Dr. Rig Patel says he can't keep up with all the twists in insurance coverage of colonoscopies, and he's president of the N.C. Society of Gastroenterologists.
As the 50-and-over crowd knows, the last thing you want to do is add unpleasantness to what's already a humbling reminder that you're getting old. Taking a superlaxitive and getting a probe of your bowels is no fun -- but the reduction of colon cancer deaths in people over 50 is one of the big success stories in the fight against cancer. So it's worth talking about a topic that makes us squirm to help people reduce the financial wallop.
A screening colonoscopy for people 50 and older is supposed to be fully covered under the Affordable Care Act. But depending on your policy, you could get a bill for sedation, for a pathologist's service or even for the whole procedure if precancerous polyps are found. Patel says private insurance companies are coming around to full coverage, but there are still exceptions -- and patients who get bills based on outdated information. His advice: Work this out with the insurance company and the billing office before you show up, rather than trying to wrangle with your doctors and nurses when the time comes.
Don't go to a hospital for the procedure unless there's a medical reason; it can double or triple your bill, Patel says. And ask how you'll be sedated. Some doctors administer Demerol and/or Versed to induce drowsiness and reduce pain. That's not likely to generate a separate bill. However, Patel says the trend is toward using propofol, which puts patients into a deeper sleep and must be done under supervision. He said his practice in Raleigh has shifted from an anesthesiologist to a certified nurse anesthetist to cut costs. Ask your doctor about the medical and financial issues beforehand.
Can a patient skip the sedation altogether? "If they're motivated we will do that," Patel said, but it's far from ideal. "You need a very quiet, peaceful patient who's not moving around. We want to be able to focus on the procedure and not on that uncomfortable patient."