How Much Is My Colonoscopy Going to Cost? $600? $5,400?

How Much Is My Colonoscopy Going to Cost? $600? $5,400?

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Screen Shot 2014-08-27 at 10.40.39 AMHow much does a colonoscopy cost? Well, that depends.

If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask.

If you’re insured, you may think it doesn’t matter. Routine, preventive screening colonoscopies are to be covered free with no co-insurance or co-payment under the Affordable Care Act.

However, we’re learning that with colonoscopies, as with mammograms, people are being asked to pay sometimes. It’s not clear to us in every case that they should pay, and since we don’t know all the details of these events, we can only offer some general thoughts. We’ve also heard from Medicare enrollees without supplemental Medicare policies that they think they’re responsible for 20 percent of the charged price — so 20 percent of $600 vs. 20 percent of $5,400 is a big deal.

If you’re on a high-deductible plan and the charge to you will be, say, $3,600, you can probably ask around and find a lower rate.

A thorough view of some colonoscopy billing issues is in this article in The New York Times by Libby Rosenthal, who has been covering health costs for the paper. We’ve heard also about in-network providers using out-of-network anesthesiologists, so it pays to pay attention.

Things to watch out for in billing

If you’re planning a colonoscopy, you might want to ask for the price in advance. Make sure that the price quoted to you includes everything: doctor’s fee, anesthesiology, lab tests and facility fee (sometimes but not always) are the main charges. Sometimes the doctor will charge an additional pre-procedure consultation fee, and sometimes the solution for “prep” to clean your system out is included, while sometimes it’s not.

Doctor’s fee. When we survey for prices, often we are quoted only a doctor’s fee, with anesthesiology and facility fee separate. Some doctors do this in their offices; some do it at different sites (a GI clinic, a hospital) and each of those sites can have a different fee. When we’re looking for prices, we always ask what’s included.

Also, make sure your doctor is in network, if you’re insured.

Anesthesiology. Sometimes this is a full general anesthetic, and sometimes it is a light dose of anesthesia resulting in what is called “twilight,” where you’ll be sleepy but able to respond to commands, essentially sedated. Generally with twilight you forget everything immediately.

There is a large body of research suggesting that full general anesthetic is wasteful for procedures like a colonoscopy, but it continues to be offered fairly frequently. A small number of people do it with no anesthesia or sedation.

“Between 2003 and 2009, the proportion of GI procedures involving anesthesia providers doubled, and overall payments for GI anesthesia tripled,”   a recent study by the Rand Corporation found.

Anesthesia can be pricey, and it’s important to be sure that the provider is in network — so make a point of asking, even if you are at an in-network doctor’s office, or other location. We hear a lot of complaints about this.

What happened to me: I asked in advance to make sure the anesthesiologist and everything else would be in network. Then when I arrived in the morning for my appointment, the receptionist gave me a form to sign guaranteeing that I would pay everything that wasn’t covered by insurance, including any out-of-network anesthesiologist or lab fees.  I refused to sign it, saying that I’d checked in advance to make sure everybody and everything was in network. They didn’t insist, and the anesthesiologist (twilight, by the way) was indeed in network. My out of pocket was $30 for anesthesiology, my standard co-pay (before the Affordable Care Act).

Lab tests. The providers generally don’t reveal in advance what lab tests will cost;  they will say that charge depends, often on what they choose to remove for testing during the procedure. We have heard labs estimated in advance to be as low as $50 and as high as “we can’t tell you in advance.”

What happened to me: I had $250 in lab charges, all covered except for a $30 co-pay (before the Affordable Care Act); my girlfriend’s lab charges were $950, about the highest I’ve heard. For her, it was completely covered, but of course that’s not always true.

Facility fee. This is a growing issue: a doctor’s office could be just an office, but it could be a facility. The facility fee is applied by hospitals, gastrointestinal ambulatory surgery centers, and just about anything that feels that it’s a facility.

In my case, there was no facility fee; the procedure took place in a doctor’s office. My girlfriend’s took place at a GI center, not her doctor’s office, and the biggest line item on the bill was $2,700, for the facility fee, of which the insurer paid a bit less than half. She was not asked to pay the balance.

Some insurers will refuse to pay a facility fee from an in-network provider. Some insurers will pay only a part of the facility fee, and depending on your insurance plan or your state’s policies on balance billing, you might be responsible for some or all of that fee.

So it pays to ask up front, “Is there a facility fee? How much is that? Is it covered by my insurance? Does there have to be a facility fee?” When we were collecting prices, we learned that some places would quote us only a facility fee, adding that the doctor fees varied by provider, and so did the anesthesiology fees. Most places said labs were extra and unpredictable.

Pre-procedure consultation. Not every provider charges this. Mine did, and it was $250. I saw a nurse, and got a checklist. My insurance company covered the whole thing, with a $30 co-pay.

Prep stuff. The medication you’re asked to drink to clean out your system is not free. We have heard prices as low as $12.10 over the counter, and as high as $38 — actually, both from the same person, which I wrote about in this blog post.

Insurers’ predictions: A grain of salt

If you’re insured, you could look at the insurance company’s prediction of prices.

My insurance company predicted this: “Estimated Treatment Cost: $1,464-3,609; Plan Responsibility: $1,125-2,952; Member Responsibility: $339-657.” My actual experience:  Bill totaled $2,797; plan paid $2,263.85; my co-pay was $120 ($30 for the consultation, $30 for the doctor, $30 for the anesthesiologist, and $30 for lab fees). I have no records on what the prep stuff cost.

My girlfriend’s experience: Bill totaled $5,544, plan paid $2,750.08, her copay was 0. (She had a different provider and has a different insurance plan; this was also pre-A.C.A.) Also, depending on your plan, under the Affordable Care Act, you should not pay anything for a routine preventive colonoscopy.

Why is it so hard to find the cost of a colonoscopy?

When we survey on colonoscopies, we ask for the following component parts of the procedure:

Doctor’s fee, for the person actually performing the exam.

Anesthesiology.

Facility fee, if any. This is a growing issue: a doctor’s office could be just an office, but it could be a facility. The facility fee is applied by hospitals, gastrointestinal ambulatory surgery centers, and just about anything that feels that it’s a facility. Lab fees.

Consultation.

Any other charges (prep liquid, for example).

In our surveys, often we are told only one or two of these charges: Statements like these are common.

“That’s the facility fee for doing it here; the doctors all charge their own rates.”

“The anesthesiologist can’t predict in advance how much they’ll need or how long they’ll take, so we can’t tell you that.”

“We can’t tell labs in advance.”

“That’s a price for facility fee, doctor and anesthesiologist. Labs run between $50 and $250 usually.”

“We don’t quote prices in advance.”

“That’s the doctor’s fee — there might be a facility fee, depending on where he does it. We don’t know until he tells us.”

We’ve written about this before several times, here and here.

O.K., so how much does a colonoscopy cost?

Here are  colonoscopy price lists for the New York area, and here are colonoscopy price lists for the Los Angeles area.

Here are  colonoscopy price lists for the San Francisco area. And here are Texas cities: colonoscopy price lists for the Houston areathe Dallas-Fort Worth areathe San Antonio area and the Austin area.

A cautionary note: the billed price, as always in the health-care marketplace, can be a price that’s not actually real.

“In Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56,” Rosenthal wrote in her New York Times piece. “Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.”

The charged price for a medical procedure (often called the Chargemaster price) is seldom the price that is actually paid. What is actually paid is either set by law and administrative rules, in the case of government payers like Medicare and Medicaid, or governed by contracts, in the case of non-government insurance plans like Blue Cross, United HealthCare and so on.

If you ask for a cash or self-pay rate, that will often be considerably lower than the regularly charged price, reflecting cash discounts if they exist, and increasingly they do.

 

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88 Comments on "How Much Is My Colonoscopy Going to Cost? $600? $5,400?"


Member

We’re getting frequent reports of people being asked to pay for their colonoscopies, from those here — CallMeMom, for example — and others. Here’s a blog post updating this piece: http://clearhealthcosts.com/blog/2016/02/free-colonoscopies-theyre-free/

Member
CallMeMom
Jul 16, 2015

I checked that my colonoscopy would be covered at 100% as a preventative screening. I was told that it would be covered by United Health Care and by the doctor. UHC did not pay for the screening, no-one can explain to me why it wasn’t covered and I’ve been getting the runaround for the past two weeks.

Under the ACA preventative colorectal cancer screenings, a colonoscopy, are meant to be covered at 100%. Even if a colon polyp is found and removed it still has to paid at 100% – this was a recent change to the ACA within the past year or so, after many consumers complained about screenings being changed to diagnostic when a polyp or some other issue is found and then having to pay all these unexpected costs. Although, all future colonoscopies will be considered diagnostic if a polyp is found, but now you’ll at least know you’ll have to pay and can shop around for the best price.

UHC documentation found on the web supports that my colonoscopy was meant to be covered at 100% even though I had 2 colon polyps removed. “Preventive v. Diagnostic Colonoscopy. UnitedHealthcare has determined that a colonoscopy performed on a person without symptoms will be considered preventive, rather than diagnostic, even if a polyp is found and removed during the procedure. While the removal of a polyp during a preventive screening colonoscopy will not convert the procedure to a diagnostic colonoscopy, all future colonoscopies are then considered diagnostic because the time intervals between future colonoscopies would be shortened.”

I believe that insurance companies are purposefully lying to their customers and are in violation of the ACA. Please, please do some research. If you are having a routine screening because you turned 50 or earlier if you are high risk because of family history your insurance is meant to pay for your colonoscopy.

Here is what I ended up having to pay: Surgical center fee – $400. Doctor fee – $700. Labs for 2 colon polyps and biopsies – $200. Total $1300

I opted for light sedation, this can be given by the doctor. This significantly reduces the cost vs. propofol and the cost of an anaesthesiologist, which can add hundreds of dollars to the cost. I opted for light sedation because no-one could tell me if the anaesthesiologist was in-network. Honestly, even though I was wide awake and talked to the doctor and nurse and remember everything – I couldn’t feel anything and wasn’t traumatized.

Also, I do recommend trying to price the procedure even if it’s going to covered by insurance. Some of the prices I’ve read about are just crazy and if you’re insurance is going to stiff you, don’t you want to pay the least amount out of pocket.

Member
Jul 2, 2015

I feel 100% shafted by my insurance company & physician’s office regarding my colonoscopy.

I am 52, in excellent health (height/weight, lifestyle, etc) and go in for stomach/lower gi issues to my PCP. He refers me to gastro doc who schedules colonoscopy, removes a single polyp which is benign.

Before the procedure I call Carefirst BCBS with code from gastro doc’s office manager and am told the procedure is covered 100% including the anesth.

Fast forward to one month later, I have nearly a $1000 bill from gastro doc and more than $500 from anesth doc…WTH? …turns out my routine colonoscopy is now a diagnostic colonoscopy and I have to pay ALL of it out of pocket.

Not only do I have premiums which have more than DOUBLED in 2 YEARS and a DEDUCTIBLE which has more than DOUBLED in 2 YEARS (THANKS OBAMA), I can’t even get a stupid routine procedure covered. It’s all on me.

“Routine, preventive screening colonoscopies are to be covered free with no co-insurance or co-payment under the Affordable Care Act.” is horsesh!t because if you have ONE polyp removed, it is suddenly surgical and the whole bill is completely yours.

Anyone have any suggestions?

Guest
Apr 29, 2015

Are these charges up to date? But it does give clear idea How it might cost. thank you. now I can reconsider my options.

Guest
Jon Dowd
Mar 24, 2015

12 hours before my procedure I discover I cannot drink the prep fluid. It’s a long story, but it ends with I cannot drink it. So. I called their answering machine and gave them as much detail as I could, letting them know I would not be there tomorrow. How much do you think they’ll charge me?

Guest

Of course they should charge you $0.

Guest
Richard Citron
Mar 10, 2015

As I read through all this … forcing myself once again to keep my eyes open, I could not help but reflect on this statement from Barry Carol in response, “The big impediment to price discovery in the commercial insurance sector is the confidentiality agreements that preclude disclosure of actual contract reimbursement rates. We need to get rid of those.” NO, what we (the long abused American health care recipient) needs “to get rid of” is private health care insurance altogether and move into this new-ish century by joining the rest of the civilized world by created a taxpayer funded, government administered universal health care system covering the entire population in the country that will render private health care insurance irrelevant … as well it should be. Private health care insurance adds nothing but higher costs to everyone and every institution involved, contributes literally nothing positive and increases health care risk to everyon. Norway started off universal national health care in 1912 and for almost fifty years now every other first world nation … and many others as well … have offered this totally rational approach to all of its citizens. Listening to or reading these unending discussions has me thinking I am listening to cavemen discussing how to find better ways how to drag stuff around from one place to another on dragging sticks, as native Americans did before Europeans showed up with the wheel. Hey, the wheel has already been invented! Don’t like the idea of adopting an idea that is “foreign”? Try calling it something else, like maybe The All-American Stars & Stripes Universal Health Care System, Best Damned System Ever Invented System”. Whatever. Just do it already. This is all so tiring to watch. Not to mention an ongoing threat to everyone still living over there.

Guest
Mar 10, 2015

@Richard Citron, I feel comfortable saying that many of these comments — maybe even most — are from people who would love to have what you have described instead of the Rube Goldberg contraption which passes for health care in America. Many of us have watched in dismay for years as it got cobbled together. Unfortunately the toothpaste is all out of the tube and not likely to be stuffed back in. Heck, ACA is the best we could do after literally decades of bipartisan efforts to correct the built-in glitches of profit-driven provider enterprises encrusted with profit-driven insurance and revenue-sucking lobbies everywhere you look.

To coin a phrase, you fight with the resources you have. The dreams of Paul Starr, Alain Enthoven and others have been picked as clean as a holiday turkey, and we still have a raft of hard-core Randians trying to recycle the carcass.

Meantime, my personal response to the colonoscopy challenge is telling my PCP that absent identifiable symptoms, I’m not having any more. And even then, I want a sigmoidoscopy, thank you, unless two doctors are convinced they really need to go further.

Welcome to The Health Care Blog. We have one of the smartest groups of commentators anywhere.

Member
Jun 12, 2015

I’m glad I’m sat on the other side of the Atlantic. This week I’ve had a Polyp removal by Colonoscopy, and a Gastroscopy session, Last week I had a Sigmoidoscopy, Total charge $0 thanks to the NHS. The US system is so far beyond insane it’s untrue

Guest
William Shirey
Mar 4, 2015

I have UHC. They pay 100% for a colonoscopy coded as Preventative . If a biopsy is taken, the coding is changed to Diagnostic and they hit you for 20% of the cost, So, in reality, you are being punished for having something wrong found in your body (as if it were your own fault), which is the purpose for the procedure in the first place. This way of thinking is absurd, a Catch-22.

Guest
Gary Jablonski
Apr 13, 2015

I went back to the same doctor that had done these procedures previously. Having had the procedure before I had in mind the costs I paid previously, about $600 with plops removed 5 years ago. So I was shocked when the EBO came and said my responsibility was $2550. Total bill from hospital $12,267 in Warwick NY. The insurance company said it was normal for the hospital to change the code from preventative to diagnostic. Why? Because they can. Reviewing the charges, the Hospital charges for the Colonoscopy with biopsy $3,485 and Colonoscopy with removal of Lesion $3,485. I asked Insurance company if this was double billing and why they would pay double billing and they gave me the same reason, it’s how the hospitals charge. There were separate charges for the Pathology lab and Anesthesiologist from rthe hospital. This does not include my doctors invoices Colonoscopy with Lesion removal $867 and Colonoscopy with Biopsy $749. All these numbers were not paid by the Insurer but were reduced. I am keeping these papers handy for my next procedure and will ask more questions of the doctor and hospital about these issues. Won’t be using the same doctor and probably not be doing it in a hospital. I will see if I can get the information about these cost before scheduling

Guest

Hey Gary, can you email me at jeanne (att) clearhealthcosts.com? Thanks!

Guest
Candice hawkins
Jan 7, 2015

Here is what Tx Blue Cross Blue Shield told my husband whose PCP told him to get a colonoscopy for a look see since he was over 50.
BC BS told him the procedure is no charge as preventative but if any abnormalities are found the price goes up a fair amt since the procedure has then changed to diagnostic.
I think that is the biggest insurance scam ever. If the doc takes one polyp biopsy the whole procedure is no longer routine. How did they get away with that.

Guest
Tom
Jan 4, 2015

You would think that shoving a camera up someones ass would be a standard procedure. Why can’t the medical profession come to an agreement on a standardized price? I mean, it shouldn’t be all that different from getting the oil changed on your car; $19.99, any make or model. I feel like I should be able to walk into any clinic and pay a set fee for a procedure that takes about 30 minutes. Why does it have to be so complicated? I’ll tell you why. Anything that is overly complicated is that way by design, it’s because you’re getting screwed.

Guest
sandra dorsey
Nov 10, 2014

MY GI doctor expects full payment up front from patient, then submit the insurance paperwork (to which I find, is now considered “a curtesy” by them to even do for ya)..WHEN/IF insurance company pays..the GI folks re-imburse us..Last time I did that kind of thing was with an emergency ORAL surgery for a bad tooth..I never did get get all my money reimbursed. the oral surgeon kept most of that money too. THAT bugger got almost 1000.00 for 1 easy emergency extraction..to which I paid over 3/4 …I got just 200 or so dollars reimbursed. Frankly, I think it is fraud/against the law to swindle people with such an expectation. Im seriously considering canceling the entire colonoscopy thing..and just let any possible cancers, etc take its course

Guest

Update: We have been crowdsourcing health care prices in California, with partners at KQED and KPCC public radio, and funding from the Knight Foundation.

Here’s our recent post, “How much does a colonoscopy cost? From $0 to $7,240 in California, we learned from our PriceCheck community.”

http://clearhealthcosts.com/blog/2014/10/cost-colonoscopy-california-insurers-paid-1800-7-240/

Love to hear your thoughts!

Guest
Sep 9, 2014

Thanks Jeanne for the link.

Could it be that a colonoscopy is considered to be a step beyond
‘colorectal cancer screening?

Or else the insurance plan here is just ignoring the law. Individual health plans have had a spotty record on compliance for a long time.

Guest

There is definitely a compliance issue with preventive care.

What we have also noticed is that a preventive screening colonoscopy, scheduled as such, is different from a diagnostic colonoscopy, scheduled to investigate a problem.

In this case, though, it might also be that the colonoscopy was free but the endoscopy (together with the colonoscopy) was not.

Guest

Bob,
what’s surprising about Jenny’s experience is that Libby Rosenthal’s piece was written before the ACA was fully in force; the ACA was supposed to make preventive care, like colonoscopies, available with no coinsurance or deductibles. So how can “free” cost $1,461?
https://www.healthcare.gov/what-are-my-preventive-care-benefits/

Guest
Sep 8, 2014

thanks Jenny.

Anyone who gets angry at reading about your experience should read the NY Times articles by Eizabeth Rosenthal. See her June 1, 2013 piece entitled
“Colonoscopies explain why US leads the world in health care expenditures.”

She notes that Medicare pays $511 for the actual colonoscopy, and something extra for anesthesiology. Germany pays about $1000 for the whole procedure.

What a savage reflection on health care price-gouging. I am not impressed by an insurance company which “negotiates” a hospital fee of $4,284 for a non acute procedure or two.

The best solution would be to publish all Medicare rates very widely.
Also to establish health courts, where if a medical provider charged more than 150% of Medicare they would have to justify what they actually did.

Guest
Jennyct
Sep 7, 2014

I arrived at this site after opening my EOB. I have a high deductible and I met that early this year with a broken ankle. After meeting my deductible, I am responsible for 20% of negotiated rates, 40% for “non-preferred”. Note that this is NOT out of network.

I had a colonoscopy and endoscopy.
Hospital fees billed: 5025.
Member rate: 4284.
My portion: 1035.

CRNA billed: 980.
Member rate: 573.
My portion: 0

Pathology (I think) billed: 780.
Member rate: 355.
My portion: 141.

Physician: 1815.
Member rate: 428.
My portion: 285.

total billed; 8600
member rate: 5640
my portion: 1461

Note that I have already met my dedcutible AND the colonoscopy for which I am supposed to have free (all screenings are supposed to be 100% covered).This is probably why the anesthesia was covered, but I was charged for the colonoscopy.

Guest

Jenny, I find this astounding. Would love to talk to you by email about this: info (at) clearhealthcosts (dot) com.