Wednesday, October 8, 2014

Prepping your wallet for a colonoscopy

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.

When I called him recently to ask about hidden costs,  he was eager to talk.  The situation is changing rapidly for the better,  he said,  but the situation is still  "very frustrating and very difficult"  for doctors and patients.

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companies are coming around to full coverage,  but there are still exceptions  --  and patients who get bills based on outdated information.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."


Clay said...

The whole thing sounds like one big pain in the butt!

Garth Vader said...


Here's a "big picture" idea that I hope you'll consider for a future above-the-fold feature.

The definition of "insurance" has been turned on its head. The dictionary/textbook/Wiki meaning of "insurance" is (using Wiki here) "the equitable transfer of the risk of a loss, from one entity to another in exchange for payment."

Let's focus on the word "risk" as it relates to insurance. Nearly every other insurance policy covers risk: automobile insurance covers the risk of accident or injury. Live insurance covers the risk of death. But health "insurance"? Well, it USED to cover risk, when it was called "catastrophic coverage" or "hospitalization".

But now? No honest person can call a system where EVERYONE receives benefits for preventive care "insurance". Call it "cost shifting". Call it "entitlement". Just don't call it "insurance".

If you doubt me, ask yourself if automobile insurance covers maintenance and preventative measures such as tuneups and tires. And ask what would happen to auto insurance rates if such policies were required to cover tuneups and tires.

John said...

Garth Vader,

Your comparison is spurious and misleading. Health coverage is fundamentally different than auto insurance in that auto insurance doesn't cover you if the vehicle simply breaks down, only if there is an accident, therefore preventative care does nothing to lower the risk that the insurance is mitigating.

Health insurance on the other hand, is specifically designed to cover the result of "wear and tear" and aging, and preventative care DOES directly reduce the risk that is being insured against and therefore is in the best interests of the insurer.