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My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one
by hirundo 6y ago
My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one it would be a "screening" colonoscopy, and covered in full by the insurance.
Under what logic does that make sense, that you get insurance coverage for a procedure but only if you don't really need it? Does it work like that anywhere outside of the U.S.?
The colonoscopy was completely clear. Two years later I was having constipation and bloating problems and went to a gastroenterologist. He examined me, asked a bunch of questions, and I asked for his advice. He said he really couldn't tell me anything ... without a colonoscopy. The two year old one didn't tell him enough, he said.
Now I'm supposed to drop another $3k, very likely for another clear test result, just to hear what the doctor says I should do about my constipation and bloating?
It felt like a scam. Instead of getting advice from a specialist M.D. I was driven to get it from the internet. And dang if it didn't work. I went on a low-residue diet that resolved my digestive problems almost immediately and has had numerous other benefits. My diabetes is in complete remission, I've lost weight, etc. But when I asked the gastroenterologist if diet changes would help, his answer was short and simple: "No."
So I'm very happy to see far less expensive alternatives. One less leverage point for the health care system to empty my wallet.
- davycro 6y agoThe test in the article screens for colon cancer, which is one of many reasons to have a colonoscopy. It sounds like the GI doctors you consulted performed colonoscopies to assess the cause of your digestive symptoms by looking at your GI tract. The test in the article could not replace that.
- perakojotgenije 6y agoAmericans and their health insurance problems. I live Serbia, to use Trump's words - in a "shithole country" (and I fully admit it is :-( ). I've never had a colonoscopy but I had a gastroscopy two months ago and it was fully covered by our single payer insurance. At the same time a friend of mine needed to have a gastroscopy and a colonoscopy. He decided to go the private route and also chose a full anesthesia. That costed him 30.000 serbian dinars (~255 euros). So it seems to me that you could buy a return plane ticket to Serbia, stay here for a few days, do a colonoscopy here and it would still cost less than what you need to pay there.
- inglor_cz 6y agoThe thing is, American healthcare prices are horribly overblown. IDK why, maybe the need for malpractice insurance in a litiguous society, but I am always shocked when I learn how much do relatively routine things (LASIK, uncomplicated birth) cost in the USA. Usually at least ten times as much as in Europe.
- devonkim 6y agoIt’s a complex question but the problem is that _everyone_ that points out one reason or another is usually right - we disagree upon which factor is the biggest. Malpractice, bloated administrations in insurance and hospitals (just like our educational and corporate systems), a dysfunctional market leading to profiteering, bad / outdated regulations, Medicare being unable to negotiate costs, bad patient health across the country, and so forth. What I will argue against is that we have the best healthcare - maybe only if you exclude the outcomes for our poor, but even the outcomes for our wealthy are no better than the middle class in other developed Western countries.
- analog31 6y agoThe system is so convoluted that nobody knows where the money is going. Every player can point their finger at someone else and say: "Those people are gouging you." But every player has an investment stake in the other players[0]. It means, when it comes right down to it, they're all gouging us. [0] For instance I read that the majority of stock in malpractice insurance companies is held by doctors.
- maxerickson 6y agoLASIK is generally a few hundred dollars per eye. Is it really $50 in Europe? As far as births, the lifetime cost of the injuries that do happen are built into the price. Maybe not a good system, but it's clear enough where the money goes.
- gdebel 6y agoHaha, nope ! As a convenience procedure, and as such exposed to liability risks, and because of the extremely high cost of the lasers, you'll have to pay 2-3000 euros for both eyes (in France, at least). It is in fact cheaper in the US. However, I'm always surprised by the cost of health in the US. The most surprising thing is that it looks like most Americans seem to not realize that it is perfectly possible to have high quality medicine and well payed doctors if the insurances don't suck all the money between the healthcare system and the patient. Our system has flaws, sure, but the US system looks like crazy to me.
- maest 6y agoWhat is a low-residue diet, if I may ask?
- hirundo 6y agoThe biggest source of residue is fiber. I'm doing this: https://www.amazon.com/Carnivore-Code-Unlocking-Returning-Ancestral-ebook/dp/B089KB41VC https://www.amazon.com/Carnivore-Code-Unlocking-Returning-An...
- TwoBit 6y agoMost gastroenterologists are like that. You want a diagnosis then you need a very recent colonoscopy. And that's a quick $1000+ hour for them, of which they will do many in a given week. But what else can they do?
- tzs 6y ago> My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one it would be a "screening" colonoscopy, and covered in full by the insurance. A similar, but at least nowhere near as expensive, gotcha in many US insurance plans happens with annual checkups. Many plans fully cover an annual check up with no deductible or co-pay. But during that checkup if you mention some issue that the doctor does not specifically find or ask about as part of the standard checkup, you might find that your insurance company counts that visit as a diagnostic visit or a treatment visit, not a checkup visit, and you pay the normal office visit deductible or co-pay. If you ask something that takes significant time for the doctor to deal with that might make sense, but I’ve read of it happening for things like you tell the doctor that you get sore wrists after a full day on the keyboard and the doctor spends a minute telling you about taking breaks and giving you some ergonomics tips.
- maxerickson 6y agoIt's the provider coding the visit as diagnostic vs annual preventative though, not the insurance company.
- petercooper 6y agoThere is a similar quirk in the UK's tax code. An employer can pay for medical checkups (which can run up to many ££££ full body medicals and scans - the works) without any tax implications for the employee or the business, but not for similar things being done as 'treatment' for something (unless it relates to an issue caused by or within the employment itself, like if you crushed an arm in a warehouse accident, say).
- kurthr 6y agoYour doctor is not good at his job or he doesn't like you. Filling out codes so that insurance pays for things is a skill that good doctors develop rapidly. The proper codes can also change rapidly, and often there is no easy way to find out what price a procedure is or how much insurance will pay for a particular code. MDs do usually have a hand up on others in figuring this out because healthcare and insurance companies will return their calls. (They also discuss it among themselves) If you are not an MD it may take 3-4weeks to find out what a code costs and what coverage will be. They'll call you about the single code and coverage that you requested, when they get around to it. However, if they have mis-billed you (eg 45min for a 15min visit) then you can get them to reverse and rebill the procedure. Personal experience.
- ssully 6y agoI would agree he isn't good at his job based on what you said, but also not even considering your diet. I've had stomach issues for a lot of my life, and my doctor was very good about asking my questions, and helping me figure out what might help me, including diet changes.
- soperj 6y ago>Your doctor is not good at his job or he doesn't like you. Filling out codes so that insurance pays for things is a skill that good doctors develop rapidly. My Doctor is great, and has zero skill w/r to filling out codes for insurance purposes. Socialized medicine for the win.
- multjoy 6y agoShould this actually be part of an MD’s job?
- omgwtfbyobbq 6y agoIt's possible that his "No." was a hard answer to whether diet changes would affect your symptoms in general, but it's also possible that it's was a response in the context of whether it would help the things that he would find on a colonoscopy. If possible I would ask him to clarify. Some doctors I've been to assume that I've already tried simple things to help with whatever issues I've had, and that is sometimes an inaccurate assumption.
- pkaye 6y ago> Under what logic does that make sense, that you get insurance coverage for a procedure but only if you don't really need it? Does it work like that anywhere outside of the U.S.? A screening procedure is considered preventive. Obamacare requires preventive care to be 100% covered. Before that, your plan might have also charged for preventive procedures.