The Cost of a Walk on the Safe Side

[captainsblog]

Our gastroenterologist called late yesterday. I'm scheduled for my second colonscopy a week from Saturday; Eleanor's went just fine a few weekends ago, and her insurance covered it in full with no deductible or co-pay because her previous one five years ago had shown some minor stuff.

Mine, last time, was perfectly fine, and I have no family history of it that I know of- so my insurance considers it premature (the standard is every ten years absent either identified issues or history), but it will cover it, subject to me picking up the whole cost of it against my $2,000 deductible.

At least I know what I'm looking at (see what I did there?), since I have Eleanor's paid bills to go by.  The Doc gets $750 for lookin' around, and the anaesthesiologist gets another $500.  That's more than half what we've got in our health savings account right now; so far, I've only paid for prescriptions out of there for this calendar year, so if I don't incur any major expense, I can roll those funds over to next year for things like getting my hearing or teeth improved upon.

This morning, I decided to schedule a consult with the doctor first- explain what possible issues I'm having and whether they're anything that's likely to be diagnosed through the procedure.  He may be able to do some less invasive looking or testing and get to the answer.  If we still think it would be advisable, I'm still scheduled for a week from Saturday.

The scary thing is how random the cost variation is.  I honestly don't know if there's any family history; most of my relatives passed long before these screenings became the routine thing they now are.  I may check with my sister to see if she knows of anything.  Given such a major cost difference, there's incentive to answer that question differently than I did; I just have much bigger incentives not to do that.

Meanwhile, my GP is bugging me to come in just because one of my maintenance scrips is up and he wants to check my BP before giving me six more months of the stuff.  And let's not even talk about how late I am getting back to the dentist.

Comments

[greenquotebook.livejournal.com]

Any particular reason why you're getting the test early? If you've been having symptoms (bleeding, pain, change in bowel habits, etc) or learned of family history (or have a family member who is newly diagnosed) you can appeal the coverage decision on that basis. I got UHC to pay for an early mammogram for me based on my family history of girly cancer.

[glenmarshall.livejournal.com]

The price of medical procedures varies wildly. You are more likely to be charged the reduced rate that your insurance has negotiated, rather the the posted price. Actually, you should insist on that, since it is covered even if you have to pay.

An alternative is a CT "virtual" colonoscopy, where they simulate a journey through your nether regions based on a CT scan. If that procedure finds polyps, than an actual colonoscopy will follow to deal with it -- paid by insurance since there are findings. I do not know the relative costs, but I bet the virtual one is cheaper.

Medical care is not consumer-friendly.

[khuckie.livejournal.com]

Not exactly. As far as I can tell, virtual colonoscopy is seldom covered by insurance due to it not being considered a "gold standard" test. A local center here offers it out of pocket for $575. If they did find something, the colonoscopy goes from screening (which is covered 100%-as long as the timing interval is correct) to diagnostic which is then subject to your deductible. I would say your best bet would be exactly what you're doing, seeing the doc, seeing what they recommend as you may not need an actual colonoscopy at this point. Hope this helps!