reducing medical bill

[retire-early]

I had a colonscopy done in August.

amount billed : $12484
amount allowed: $ 2840.83
amount owed: $ 7315


What can I do to bring down the $7315?

I am in panic mode.

 

[PaunchyPirate]

Do you disagree with the amount based upon your understanding of your insurance coverage? That number seems high, but it can vary greatly by location and providers.

 

[38Chevy454]

Did you go through your insurance? If so then it should have a reduced amount owed after adjustments since the provider has negotiated amount for a given procedure. Unless you did not go through a provider in the insurance network?

Did you just have this done recently? If so wait a little and see what the insurance actually paid and what they say you owe. The ins co sends you an "explanation of benfits" that shows the revised amounts. Not what the provider says right now before the insurance process is completed.

The other thing you can do if the $7315 is in fact what they are requiring you to pay is call and negotiate yourself. You can get the amount reduced by considerable amount if you call and discuss, especially if you can make a one-time payment where they accept as paid in full at the reduced amount.

 

[RetiredHappy]

I assume this is not a preventative colonoscopy as it is free.

Was this sent out by the insurance company to you or by the provider? A bill sent by the insurance company should show "negotiated" amount, and your share of cost. If this is sent out by the provider, you need the insurance company copy to see what you should have been billed. If insurance company shows the same amount, you need to call the provider to negotiate down the amount.

 

[Aerides]

was this a standard colonoscopy? Aren't those basically free on most insurance plans now? I don't have any payment on those unless it becomes diagnostic (ie polyp removals).

If you've received the bill, call your insurance first thing.

 

[retire-early]

I think the problem is that the hospital listed the date as 8/9 whereas the actual date of the colonscopy is 8/11.

the code M007a =
THIS SERVICE IS NOT PAID. THE MEMBER HAS EXCEEDED THE 1 VISIT LIMIT FOR COLORECTAL (ROUTINE/AGE 50+) ALLOWED PER CALENDAR YEAR UNDER THEIR HEALTH BENEFIT PLAN.

 

[PaunchyPirate]

I think the problem is that the hospital listed the date as 8/9 whereas the actual date of the colonscopy is 8/11.

the code M007a =
THIS SERVICE IS NOT PAID. THE MEMBER HAS EXCEEDED THE 1 VISIT LIMIT FOR COLORECTAL (ROUTINE/AGE 50+) ALLOWED PER CALENDAR YEAR UNDER THEIR HEALTH BENEFIT PLAN.

Does your insurance cover an annual colonoscopy? Did you just have one a year earlier? That’s very frequent by most standards I have seen. Usually they are every 5-7 years after the age of 50.

But, yes, if your insurance will cover one every year, and you waited a year, it sounds like you need to have the provider correct the date.

 

[MRG]

Call and ask them. Listen carefully to what they tell you any options.

I had a procedure done out of state because I couldn't do the travel the insurance company required. I called and they would give me 5% discount to pay now or apply for financial aid.... A couple of forms backed by two years tax returns and poof the bill disappeared.

 

[retire-early]

Does your insurance cover an annual colonoscopy? Did you just have one a year earlier? That’s very frequent by most standards I have seen. Usually they are every 5-7 years after the age of 50.

But, yes, if your insurance will cover one every year, and you waited a year, it sounds like you need to have the provider correct the date.

No. The last one I had was 6 years ago.
I think the insurance company is confused by the hospital's billing
8/9 was the Covid test.
But for some reasone the line for Diagnostic Colonoscopy also lists 8/9.
Then everything else for the colonoscopy lists 8/11.
I am thinking this is what is prompting this confusion.

 

[Bamaman]

You might start by talking to the insurance company. Most endoscopic clinics get prior approval before doing any procedures. And even then, they most often have already negotiated a price. There may be a chance that the hospital or clinic hasn't fully processed the transaction in their books.

$12K? Last time I had a colonoscopy, it was more like $5K.

Where so many people today get caught on billings is services done by independent physicians like Anesthesiologists and Emergency Room doctors. Most hospitals contract out such work, and the doctors don't accept Medicare and especially Medicaid.

I have a close friend that works in a large hospital endoscopic clinic. They do 115 procedures daily at their main location and about 50 at a secondary clinic. It's the hospital's largest profit department, and their nurses are making $6 figures.

 

[grasshopper]

Something seems wrong here. I was required to test for covid before my colonoscopy in March. I think they screwed the dates up. Mine on Medicare and Supp G came to $0.

 

[mystang52]

All insurance companies have an appeal process. Send in an appeal, and point out the correct 8/11 date.
Also, if your doctor is approved by your insurer, then that typically means he/she is contractually obligated to accept the insurer's "allowed amount." That allowed amount, less the insurer's contractual payment, would be your legal obligation.
A lot of moving parts here, so go one step at a time:
1) Does the 8/11 date have any effect on the insurer's payment amount?
2) Is your doctor a participating doctor with your insurer?
3) Wait for the EOB to see breakdown of billed, allowed amount, and insurer payment
4) Must your doctor, according to the terms of your insurance, accept the allowed amount as payment in full?

