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