FIREd_2015
Recycles dryer sheets
I thought I'd share my recent experience in case someone else is considering getting colon cancer screening done under ACA.
I have the Blue Shield Bronze plan so my annual deductible is $7550. I went in recently for my annual check up and asked my Primary Care Doc about colon cancer screening since I'm overdue by 9 years. I was hesitant to get a colonoscopy and wanted to do a stool test instead partly because I've read stories including on this forum of others getting charged several thousand dollars if polyps are found. I told my Doc that I've been buying the retail test kits available from Walgreen and they've always come back negative but I've read that they weren't that accurate. The Doc said colonoscopy is the gold standard and by far the best way to screen for colon cancer. So I relented and agreed to do a colonoscopy and accepted the fact that because I have the Bronze plan I may have to shell out several thousand dollars.
When I got home, I started researching colonoscopies and found that under ACA rules, a screening colonoscopy should be fully covered as preventive without any co-pay including removal of polyps, sedation and biopsies. However, if I had opted for a stool test and it came back positive then I would have to have a colonoscopy which then becomes a diagnostic test and my $7550 deductible would apply before any coverage kicked in. So I was happy my Doc talked me into a colonoscopy. I then called my insurance carrier and asked if removal of polyps would be covered and was told no - the insurance would only cover screening but not removal of polyps. I decided to go ahead with the procedure anyway hoping they would not find any polpys.
During the colonoscopy they found and removed 4 polyps. The bill for the procedure was over 9 thousand dollars. As expected, Blue Shield did not cover the removal of the polyps or all of the sedation and facility costs and wanted me to pay over $2000. I did some more research and found several official government documents and websites stating that everything should be covered. I called Blue Shield and told the rep that all the official documents and even a Blue Cross Blue Shield FAQ from New Mexico stated it should be fully covered. The Rep said that Blue Shield of CA is not related to New Mexico insurance plans. I responded by saying ACA applies equally to every insurance carrier. It doesn't matter if you are Blue Shield, Blue Cross, Aetna or whoever since it's a federal program and I'm pretty sure that California did not get an exception to the rules so I disagree with your denial of coverage and would like to file an appeal. After being on hold for several minutes the rep came back and said Blue Shield could do a one time exception to cover all the expenses. I said great as long as it covered all of the charges related to the colonoscopy since some of the charges had not shown up in their system yet. The rep said they would put a note in my file so that pending charges would also be covered.
Ironically, I met a Blue Cross customer service rep from another State the day after my phone call with Blue Shield and I told this rep about my encounter. The rep said that patients really need to do their homework otherwise they are liable to end up paying for services that should be covered.
I have the Blue Shield Bronze plan so my annual deductible is $7550. I went in recently for my annual check up and asked my Primary Care Doc about colon cancer screening since I'm overdue by 9 years. I was hesitant to get a colonoscopy and wanted to do a stool test instead partly because I've read stories including on this forum of others getting charged several thousand dollars if polyps are found. I told my Doc that I've been buying the retail test kits available from Walgreen and they've always come back negative but I've read that they weren't that accurate. The Doc said colonoscopy is the gold standard and by far the best way to screen for colon cancer. So I relented and agreed to do a colonoscopy and accepted the fact that because I have the Bronze plan I may have to shell out several thousand dollars.
When I got home, I started researching colonoscopies and found that under ACA rules, a screening colonoscopy should be fully covered as preventive without any co-pay including removal of polyps, sedation and biopsies. However, if I had opted for a stool test and it came back positive then I would have to have a colonoscopy which then becomes a diagnostic test and my $7550 deductible would apply before any coverage kicked in. So I was happy my Doc talked me into a colonoscopy. I then called my insurance carrier and asked if removal of polyps would be covered and was told no - the insurance would only cover screening but not removal of polyps. I decided to go ahead with the procedure anyway hoping they would not find any polpys.
During the colonoscopy they found and removed 4 polyps. The bill for the procedure was over 9 thousand dollars. As expected, Blue Shield did not cover the removal of the polyps or all of the sedation and facility costs and wanted me to pay over $2000. I did some more research and found several official government documents and websites stating that everything should be covered. I called Blue Shield and told the rep that all the official documents and even a Blue Cross Blue Shield FAQ from New Mexico stated it should be fully covered. The Rep said that Blue Shield of CA is not related to New Mexico insurance plans. I responded by saying ACA applies equally to every insurance carrier. It doesn't matter if you are Blue Shield, Blue Cross, Aetna or whoever since it's a federal program and I'm pretty sure that California did not get an exception to the rules so I disagree with your denial of coverage and would like to file an appeal. After being on hold for several minutes the rep came back and said Blue Shield could do a one time exception to cover all the expenses. I said great as long as it covered all of the charges related to the colonoscopy since some of the charges had not shown up in their system yet. The rep said they would put a note in my file so that pending charges would also be covered.
Ironically, I met a Blue Cross customer service rep from another State the day after my phone call with Blue Shield and I told this rep about my encounter. The rep said that patients really need to do their homework otherwise they are liable to end up paying for services that should be covered.