Scoping Out Your Colonoscopy Medical Bills

If you are having a lower endoscopy (colonoscopy) or upper endoscopy (EGD), there are a few things you should bear in mind.

1) Site-of-service cost difference

On the cheap end, some insurance companies have negotiated contract rates for colonoscopy costs at ambulatory surgery centers and endoscopy centers as low as $384 for the facility fee. On the expensive end, facility fees for some outpatient hospital departments are as high as $2,000 for a colonoscopy. Don’t let anyone fool you into thinking a colonoscopy is an expensive procedure to perform. The material and supply component of colonoscopy costs are only about $50-$60 and it only takes 20 minutes to perform the procedure.

You may also have to pay a lab and pathologist if a tissue sample or polyp is removed during the procedure.

Total patient out-of-pocket colonoscopy costs with a high-deductible or self-pay case could be $684 on the low end and $3,300 on the high end for the surgery facility, surgeon, and anesthesia costs. The low-end prices will only be accessible in markets like Florida, Illinois, Michigan, and New York city where some commercial insurers pay providers about the same as Medicare.

Elsewhere, you can still easily save yourself at least $1,350 on facility selection by making a few calls and probably another $439 on the anesthesia component of your colonoscopy costs. Anesthesia is discussed below.

3) Expect a biopsy

You should also know that about 1 in 10 colonoscopies will involve a biopsy or tissue sample. This is usually a few hundred extra dollars in additional colonoscopy costs to the patient, so it would be best to set some money aside to pay for this if you are a high-deductible and self-pay patient.

4) Avoid monitored anesthesia care

One thing that can save you money on a colonoscopy costs is verifying that your gastroenterologist or internal medicine physician uses conscious sedation instead of monitored anesthesia care (MAC). Conscious sedation is the standard of care for colonoscopies and can be administered by a nurse of the facility, whereas monitored anesthesia care has to be administered by an anesthesiologist. Conscious sedation saves you money on colonoscopy costs as the patient because you don’t have to pay extra money to an anesthesiologist to supervise while you’re unconscious.

If your physician is one of the few who prefers to use monitored anesthesia care, ask him or her if they have a partner that uses conscious sedation.

5) Mitigate repeats of the procedure

You can avoid paying extra costs by being extra diligent with your colonoscopy prep. There is a risk that if you cheat on your prep by eating food or by not drinking the entire laxative, that your physician will have to abort the procedure and you will have to pay to have the procedure done again. The only thing more unpleasant than having to go through prep for a colonoscopy would be going through it twice and then incurring the twice the cost.

6) Colonoscopy screenings and the Affordable Care Act

Medicare patients no longer have to pay deductibles or coinsurance for colonoscopy screenings as of January 1, 2011. The key qualifier here is the term screening. If the patient presents with no symptoms and the colonoscopy is purely a preventative measure, then it is a screening. However, if the polyps are found during a colonoscopy screening or if the patient is having a colonoscopy to investigate gastrointestinal symptoms, then the procedure becomes “diagnostic” and the patient’s out-of-pocket costs will apply. A screening becomes diagnostic if polyps are found.

Author Bio: Contributed by Nicholas Newsad, M.H.S.A., author of Medical Bill Help and The Medical Bill Survival Guide.

Category: Medical Business
Keywords: medical bills,colonscopy

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