audreyh1
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DH and I have been down a bit of a rabbit hole trying to understand the Medicare billing for a screening colonoscopy DH had early in the year.
We would perhaps have never even noticed except that DH visited an Ophthalmologist late in the year and we were shocked that he hadn’t already met his deductible.
DH has traditional Medicare plus Medigap Plan G.
So it turns out that for the colonoscopy, because they found a polyp and removed it, the charging was different. Nothing was applied to the deductible. Instead DH was charged a 15% coinsurance for the procedure. We had fallen into the Medicare colonoscopy loophole.
So the rate for 2023 the coinsurance was apparently 15%. This silliness will eventually go away but not until 2030.
If it was not applied against our deductible, but instead we were charged a coinsurance amount, why was that not sent to our Medigap insurer for them to pay it? Medicare.gov knows who that is. Is there some other weird related loophole that a Medigap policy doesn’t cover this? Do Plan F insured have to pay out of pocket too?
Another informative reference regarding Medicare coverage for colonoscopy:
Why Did Medicare Charge Me for a Colonoscopy? https://www.verywellhealth.com/medicare-colonoscopy-5120481
We would perhaps have never even noticed except that DH visited an Ophthalmologist late in the year and we were shocked that he hadn’t already met his deductible.
DH has traditional Medicare plus Medigap Plan G.
So it turns out that for the colonoscopy, because they found a polyp and removed it, the charging was different. Nothing was applied to the deductible. Instead DH was charged a 15% coinsurance for the procedure. We had fallen into the Medicare colonoscopy loophole.
From https://www.valuepenguin.com/does-medicare-cover-colonoscopyWhat is the Medicare colonoscopy loophole?
The "Medicare loophole" happens when your routine colonoscopy screening detects medical issues. When that occurs, your test is no longer considered a screening and is no longer free. It then becomes a diagnostic procedure, and you're charged the 20% Medicare coinsurance.
In 2020, a "Medicare loophole" law was passed that protects Medicare patients who get a screening colonoscopy that turns into a diagnostic procedure.
The law, called the Removing Barriers to Colorectal Cancer Screening Act, gradually reduces Medicare patients' coinsurance and will eliminate out-of-pocket costs completely by 2030. The colonoscopy procedure itself will not change, just how patients are billed.
Meanwhile, if you're billed for a colonoscopy screening, you may want to contact your provider or Medicare (at 800-633-4227 or Medicare.gov) to be sure you are charged the correct amount.
So the rate for 2023 the coinsurance was apparently 15%. This silliness will eventually go away but not until 2030.
If it was not applied against our deductible, but instead we were charged a coinsurance amount, why was that not sent to our Medigap insurer for them to pay it? Medicare.gov knows who that is. Is there some other weird related loophole that a Medigap policy doesn’t cover this? Do Plan F insured have to pay out of pocket too?
Another informative reference regarding Medicare coverage for colonoscopy:
Why Did Medicare Charge Me for a Colonoscopy? https://www.verywellhealth.com/medicare-colonoscopy-5120481
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