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Preventive Care Screenings
posted at October 10, 2011 4:24 PM EDT
Re: Preventive Care Screenings
posted at October 10, 2011 6:19 PM EDT
First: January 28, 2008
Last: March 8, 2014
I wouldn't give up Trying to get some help from the hospital or the insurer. There may be a procedure to get a third party arbitration or the hospital may make arrangements for a long term payment. Go to the highest levels of each to tell your story. Good luck.
In Response to Preventive Care Screenings:
On June 6, 2011, I went in for my colorectal screening (colonoscopy) at Tahoe Forest Hospital in Truckee, CA. Trying to be prepared before my appointment, I made inquiries to the billing office at the hospital and doctor’s office and, also, my insurance company into how much money I would have to pay for this screening. According to the hospital’s billing office and my insurance company, because I am now 50 years old, it is a recommended preventive care screening and would be paid at 100% with no co-pay and no deductible. (I even got a nice checklist from my insurance company entitled “Your preventive care checklist” which reminds me of all of the screenings I should have done this year.) During the screening, the doctor took a few scrapings and sent them in to a lab for testing. The rest of the screening went pretty well. (What I had to do to get ready for the screening was the worst part!) Several weeks later, I was very surprised when I got a bill from the hospital’s billing office for $550 and the Explanation of Benefits from my insurance company outlining why I owed $550 to the hospital. According to both, instead of a colorectal screening, I had “Abdominal Surgery”. I immediately contacted my doctor’s office to find out why they had categorized my screening as surgery. I was told by my doctor’s office I did not have abdominal surgery, I had a colonoscopy screening. When I called the hospital to tell them they had made a mistake I was told, by the billing office, any time a scraping is done during a screening, it is no longer considered a screening, it is surgery. In this case, abdominal surgery. When I called the insurance company to file a complaint, they told me the same thing the hospital billing office had -- my screening was now considered abdominal surgery so it would not be paid at 100%. Now, because it was considered surgery, I had to pay 20% of the bill (anesthesia, lab pathology, drugs, IV solutions, supplies, operating room, etc.) after my deductible was met. If I had known beforehand there was a possibility I would have to pay $550, I would have postponed the procedure. I am currently disabled and my husband recently lost his job so we don’t have money for anything “frivolous”. Thinking about it now, I guess I was very naïve when I took what I was told at face value and didn’t ask questions. So, if you are going to take advantage of the many preventative care screenings that insurance companies are now offering, ask a lot of questions and buyer beware!
Posted by zcarbo
Re: Preventive Care Screenings
posted at December 10, 2011 5:13 PM EST
First: November 27, 2011
Last: March 8, 2014
It is important to understand any insurance benefit that you have and not rely upon the intrepretation of others - that goes for Medicare as well as private insurance.
Under Medicare for 2011 you get what is called a "Wellness" Visit - this does cover several preventative screenings but knowing which ones and under what conditions is where you must decide the scope of the test and your wallet.
From the Center of Medicare and Medicaid Services (CMS) - Your Guide yo Medicare's Preventative Services
Section 1 on page 6 says this:
"In providing good care, your doctor or health care provider may do exams
or tests that Medicare doesn’t cover. Your doctor or health care provider may
also recommend that you have tests more or less often than Medicare covers
them. Medicare also pays for some diagnostic tests. A diagnostic test may be
recommended when a screening test or exam shows an abnormality.
In some cases, you may have to pay for these services."
Pages 9 & 10 cover the ONE-Time ONLY "Welcome to Medicare” preventive visit.
Beginning on Page 11 is the Yearly “Wellness” Visit in detail. For your topic in question, it says this:
'Colorectal Cancer Screening
Colorectal cancer is usually found in people age 50 or older, and the risk of getting
it increases with age. Medicare covers colorectal screening tests to help find
pre-cancerous polyps (growths in the colon) so they can be removed before they
become cancerous and to help find colorectal cancer at an early stage. Treatment
works best when colorectal cancer is found early.
Who is covered?
All people with Medicare age 50 and older, but there is no minimum age for
having a screening colonoscopy.
How often is it covered?
• Fecal Occult Blood Test—Once every 12 months.
• Flexible Sigmoidoscopy—Once every 48 months after the last flexible
sigmoidoscopy or barium enema; or 120 months after a previous screening
• Screening Colonoscopy—Once every 120 months (high risk every 24
months) or 48 months after a previous flexible sigmoidoscopy.
• Barium Enema—Once every 48 months (high risk every 24 months) when
used instead of sigmoidoscopy or colonoscopy.
Your costs if you have Original Medicare.
You pay nothing for the fecal occult blood test. You pay nothing for the flexible
sigmoidoscopy or screening colonoscopy, if your doctor accepts assignment.
For barium enemas, you pay 20% of the Medicare-approved amount for the
doctor’s services. The Part B deductible doesn’t apply. If it’s done in a hospital
outpatient setting, you pay a copayment."
If pre-cancerous polyps (growths in the colon) are found during the screening, they can be removed before they
become cancerous- since they found yours while in the process of the screening, they removed them at this same time - probably saving you some money in the long run and maybe even your life.