Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I have a colon condition so my colonoscopies are never considered to be screening any more. But I’ve been in the waiting room and heard the staff inform many, many patients that while it may be considered a screening colonoscopy when you go in, if they find anything then it automatically becomes a diagnostic colonoscopy, and they will be charging you.
I have a colon condition so my colonoscopies are never considered to be screening any more. But I’ve been in the waiting room and heard the staff inform many, many patients that while it may be considered a screening colonoscopy when you go in, if they find anything then it automatically becomes a diagnostic colonoscopy, and they will be charging you.
My insurance covers the screening part 100%. When they found a polyp and did the biopsy, then that is what they charged me for. Not the original procedure.
Definitely not true. For CPT codes (doc services) there are detailed instructions. Codes chosen must be supported by medical records, and can be audited.
Maybe you can clarify a confusing issue I have. I offer a fully funded health care plan to my employees. Per the administrator of the plan, starting in 2017 the regulations say that if a person goes in for a colonoscopy that is strictly diagnostic from the start, and something if found, it's no longer coded as diagnostic but remains preventive for the colonoscopy procedure. Everything else is regular billing. Is this universal, only for employer plans, or is it just a function of the plan I selected? Another business colleague said they were told the same but many providers haven't been told how code the claim.
We all go through similar crap. I had a colonoscopy last year and it was fully covered. OK no problem but they found one polyp and did a biopsy on it and since my deductible was high and this was considered diagnostic (not covered) I had to foot the bill for a total of $3600. We'll see how quickly they get their money.. I started paying them $25 a month, lol and I forget to pay on some months. They will eventually eat it and the only reason I'm paying anything at all is I do not want it to show up on my credit report.
Sounds like that one polyp made all the difference in which way the coverage and costs went. Sure sounds suspicious; only one to remove. If there were many that'd be one thing, and point to a higher risk. But just one? Sounds like they had an agenda and plan, and did the little necessary to make the difference in their financial favor.
I'm getting the impression these things are pushed more for money-making than true prevention and screening. The doctor pushes it and says if clear it's fully covered, the insurance is mute in the background. Then the work is performed and "Oh, we found something". Then the insurance company steps out of the shadows with the bill. It's probably huge business for doctors and insurance companies.
Sounds like that one polyp made all the difference in which way the coverage and costs went. Sure sounds suspicious; only one to remove. If there were many that'd be one thing, and point to a higher risk. But just one? Sounds like they had an agenda and plan, and did the little necessary to make the difference in their financial favor.
I'm getting the impression these things are pushed more for money-making than true prevention and screening. The doctor pushes it and says if clear it's fully covered, the insurance is mute in the background. Then the work is performed and "Oh, we found something". Then the insurance company steps out of the shadows with the bill. It's probably huge business for doctors and insurance companies.
This is not my experience. two colonoscopies 12 years apart. Nothing found in either procedure. Note that polyps are photographed before removal. Hard to fake for money. Note too that the procedure has been very successful in finding early cancers, and removing pre-cancerous polyps seems to lower the risk.
Sounds like that one polyp made all the difference in which way the coverage and costs went. Sure sounds suspicious; only one to remove. If there were many that'd be one thing, and point to a higher risk. But just one? Sounds like they had an agenda and plan, and did the little necessary to make the difference in their financial favor.
I'm getting the impression these things are pushed more for money-making than true prevention and screening. The doctor pushes it and says if clear it's fully covered, the insurance is mute in the background. Then the work is performed and "Oh, we found something". Then the insurance company steps out of the shadows with the bill. It's probably huge business for doctors and insurance companies.
1. Not all colon polyps become cancerous but all colon cancers begin as a polyp, so it only takes ONE.
2. What exactly is suspicious about having ONLY ONE? Oh right, NOTHING at all suspicious in fact not at all uncommon to find one or two polyps...agenda and plan?? Seriously??
3. Your second paragraph of paranoia makes ZERO sense...
First off, doctors don't usually tell a patient ANY procedure or test is "fully covered" since that is an insurance decision not a MD decision and everyone has different insurances and different coverages
Secondly, the insurance company isn't "hiding in the shadows"??? What is that even supposed to mean??
If a gastroenterologist performs a colonoscopy he is getting paid one way or another either from insurance or the patient. The doc has nothing to gain by saying "We found something"
How exactly is this "big business" for insurance companies?? You realize the ultimate goal for insurance companies is NOT to pay money right? They don't make money off of colonoscopies....
If you have insurance and you have a colonoscopy, the insurance company is PAYING money for the procedure, if you end up paying a deductible the insurance company PAYS a little less but they are still PAYING the majority of the bill.
I am never in the business of defending insurance companies but the idea that insurance companies MAKE money off of medical procedures demonstrates a complete lack of understanding of how insurance works...
1. Not all colon polyps become cancerous but all colon cancers begin as a polyp, so it only takes ONE.
2. What exactly is suspicious about having ONLY ONE? Oh right, NOTHING at all suspicious in fact not at all uncommon to find one or two polyps...agenda and plan?? Seriously??
3. Your second paragraph of paranoia makes ZERO sense...
First off, doctors don't usually tell a patient ANY procedure or test is "fully covered" since that is an insurance decision not a MD decision and everyone has different insurances and different coverages
Secondly, the insurance company isn't "hiding in the shadows"??? What is that even supposed to mean??
If a gastroenterologist performs a colonoscopy he is getting paid one way or another either from insurance or the patient. The doc has nothing to gain by saying "We found something"
How exactly is this "big business" for insurance companies?? You realize the ultimate goal for insurance companies is NOT to pay money right? They don't make money off of colonoscopies....
If you have insurance and you have a colonoscopy, the insurance company is PAYING money for the procedure, if you end up paying a deductible the insurance company PAYS a little less but they are still PAYING the majority of the bill.
I am never in the business of defending insurance companies but the idea that insurance companies MAKE money off of medical procedures demonstrates a complete lack of understanding of how insurance works...
Stop. Don't confuse us with facts and logic.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
