The Kaiser Family Foundation just published an interesting analysis of colonoscopy billing issues under the PPACA. Colonoscopies are one of the preventive screenings that are supposed to be covered without copay, deductible or any cost sharing. People take the test and in some cases are still being required to pay. This paper (here) explains what and why.
In summary, it breaks down the cases where unexpected billing occurs to three categories: 1) when a polyp is detected and removed during a screening colonoscopy; 2) when a colonoscopy is performed as part of a two-step screening process following a positive stool blood test; and 3) when the individual is at increased risk for colorectal cancer and may receive earlier or more frequent screening compared with average risk adults. It then attributes the billing to two causes: 1) how the insurance companies interpret and implement the PPACA mandate and 2) how the doctor or service provider codes the procedure.
The charges here can be substantial, and similar confusion could be expected from other preventive screenings. Some insurance companies appear to follow very narrow interpretations and their users may face more unexpected costs.
In summary, it breaks down the cases where unexpected billing occurs to three categories: 1) when a polyp is detected and removed during a screening colonoscopy; 2) when a colonoscopy is performed as part of a two-step screening process following a positive stool blood test; and 3) when the individual is at increased risk for colorectal cancer and may receive earlier or more frequent screening compared with average risk adults. It then attributes the billing to two causes: 1) how the insurance companies interpret and implement the PPACA mandate and 2) how the doctor or service provider codes the procedure.
The charges here can be substantial, and similar confusion could be expected from other preventive screenings. Some insurance companies appear to follow very narrow interpretations and their users may face more unexpected costs.