SteveL
Recycles dryer sheets
- Joined
- Aug 1, 2005
- Messages
- 380
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.
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.