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Screening Colonoscopies Should be Free - Why are patients receiving bills?

Health care systems are convoluted and confusing. In DPC, we see ourselves as patient advocates and translators, in addition to our duties as physicians. Many patients get caught between large health systems and insurances often finding themselves paying large bills that either they didn't foresee. There is a lot of emotion in health care, fear of diagnosis, fear of procedures and now, more and more, fear of unexpected medical debt.

In medical school, we take a vow to do no harm. I believe this also means do no financial harm.

Recently, many patients have made local and national news after receiving bills for over $2000 after having what they thought would be a screening, presumably free, screening colonoscopy. Our natural inclination is to blame insurance companies but in this case, this is a billing issue. This reflects the billing departments decision to change it from a screening colonoscopy to a diagnostic colonoscopy because a polyp was found. When it becomes a diagnostic procedure, the code changes and the bill is processed in a different way through insurance. The cost then transfers to the patient. Insurance companies can't change codes submitted by the physician as it is "insurance fraud." This leave the patient holding the cost when there was no way they would know the outcome of the procedure.

This leads to fear of medical debt, deferring of preventative measures and delay to diagnosis. What is the point? There is a local hospital where you can get a full colonoscopy with a cash pay of $850 with prompt pay discount. Maybe our patients would rather pay out of pocket than risk a bill for $2000. How does one make informed medical decisions with such lack of transparency?

Please call if this happens to you. We are happy to call the medical offices and ask them to review the claims and resubmit. Finding a polyp on a colonoscopy is a known and likely possibility on colonoscopy. Insurances should plan ahead for this likelihood and have a separate benefit that will cap the out-of-pocket cost for the additive procedure. Hopefully this will be the trend moving forward.

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