My $1,000 Colonoscopy

[Dirty Socialist]

I recently had a colonoscopy done and they found a benign polyp. Since they found one, they considered me to have a pre-existing condition. Because of this, the colonoscopy is considered to be diagnostic, not preventative. The insurance company agreed to cover only 1/3 of the procedure. I have to pay over $1,000.
The insurance company (Anthem) has a good thing going!

[Honeycombe8]

1. I had BCBS (Anthem) for years w/the ACA. I was so glad to finally get rid of it...

I qualified for Medicare FINALLY, and look forward to having decent health care. Phew!

[Yo_Mama_Been_Loggin]

2. Interesting -

I have Anthem and didn't have to pay for mine a couple of years ago. I believe the insurance company has to cover it per Obamacare as long as it's part of routine screening.

[Chin music]

3. Right. Bc, who here has had a spotless colonoscopy? (unless you're 18 years old.)

There's almost ALWAYS a polyp.
Hopefully you got a nice set of 'still shots' for the Grand.

[Retrograde]

18. I did

back when I was in my 50s. The doctor's comment was, whatever you're doing keep doing it. It was different in my mid 60s. Even then, though, it was treated as a preventive procedure and didn't cost me anything out of pocket (well, aside from what I pay each month to Medicare and Kaisar)

[Maru Kitteh]

19. I just had one. Nada.

Vegetarian.

[Hassin Bin Sober]

4. That doesn't make any sense.

You have a diagnostic exam when you have a symptom.

You have a preventative exam when you have no symptoms.

You remove a polyp to “prevent” further issues.

[Dirty Socialist]

5. And Another Thing

Since I had a polyp, I will be considered to have a pre-existing condition for the next 10 years, so I will have to pay out the ASS before 2029.

[fescuerescue]

10. Something isn't quite right

Pre-existing conditions are supposed to be irrelevant to health insurance since the ACA.

Not saying they aren't screwing you over, but somthing is getting lost in translation (which happens to the best of us when it comes to insurance confusion)

[bahrbearian]

6. They did that to me too.

[DFW]

7. My nearly fatal colonoscopy

My insurance, who HATES paying for anything, usually is good about colonoscopies. The first time, I had a polyp, none since. With my family history (both parents and all of their siblings had cancer), I don't dare NOT do it. But in 2011, the prep instructions said to go off blood thinners for ten days before the procedure. Due to my heart condition, I have to take them every day. But I stopped for ten day prior. Right after the procedure, i started to feel weak, and soon after was fighting not to lose consciousness. My friends in Dallas drove me to the hospital ER. I slowly started coming to, and my GP was called in. He called a cardiologist who got an immediate blood test and frowned. He was positive I was having a heart attack, but a certain enzyme count that ALWAYS goes up when you're having a heart attack refused to go up. He said to treat me as if I was having a heart attack anyway, which indeed I was (the enzyme count FINALLY went up). One of the stents put in in 2004 had clogged because the white cells that clog up arteries need about ten days to regenerate fully when you go off blood thinners. The cardiologist went nuts on the colonoscopy people. The hospital went in, did an angioplasty and cleared out the clogged stent, and I was out three days after going in. That little episode was billed at $35,500, reduced to $26,000 because I was submitting it to an insurance company (that's how they do it in the States, apparently).

The next time I got a colonoscopy was the usual 5 years later, and the instructions said (SOMEbody was paying attention) if you are taking blood thinners, go off them for FIVE days before the procedure. Other than that just the usual co-pay (and no polyps, and... NO heart attack!)

[lindysalsagal]

12. I'm glad you're ok.

🙂

[DFW]

17. The Grim Reaper was not happy with me

Saint Peter don't you call me, 'cause I can't go.............

[forthemiddle]

8. If there were absolutely no symptoms

And the colonoscopy was scheduled as a routine screening only, call the billing department and ask them to resubmit it with the screening code (Z12.11) as the primary diagnosis and the code for polyp listed secondary (D12.0 - D12.9), and it should be covered.
If on the other hand, you had any symptoms whatsoever, it is no longer considered screening, and won’t be covered under preventive medicine.
They can also try billing the main procedure code with a 33 modifier, but not all insurance recognizes that code.

[Dirty Socialist]

9. I had an endoscopy before the colonoscopy

That's when they found the polyp. Maybe I should not let them give me an endoscopy?

[forthemiddle]

11. Yes

It sounds like they did the colonoscopy because of the polyp, and not to screen if you had one. Sorry,but your probably out of luck.
I know it’s semantics, but but it’s no longer preventative medicine.
As for if you needed the endoscopy, you obviously needed that for another condition, since they aren’t part of any preventative medicine schedule.

[MotorCityMan]

13. My colonoscopy story

So finally I decided to bite the bullet and get a colonoscopy as I was 50 and have a cancer history in my family. Went through it, and the doctor left one polyp in because he wasn't sure and wanted to test it. It tested benign, thank goodness. My cost: $900 with UHC.

SO six months later went through another one so he could get rid of the one he left in. Afterwards, I find out he couldn't remove it as it was on a valve in my colon. Of course, my thought was, you couldn't tell the location the first time? And this was all a waste of time and money? My cost: $950 with UHC.

So next I had to get colonectomy surgery done to remove it. This entailed 5 days recovery in the hospital. They removed it and it was still benign. My cost: $3,600 with UHC.

[area51]

14. Good grief, but I'm glad you're okay.

Please contact your reps about comprehensive Medicare For All, so BS like this can't happen. Also, please ask Speaker Pelosi to support it.

[Hawaii Hiker]

15. Are there any benefits to the far less invasive tests like

the fecal immuenochemistry test or Colo-guard?...

Can either of these replace the colonoscopy?

[Blue_true]

16. Because of my family history, I have had to get my colon checked from a young age.

I vastly prefer the colonoscopy. It takes a day of prep and I need a driver on the day of, but it is efficient and works.

The other tests take something like a week of collecting some of your stole each day and then waiting for results. And it has you on a restricted diet during the collection period.