-09-2011, 08:36 PM   #12
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I've always been under the impression Fleet went in the other end, but whatever...
The fleet I took was oral - maybe that's why I was delirious.
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Old 11-09-2011, 10:27 PM   #13
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Same thing happened to a buddy of mine. Took him forever to get it corrected.

Not long ago I had a physical and the doc asked when was the last time I had a colon scope. I told him 5 years and that they said I should come back anywhere from 5 to 10 years. He laughed and said that is one thing about the medical profession, there can be a wide range recommended on certain procedures. I asked him how often he has it done and he said every 10 years. My a$$ instantly unpuckered and so did my wallet.
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