3 ms·

Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me

Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me more than I was expecting because they didn't categorize it as preventive care.

VerifiedReports 5mo ago
I think so, even with shitty U.S. providers. I've never had a problem.
cdcarter 5mo ago
Most US insurance has very strict guidelines about what is diagnostic vs preventative for a colonoscopy. And its almost certianly diagnostic.
- ipsento606 5mo ago
  diagnostic does not mean "not covered", it just means it moves out of the "zero cost even if you haven't met your deductible yet" categroy defined by the ACA, and into the regular category where you pay your deductible, copays and coinsurance
leviathant 5mo ago
I did a colonoscopy at 38, because I saw something in the toilet that looked like the lingonberries at Ikea. Everyone was like "Man that seems early" but when I woke up, the doctor expressed some surprise when he told me they removed a couple of polyps. A week or two later, I got a bill for several thousand dollars, and I just had to roll with it. I believe that in the US, there is a certain age, after which, they're covered.
- deaton 5mo ago
  Not ideal but better a couple thousand bucks than cancer... but seriously, especially if they actually found something worrying like polyps, the insurance shouldn't even get a say.
- ipsento606 5mo ago
  > I believe that in the US, there is a certain age, after which, they're covered. There is a lot of confusion over this point, even among support agents for health insurance companies. i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0. ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure. In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA" It's common for people to confuse these things. In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars. [i] https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
  - abuani 5mo ago
    Reading this should make everyone in the US furious about the state of our health system
    - dqv 5mo ago
      I mean it does. That's why so many people cheered when Brian Thompson was... involved in a shooting and died.
goosejuice 5mo ago
In situ should be medically necessary and thus should be widely covered. That's surprising.

VerifiedReports 5mo ago

I think so, even with shitty U.S. providers. I've never had a problem.

cdcarter 5mo ago

Most US insurance has very strict guidelines about what is diagnostic vs preventative for a colonoscopy. And its almost certianly diagnostic.

ipsento606 5mo ago
diagnostic does not mean "not covered", it just means it moves out of the "zero cost even if you haven't met your deductible yet" categroy defined by the ACA, and into the regular category where you pay your deductible, copays and coinsurance

leviathant 5mo ago

I did a colonoscopy at 38, because I saw something in the toilet that looked like the lingonberries at Ikea. Everyone was like "Man that seems early" but when I woke up, the doctor expressed some surprise when he told me they removed a couple of polyps. A week or two later, I got a bill for several thousand dollars, and I just had to roll with it. I believe that in the US, there is a certain age, after which, they're covered.

deaton 5mo ago
Not ideal but better a couple thousand bucks than cancer... but seriously, especially if they actually found something worrying like polyps, the insurance shouldn't even get a say.
ipsento606 5mo ago
> I believe that in the US, there is a certain age, after which, they're covered. There is a lot of confusion over this point, even among support agents for health insurance companies. i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0. ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure. In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA" It's common for people to confuse these things. In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars. [i] https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
- abuani 5mo ago
  Reading this should make everyone in the US furious about the state of our health system
  - dqv 5mo ago
    I mean it does. That's why so many people cheered when Brian Thompson was... involved in a shooting and died.

goosejuice 5mo ago

In situ should be medically necessary and thus should be widely covered. That's surprising.