Finally, keep in mind doctors' billing practices often routinely send a balance due bill before the insurance process has been completed.

 

[Aerides]

But for some reasone the line for Diagnostic Colonoscopy also lists 8/9.

It might be the dates, but it might well be the coding as Diagnostic. A preventative one - normal, every 5 years or so - would leave you with no charge.

Were polyps removed? That would change it to Diagnostic. But yes, you need to call the insurance company first and ask what gives.

 

[jollystomper]

I think the problem is that the hospital listed the date as 8/9 whereas the actual date of the colonscopy is 8/11.

the code M007a =
THIS SERVICE IS NOT PAID. THE MEMBER HAS EXCEEDED THE 1 VISIT LIMIT FOR COLORECTAL (ROUTINE/AGE 50+) ALLOWED PER CALENDAR YEAR UNDER THEIR HEALTH BENEFIT PLAN.

You have their explanation here, so call the insurance company and ask them to elaborate so that you can clarify things. I have have similar denials that once contacted were always resolved in my favor, and many times were the result of either a data entry error or missing info from the doctor (and was often resolved before an actual bill was issued).

 

[retire-early]

You have their explanation here, so call the insurance company and ask them to elaborate so that you can clarify things. I have have similar denials that once contacted were always resolved in my favor, and many times were the result of either a data entry error or missing info from the doctor (and was often resolved before an actual bill was issued).

I called the insurance company this morning.
After some discussion, he thought that the hospital would need to re-submit the bill.
He puts me on hold and he calls the hospital.
After a long wait, he tells me that the hospital told him that I did not have an outstanding bill for the colonoscopy. Yay!

I am still not sure what happened.

I tend to get stressed out by things like this, so I did not sleep well last night.

 

[MRG]

I called the insurance company this morning.

After some discussion, he thought that the hospital would need to re-submit the bill.

He puts me on hold and he calls the hospital.

After a long wait, he tells me that the hospital told him that I did not have an outstanding bill for the colonoscopy. Yay!



I am still not sure what happened.



I tend to get stressed out by things like this, so I did not sleep well last night.

The mystery of medical billing.

Likely already resolved by the provider and you were provided an "old picture" via the bill. If possible it's best to call the provider before losing sleep.

 

[athena53]

I tend to get stressed out by things like this, so I did not sleep well last night.

A surprise bill of $7,000 would stress any of us out- even if you can handle it there are a lot more fun things to do with $7,000 than pay a surprise medical bill.

I'm glad you got it resolved!

 

[oldphd]

A surprise bill of $7,000 would stress any of us out- even if you can handle it there are a lot more fun things to do with $7,000 than pay a surprise medical bill.

I'm glad you got it resolved!

Several years ago, DW had open heart surgery for mitral valve repair. They got a predetermination for a couple of different codes based on the imaging tests they'd done. Turns out that they needed to do something different once they got in there and could see it first hand.

My first EOB from the insurance company had a bill for something in the range of $150K+, followed by "coverage denied". Thought I was going to be the one needing heart work after reading that!

They got the code adjusted and all was well, so we owed a more reasonable amount.

 

[braumeister]

Several years ago, DW had open heart surgery for mitral valve repair. They got a predetermination for a couple of different codes based on the imaging tests they'd done. Turns out that they needed to do something different once they got in there and could see it first hand.

Somewhat similar, my doc wanted me to get a stress echo a few years ago to rule something out, so he had his office folks make a phone call to check that it would be covered. The answer was no, and it would have cost me a couple thousand bucks, so he told them to just keep trying different code combinations until they got it covered.

I stood there watching while one person was on the phone with somewhere, her partner was on the phone with another office, and they were both frantically keyboarding and looking at each other's screens. It was about 15 minutes of activity but they finally got it figured out and told me not to worry about paying anything. A very impressive performance!

 

[retire to nature]

I called the insurance company this morning.
After some discussion, he thought that the hospital would need to re-submit the bill.
He puts me on hold and he calls the hospital.
After a long wait, he tells me that the hospital told him that I did not have an outstanding bill for the colonoscopy. Yay!

I am still not sure what happened.

I tend to get stressed out by things like this, so I did not sleep well last night.

These mistakes are so often. I had OB/GYN procedure and got $30k bill after I paid $800 initially. it turned out they made a mistake. Not many people would sleep well like your case.

 

[Clover5]

We live in Mexico but go to states for major surgery and treatment. That said, my sister tore an arm muscle and went to the emergency room here at a private hospital. $117.00 USD for emergency services, nurse, X-ray, Dr, sling for arm and drugs. Colonoscopy’s run north of $600. A CT scan is about 100$, full blood panel $25.00 and on and on. These are out of pocket with no insurance, US numbers are so far past ridiculous that it’s just insane.

Granted I would not treat cancer or do open heart here but they have first class stabilization for strokes and heart that we can use before we head north.

 

[retire-early]

The USA is at the top for extraordinary medicine.

But if you want something "simple", the cost is outrageous in the USA.