colonoscopy procedure and insurance

[cookiedough]

I have to just love how the way procedure codes affect payout for health insurance plans. 

My wife works with a person who had a colonoscopy.  According to our health insurance plan a colonoscopy is 100% covered as preventive procedure.  However,  they found a polyp in there and removed it.  It changed the procedure code from preventative being paid in full 100% to TREATMENT thus subject to the $3000 family deductible which they had to pay near the entire procedure for. 

Insurance and coding for billing is F'ed up for sure. 

Our daughter has to have her wisdom teeth pulled this summer and of course medical plan has a FIRST 3000 deductible as well on a 3365 procedure.  What the F good is insurance if nothing is covered thanks to a 3K family deductible that has to met first?    Over 3300 to remove 4 wisdom teeth is insane so I got another estimate from another oral surgeon and is only 200 dollars cheaper but that place is OUT of network vs. IN network with our insurance plan.

gotta love it!   

Dental only covers 1500 per year per person, so there goes around 2 grand out of our pocket to rip out 4 wisdom teeth.    I asked a dentist to review xrays and they said 2 of the bottom teeth are worse and could say do 2 now and 2 next year at say 1500 each oral surgery so most is covered vs. spending near 2K out of pocket for all after dental insurance pays.  I say do that but wife and kid disagree get them all done at once.    About 800 bucks per tooth for extraction is crazy if you ask me even if having to be knocked out and sedated. 

Not trying to scare anyone off on getting the colonoscopy procedure done, but does not hurt to call your insurance plan up to check what is and what is NOT covered.

[oldsmokey]

Insurance companies give you a colonoscopy everyday. ..RIGHT
Had a wisdom tooth pulled by my dentist about 9 years ago, couple shots, (should have been bourbon for each of us) busted it out in 3 pieces, 45 min later done. $0...

[old2soon]

Look up and grab yer ankles when/after/during observing the price of dental implants.   V A at this point in time will NOT cover my dental. And EVEN with the discount places available to me here in Missouri and Arkansas STILL a tad bit spendy for a guy on social insecurity. I looked into dental insurance-high premiums and similar deductible problem as you just sighted. Couple places I'm looking at have a monthly payment plan with fairly low interest rates. Who in the heck ever thought I would need to float a loan for a full set of dentures?   While I'm fairly certain greed had a lot to do with the insurance mess I am also fairly certain the mess that was RAMMED/FORCED/JAMMED down our collective throats and up our nether regions didn't help either!   RIDE SAFE.

[Robert]

Insurance is a joke I pay more for the insurance than I have procedures and I pay the procedures because like you a deductible. I don't understand why if the Supreme court deemed O care a tax why we cannot take the biggest tax increase in history off our taxes

[Jess from VA]

I have a shitty little dental plan (add-on).  If tooth/teeth problems are not causing immediate pain/problems, or risk causing greater damage if immediately untreated, I spread my work out over time (past the new year), so I have some damn coverage.  Sometimes my dentist is a little peeved as he'd like to clean everything up that needs it (and BTW get paid for it).   I'd like to get it all done too (in a perfect world), but waiting can save me money.  So, if I'm not bothered and if it isn't infected or something, I put it off until I have my shitty little coverage again.

When growing up, a cleaning and exam with xray was $35 or so.  Now it's many times that, and uses up my coverage.  So I brush and floss, and waterpic, and don't get dental cleanings anymore.  I save coverage for drilling or cutting I cannot do myself (with any accuracy LOL).  That peeves the dentist and his hygienist.

Cookie, it's none of my bidness, but how old is your daughter?  If she's working, here would be my deal.  (If there are no immediate medical issues) Get two done this year and two next year, and I'll take care of it.  If you want all four now, I'll still take care of it, but you'll owe me my extra cost for getting them all done at once, and can make payments to pay me back.

Welcome to capitalism.  (no offense intended, none of my business of course)      

[Alien]

Just make sure the Doc only has one hand on your shoulder.

