Fermion
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
My wife and I recently had our age 50+ colonoscopy done.
Neither of us had any pre-existing conditions, previous tests, stool samples, etc.
My procedure had no issues, no polyps found and I was charged $0, all covered under insurance.
My wife's procedure they removed 2 benign polyps and she was charged $550 into our copay because of the polyp removal. They essentially changed the procedure from a screening to a diagnostic while she was under anesthesia.
I had thought and was told colonoscopy was covered 100% if there had not been any previous history or tests and you were of the right age and other factors.
I contacted the hospital and they are sticking by the codes they filed for the procedure and told me to contact my insurance company. I have not made progress with the insurance company as of yet.
Is this correct under current law? Does a procedure change because of the discovery of polyps? I can understand it changing for the next time you have a colonoscopy, but does it change while you are under?
edit: I found this on cancer.org
"Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a ‘screening’ test if a polyp was removed during the procedure. It would then be a ‘diagnostic’ test, and would therefore be subject to co-pays and deductibles. However, the US Department of Health and Human Services has clarified that removal of a polyp is an integral part of a screening colonoscopy, and therefore patients with private insurance should not have to pay out-of-pocket for it (although this does not apply to Medicare, as discussed below)."
Neither of us had any pre-existing conditions, previous tests, stool samples, etc.
My procedure had no issues, no polyps found and I was charged $0, all covered under insurance.
My wife's procedure they removed 2 benign polyps and she was charged $550 into our copay because of the polyp removal. They essentially changed the procedure from a screening to a diagnostic while she was under anesthesia.
I had thought and was told colonoscopy was covered 100% if there had not been any previous history or tests and you were of the right age and other factors.
I contacted the hospital and they are sticking by the codes they filed for the procedure and told me to contact my insurance company. I have not made progress with the insurance company as of yet.
Is this correct under current law? Does a procedure change because of the discovery of polyps? I can understand it changing for the next time you have a colonoscopy, but does it change while you are under?
edit: I found this on cancer.org
"Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a ‘screening’ test if a polyp was removed during the procedure. It would then be a ‘diagnostic’ test, and would therefore be subject to co-pays and deductibles. However, the US Department of Health and Human Services has clarified that removal of a polyp is an integral part of a screening colonoscopy, and therefore patients with private insurance should not have to pay out-of-pocket for it (although this does not apply to Medicare, as discussed below)."
Last edited: