Getting an Estimate

A couple of years ago my primary care physician suggested that I have a colonoscopy at the age of 47. My father died from Hodgkin’s disease at 34 and my mom survived breast cancer in her 40’s. I suffer from irritable bowel syndrome so she suggested that I have my colon checked out just in case. She recommended a very experienced gastroenterologist at a major Boston hospital.

My insurance would not cover the procedure because I am younger than 50, so I called the hospital to investigate how much it would cost me to have the procedure. Their first answer was that they did not know because no one had ever called in with that question before. This is a hospital which probably does more than one thousand of these every year.

I was transferred to someone else who was more helpful. She said it would depend quite a bit on what they discovered while I was undergoing the colonoscopy, but gave me a range of $2,000 to $4,500. I asked if there would be other charges and she said that the physician screening could cost $770 or more.

I asked if there were other charges. She then mentioned that there would be a fee for an anesthesiologist, but they didn’t know how much that would be. I asked whether I should call that office, but they said that they use several different anesthesiologists and there is no way in advance for them to know which one will be there for the procedure. Finally, they mentioned that there may be several other charges as well. I asked for something in writing about the various charges, but she said they did not have anything like that.

That’s the point where I gave up. We were already potentially over $5,000 and it was going to take some time to figure out an estimate for the anesthesiologist. Also, I had no confidence that we had gotten to the bottom of all of the potential charges. I was not going to get an estimate before agreeing to do this procedure.

I liken this experience to hiring a general contractor for a recent major home improvement. I received three estimates from three different general contractors which included all of the costs including the electrician, masonry, disposal, painting, etc. Sometimes there are unexpected costs with construction, and sometimes there are unexpected costs with colonoscopies. However, the inability of our medical system to even identify all of the costs, or to even appreciate that this is an important element to making the decision, was emblematic to me of a much deeper problem.

I will celebrate my 50th birthday in less than 2 months and will let the insurance company sort this all out while I focus on the procedure.

Monte Jaffe is an accountant and patient from Massachusetts.

Cost of Care:
On Labor Day Costs of Care, a Boston-based nonprofit, offerred $1000 prizes for the best anecdotes from doctors and patients that illustrate the importance of cost-awareness in medicine. Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. To learn more about the contest and read more of our stories please visit www.CostsOfCare.org (Twitter: @CostsOfCare).

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21 replies »

  1. turning 50 in 2 weeks,, had a consult for a colonoscopy , called the doctor to ask how much, they seemed confused,, requested a code for my insurance. emblem notified me anesth,, not included,, out of network,, made 5 calls to anesth.. no one could give me an answer,,, I asked the person if this question is unique.. she could not give me a straight answer,, finally a get a call back after many contradictory statements.. 1600 hundred for 45 minutes, 1800 for 60 minutes.. 10% discount if I paid ahead.. Am I buying a car? the colonoscopy is 477 under my insurance ,, i have a 6000 dollar deductible,. i am cancelling my procedure ,, anesth , is a ripoff.. ithe whole incident was immoral and criminal… i will take my chances..

  2. Agree that this is ridiculous….you have a better chance of getting a fair estimate from a remodeling contractor, as they are used to being transparent with fees.

  3. I’d suggest cash paying customers get the facility to sign a form saying that this is payment in full .. everyone knows where they stand. Adding another 40% on top of the quote is just not ethical business.

  4. I’m trying to think of some other circumstance where a customer, client or recipient of a product or service is expected to sign a blank check in advance, but nothing comes to mind. Even when the outcome is not predictable (legal action, unknown government requirements that later come to bite you, even wildcat drilling for petroleum) the higher and lower amounts fall within some predictable range.
    Seems to me the “costs” formula for medical care is to throw a bunch of stuff against the wall and see what sticks. The range of possibilities is completely crazy. The word “insurance” should not be used if it fails to insure.

  5. here argument is bs, hospitals already know what their competitors get reimbursed, it is far from a seceret

  6. Everyone needs to remember Karen speaks for only for large insurers and most of what she says only applies to fully insured plans. Fully insured plans make up less then 50% of the employer market. That being said I pray they stick to that argument every time they are asked.

    With some of the PPOs I rent we have a company that does exactly what you mention, for a given procedure the member can look up the PPO providers doing it and what the range of discounted allowable is.

    When I’m out pitching United, Aetna, or Anthem clients on why they need to dump them and go self funded it is one of the first things I show them, that and what a transparent PBM looks like. Carriers are already losing business to self funded, as long as washington stays out of it they will easily lose another 10-15% over the next couple years. They will have no choice but to get on board…..assuming politicians don’t step in to protect them.

  7. I was in a meeting last week with Karen Ignagni, CEO of America’s Health Insurance Plans (AHIP). I asked her what she and her members thought about disclosing actual insurer contract reimbursement rates so patients and referring doctors could more easily identify the most cost-effective providers. Disclosure is currently prohibited by confidentiality agreements. Her answer was the standard insurance industry argument that if actual reimbursement rates were disclosed, all the hospitals and other providers who were paid less than the best paid providers would clamor to have their payment rates raised up to or at least closer to what the best paid providers receive. In the end, they all claim, it would raise costs for the system. Personally, I don’t buy it.

    If Medicare rates are easily determinable and the charge to a non-Medicare patient are far above the Medicare allowable, the charges should be challenged. I would offer to pay 120%-125% of Medicare or perhaps a bit more. If that’s not acceptable, maybe a threat to sue for dealing in bad faith might be worth a shot. I would also ask the billing people or other finance types at the hospital how they would feel if they were presented with these bills knowing full well that far lower amounts are routinely accepted as payment in full from Medicare and other payers.

  8. I do colonoscopies and want to move near you where they apparently pay $2,500 0 $4,000 a pop. Wow! We’re paupers here in Ohio. I confess that I wouldn’t be able to answer accurately if a patient asked me the cost of the procedure. Every carrier is different. If tissue is removed, there will be a pathology charge. If it’s done in the hospital, then double everything. It’s an absurdly complex system.

  9. OK, so everyone around the country is having the same problem of price discovery for medical services. WHY is this? A lot of complaining here, but no solutions because of lack of understanding. Doesn’t it make sense that in any other business if someone is charging multiples of what a given service costs, the incentive for a competitor is huge?

  10. I didn’t pay the bill for six months but they were threatening to send me to a collection agency and ruin by credit score. Since I was in the middle of refinancing my house, I didn’t think it was wise to have a bad mark on my credit. They are immoral scum and they screwed me. I have no problem publicizing their name: Renown Medical Center in Reno, Nevada.

  11. Why did you pay the bill for? An unexplained and unquoted item .. should have refused. If people rollover and pay these outrageous charges, they will only continue.

    And you don’t need an anesthetist, just a little IV sedation with an amnestic works fine.

  12. I recently had a colonoscopy and called around to try to get the best price. I had a similar experience in that no one would quote a firm price but were ignorant or gave estimates. I picked what seemed like a good place (outpatient surgery center run by a regional hospital) and paid for the procedure in cash on the day of service. Two weeks later I get a bill for an additional $2000 in charges with no explanation (it was a routine colonoscopy). I spent six months trying to get someone to explain the extra charges while fending off collection agencies. I never did get an explanation and finally settled the bill. Total cost $5000… total rip off.
    This Christmas I took a vacation to Thailand. They have a first quality (JCAH certified) International hospital (Bumrungrad). I discovered I could have had the procedure for $1200 including all doctor, anes, path, lab, etc.

  13. Outpatient endoscopy centers operated by GIs and/or colorectal surgeons provide screening colonoscopies including physicians fees for between $1,500 and $2,000 depending on the state in whcih the facilities are located. Medicare reimburses these facilities less than $500. The outpatient endoscopy center are more than willing to provide patients a reliable cost quote and most will work with the patient to develop an affordable payment plan.
    Since you had a reasonably suspicious family medical history your screening should have been covered as medically necessary. Asking the insurance plan for a review would have been an appropriate action.

  14. self-pay patients choose to pay more. No one forces them to go to an overpriced hospital. There are numerous cheaper options available yet people choose to forgo those more affordable and convienent options. If someone chooses to spend their personal money inefficently then that is their right. This is not a system problem this is a personal choice problem.

  15. This is not a unique phenomenon. In fact, self-pay patients (especially middle class patients whose insurance won’t pay) are charged _more_ than anyone else.

    Because it’s int the interest of hospitals and docs to inflate prices in a fee-for-service world–remember, they;re bargaining–patients who have to pay for medical care suffer the most.

  16. Here is the cost in Canadian hospitals;

    “The cost of a diagnostic colonoscopy was $157 and the cost of a therapeutic colonoscopy was $199. Overhead costs represented approximately 30% of these amounts. When physician fees were added, these costs rose to $352 and $467, respectively.”

    Boy, Americans are really easily duped into thinking they have even close to an efficient system.

  17. Tell you what. Give me your details, and i’ll fix up a colonoscopy for you in Wellington, NZ. It’ll cost you about US$800, and you can spend the rest on airfares, a hotel and get a holiday at the same time.

  18. Not sure we should indict the entire system over the failures of one hospital, A Boston one at that, they aren’t known for their efficient business skills there. When we shop onhealf of members for MRI’s, surgeries, or other services there is a night and day difference between hospitals and outpatient centers. The last place I would start if I was paying would be the Boston Hospital.

    When we call surgery centers or outpatient centers they can usually recite the cost off the top of their head. Suburn or rural hospitals are also easier to work with and usually have a better grasp on the cost of their services.

  19. “I liken this experience to hiring a general contractor for a recent major home improvement.”

    One difference, though, is that a contractor’s quote is likely to be a reliable estimate of costs (materials, equipment, payroll, overhead, etc) and, unless it’s a fixed bid, is negotiable. Or, at the very least, you can get a reasonable itemization of the contractor’s costs.

    With medical care, anything’s game. I have a HDHP and paid out of pocket for a MRI two years ago. The price quoted at the time of service was $1281, which I paid by check. A month later, I received a bill showing the cost was actually $1477 and I owed $196. No “radiologist fee” or anything else. Just a different cost. Kaiser still hasn’t responded to my request for an explanation.