Ride Safe,

Alien

[Reb]

I have to just love how the way procedure codes affect payout for health insurance plans. 

My wife works with a person who had a colonoscopy.  According to our health insurance plan a colonoscopy is 100% covered as preventive procedure.  However,  they found a polyp in there and removed it.  It changed the procedure code from preventative being paid in full 100% to TREATMENT thus subject to the $3000 family deductible which they had to pay near the entire procedure for. 

Insurance and coding for billing is F'ed up for sure. 

Our daughter has to have her wisdom teeth pulled this summer and of course medical plan has a FIRST 3000 deductible as well on a 3365 procedure.  What the F good is insurance if nothing is covered thanks to a 3K family deductible that has to met first?    Over 3300 to remove 4 wisdom teeth is insane so I got another estimate from another oral surgeon and is only 200 dollars cheaper but that place is OUT of network vs. IN network with our insurance plan.

gotta love it!   

Dental only covers 1500 per year per person, so there goes around 2 grand out of our pocket to rip out 4 wisdom teeth.    I asked a dentist to review xrays and they said 2 of the bottom teeth are worse and could say do 2 now and 2 next year at say 1500 each oral surgery so most is covered vs. spending near 2K out of pocket for all after dental insurance pays.  I say do that but wife and kid disagree get them all done at once.    About 800 bucks per tooth for extraction is crazy if you ask me even if having to be knocked out and sedated. 

Not trying to scare anyone off on getting the colonoscopy procedure done, but does not hurt to call your insurance plan up to check what is and what is NOT covered.

Dental procedures are getting ridiculous. I just had oral surgery performed to extract what was left of my front tooth in preparation for an implant to replace it (old high school sports injury). Luckily I have an HSA through my company. Sure comes in handy for expensive procedures. I was fortunate enough to have insurance pay half of the $3200 cost for a single implant. If you have the opportunity to open or start an HSA is really helps.

[cookiedough]

I have a shitty little dental plan (add-on).  If tooth/teeth problems are not causing immediate pain/problems, or risk causing greater damage if immediately untreated, I spread my work out over time (past the new year), so I have some damn coverage.  Sometimes my dentist is a little peeved as he'd like to clean everything up that needs it (and BTW get paid for it).   I'd like to get it all done too (in a perfect world), but waiting can save me money.  So, if I'm not bothered and if it isn't infected or something, I put it off until I have my shitty little coverage again.

When growing up, a cleaning and exam with xray was $35 or so.  Now it's many times that, and uses up my coverage.  So I brush and floss, and waterpic, and don't get dental cleanings anymore.  I save coverage for drilling or cutting I cannot do myself (with any accuracy LOL).  That peeves the dentist and his hygienist.

Cookie, it's none of my bidness, but how old is your daughter?  If she's working, here would be my deal.  (If there are no immediate medical issues) Get two done this year and two next year, and I'll take care of it.  If you want all four now, I'll still take care of it, but you'll owe me my extra cost for getting them all done at once, and can make payments to pay me back.

Welcome to capitalism.  (no offense intended, none of my business of course)      

daughter is 18 going to college first year no real income to speak of coming in that has her own insurance, etc.   I am tempted to say 2 wisdom teeth done in 2016, 2 in 2017 if they can wait so most of the 3300 is covered vs. less than 1/2 at 1500 tops paid out thru dental if all done in 2016.

Just doing taxes now also really pisses me off you cannot claim as a 1000 child tax credit any child age 17 and over., but still can for an exemption.  MOST kids age 17 and possibly 18 still are at home living with the parents, so why not make that the RULE for child tax credit vs. limiting it to age 16 tops.  ALL 17 year olds are still in high school living at home, but the darn federal govt. and IRS makes up a stupid rule that if age 17,  NO child tax credit.  IDIOTS in charge of our taxes and insurance both. 

[Oss]

OVER 24K for medical, no dental or eyeglasses coverage  consider yourself lucky

Since You did not schedule the polyp removal you should fight the code change  You could have had him or her leave it where it could do more damage or not

Either way You'll still have to pay deductible for the removal of the polyp

Probably not worth the fight in the end

[scooperhsd]

Dental expense - OUCH !!!!

Fortunately, Uncle Sam took out my wisdom teeth (3 impacted, had one dry socket) all at once.  In my last tour in DC, we had the Wife's insurance pay for orthodontics for me - but it still cost us a pretty penny.

In the last year my dentist has gotten on a tooth pulling kick - both of my remaining lower right molars (replaced with a partial denture - NOT quite the same !!!) Forget dental implants - I can't afford $5000 each. My regular dentist also wanted to pull my last upper right molar - I put the kibosh on that and we went to a specialist for the crown replacement prep / crown - and this was out of network.

 At this point, I'm missing around 10-12 natural teeth . I'm not losing any more unless it's absolutely hopeless.

[Challenger]

Yup! Same thing happened to me with a scheduled colonoscopy (wellness exam), Found I had colitis and diverticulitis, They then went for an endoscopy.  So now it is not a preventive wellness exam and I get to pay for all of it. 
Spoke to the Dr. about it after I git the bill and he said we could have rescheduled the endoscopy for another day and they might have covered the colonoscopy. Now he tells!     

[Valker]

There sure are a LOT of folks who cross into Mexico for their implants and other dental work. Several dentists just across the border work on Americans exclusively and have great reviews. Price is usually 25%-50% of the US charges. (I'd probably avoid Juarez and go closer to Nuevo Laredo or Matamoros).

[Daddie O]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

[John Schmidt]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

Last I heard the Canadians are rethinking that type of health coverage. Seems to have turned into as big a boondogle as Obama's wet dream and it's killing the gov't. finances according to what I've read. It would be great if you could get the same fast and effective service under that system as now, at least my providers don't put me off for weeks if not months. As I understand it, the wait time in the UK is quite long for anything other than routine service, and even that needs be tempered with patience. Again, it's what I've read in various sources, I assume there's a high degree of truth since most articles reported the same basic problems.

[cookiedough]

I just think that PER wisdom tooth,  800 each is insane pricing.  Yah, it is surgery, but per tooth, come on!!  Another place came in at 3100 vs. 3300 total for 4 wisdom teeth extractions. 

I was told 2500-3K or so at my local dentist. I sure was hoping for 2500 vs. 3300 though.  1800+ out of pocket is not chump change after dental side covers near 1500 after a few more fillings needed. 

What got this whole thing going is my daughter switched dentists to one nearby her college.  BAD idea.  He wanted to pad his wallet with MY money said 7 of my daughters teeth need fillings done this year. I got 2nd opinion (and 3rd opinion), free of charge to do that with our dental insurance if coded properly, and both others concur 2 needed ASAP and maybe 2-3 more tops iffy in 2017 still, but the other 2-3 teeth can wait until 2017 or later on a watch list is all.  Needless to say that crooked new dentist my daughter saw will NOT be going back EVER again.  I should report him to our dental insurance carrier and get him removed from PPO status for procedures NOT needed.   

Luckily in America we can say NO and go elsewhere easy enough until we get the right answers. Like said, our old dentist who left and new lady dentist came in wanted 20K of cosmetic work done to my wife and my teeth and NONE needed.  We dropped her ASAP and went elsewhere not going to make her richer than she was.  For 20K I will go toothless like my parents have done - good way to toughen up the old gums....

[cookiedough]

Yup! Same thing happened to me with a scheduled colonoscopy (wellness exam), Found I had colitis and diverticulitis, They then went for an endoscopy.  So now it is not a preventive wellness exam and I get to pay for all of it. 
Spoke to the Dr. about it after I git the bill and he said we could have rescheduled the endoscopy for another day and they might have covered the colonoscopy. Now he tells!     

I agree,  how are we suppose to know a colonoscopy is preventive  paid for until they find something then NOT covered at all entire procedure if having to remove something?  It is not like we can say during procedure if asked to leave it back up in there until we can call our insurance provider and get a pre-authorization once into surgery.  Sort of pisses me off you go in for something that should be done and get rammed up the REAR not once, but twice.  It was not me, but a guy my wife works with that got the shaft on paying for it all. 

I think the whole medical scheme needs to be redone like things for this.  Say the procedure is covered 100%, but just a small portion of the removal process is required to meet the high deductible having to pay.  ALL of the colonoscopy should NOT be covered at all due to removing 1-2 polyps is all.

I will not go into detail, but one small procedure I felt strongly on was coded wrong years ago on me.  I refused payment sending letters to clinic on reasons why not right, sent to collection agency and never did pay it.  Screw the credit rating and collection calls, right is right, wrong is wrong, and code the darn procedure properly right the first time, problem solved. 

[Hooter]

I just had Mohs skin cancer surgery. A 5 hour procedure and some 60 stitches later in my face and gord.  $6500 was the total cost. Out of that amount my outa pocket is $2100. When your retired that's a little tough to swallow. I can think of better ways to use that money. 

I made some phone calls asking WTH but got no place with anyone. And they wonder why people are not going to the doctor or dentist!   

[Gryphon Rider]

OVER 24K for medical, no dental or eyeglasses coverage  consider yourself lucky

Are you saying you pay $24,000 per year for medical coverage?  For how many people?

[RDAbull]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

The VA is a single payer federal insurance program. 
Boy that has worked out well, let's turn everybody over to the government for more of that great treatment.

[cajunito]

There sure are a LOT of folks who cross into Mexico for their implants and other dental work. Several dentists just across the border work on Americans exclusively and have great reviews. Price is usually 25%-50% of the US charges. (I'd probably avoid Juarez and go closer to Nuevo Laredo or Matamoros).

 I wouldn't be going anywhere close to Nuevo Laredo or Matamoros these days without a tank and a Marine regiment.

[Bighead]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

Yeah just hang more expense on the working stiffs.

[Novavalker]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

https://waittimes.novascotia.ca/procedure/knee-replacement

Lets see a knee replacement wait time in a major city is 375 days for a consult. The surgery will have to wait 900 + days after your consult.
Electrophysiology Clinic .......559 days.

I call it rationed healthcare. Anxiety caused by wait times will take its toll.

[Jess from VA]

And I bet the guy walking around on a knee bad enough to be replaced is loving that three year wait.

Ever hear of justice delayed is justice denied?

Here's a golden rule for our lifetimes............... If the government runs it, it will suck, then fail.    (directed at the US, not Canada)

[Beardo]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

Last I heard the Canadians are rethinking that type of health coverage. Seems to have turned into as big a boondogle as Obama's wet dream and it's killing the gov't. finances according to what I've read. It would be great if you could get the same fast and effective service under that system as now, at least my providers don't put me off for weeks if not months. As I understand it, the wait time in the UK is quite long for anything other than routine service, and even that needs be tempered with patience. Again, it's what I've read in various sources, I assume there's a high degree of truth since most articles reported the same basic problems.

Our system is far from perfect. There are issues with wait times for surgery, etc. And we do pay a hefty tax bill for our "free" health care.  Getting into the ER can take a while sometimes too. I'd like to see a small fee for every ER visit to get rid of he people who are there for a cold or whatever. My son sat in the waiting room with a dislocated shoulder for a couple hours one time before he got in. The next time he did it though, he was in within minutes. He got the surgery to repair it a couple months later, which was quicker than we expected, and it allowed him to recover in time for the next football season, so we were happy.

Having said that our system isn't perfect, no one here will forego any treatment here because they can't afford it. It's never a factor. Not criticizing the American system, just saying that many of the horror stories about of our system are true, but many are not.

Do most people down there not have dental insurance through their work?  Most employers here have a dental plan. Most of my dental work is covered 100%. So are chiropractors, massages, hearing aids, etc.

[Bighead]

This thread illustrates the need for single payer universal health care, as opposed to getting raped by private for profit insurance companies.

If you disagree, maybe you could enlighten me on why you prefer to pay taxes to the government AND pay premiums to private insurance companies that charge outrageous deductibles, instead of paying taxes and having procedures done with no out of pocket expenses (like every other 1st world country on Earth).

Last I heard the Canadians are rethinking that type of health coverage. Seems to have turned into as big a boondogle as Obama's wet dream and it's killing the gov't. finances according to what I've read. It would be great if you could get the same fast and effective service under that system as now, at least my providers don't put me off for weeks if not months. As I understand it, the wait time in the UK is quite long for anything other than routine service, and even that needs be tempered with patience. Again, it's what I've read in various sources, I assume there's a high degree of truth since most articles reported the same basic problems.

Our system is far from perfect. There are issues with wait times for surgery, etc. And we do pay a hefty tax bill for our "free" health care.  Getting into the ER can take a while sometimes too. I'd like to see a small fee for every ER visit to get rid of he people who are there for a cold or whatever. My son sat in the waiting room with a dislocated shoulder for a couple hours one time before he got in. The next time he did it though, he was in within minutes. He got the surgery to repair it a couple months later, which was quicker than we expected, and it allowed him to recover in time for the next football season, so we were happy.

Having said that our system isn't perfect, no one here will forego any treatment here because they can't afford it. It's never a factor. Not criticizing the American system, just saying that many of the horror stories about of our system are true, but many are not.

Do most people down there not have dental insurance through their work?  Most employers here have a dental plan. Most of my dental work is covered 100%. So are chiropractors, massages, hearing aids, etc.

No one in this country has to wait for medical care( a county hospital cannot refuse treatment to anyone) . Ask me how I know! I have worked in the business for 32+ years and not Once did you read that correctly? ONCE  has a patient that NEEDED care was refused in my practice REGAURDLESS of their ability to pay. 1/3 of the surgery or other treatment we do is on Uninsured patients. Are they treated differently HELL NO.
The worst part about having to treat those patients is that it is a revenue loss and guess what the lawyers have fixed it so the Dr CANNOT write it off as a Loss so they have to pay out of pocket to treat someone for free and can't claim a loss come tax time. But they ALL get treated and treated equally. At least here in my part of the world. And if someone needs surgery no they don't have to wait and raise the money they get the need care in a timely manner.

[Beardo]

I'm sure the exaggerated stories we hear about how bad the US system is are just as many as the exaggerated stories you guys hear about ours.

Nothing wrong with dispelling the myths by having a conversation about it.    The US system has always been kind of a mystery to me. We're so used to just going to the dr or hospital and not worrying about insurance or cost. Maybe your system isn't as bad as some make it out to be.

I'd imagine we both end up paying roughly the same thing in the long run, and if we're getting the care we need, then great.

[gregk]

Yup, go have the girls at the billing office change the codes to just a normal inspection as you are not going there to have a specific router job done.  The wife wife and me had no problem. Good luck.
 As far as dental  I always figured the cost would be the same so I just cut the extra paper work.  And glasses the same way. Only wife wares glasses so I don't have that coverage either. Although I did get coverage one year when I had cataracts and other people at work are saying they weren't happy with the glasses they had, my wife wasent happy an they fd mine up. The Line in the glasses were not high enough and they had all this special gadgets. Cripes I had to have the damn things pressed right to my head, so after I had surgery we did away with the bs insurance and actually pay less because the wife don't need glasses every year.

[cookiedough]

Yup, go have the girls at the billing office change the codes to just a normal inspection as you are not going there to have a specific router job done.  The wife wife and me had no problem. Good luck.
 As far as dental  I always figured the cost would be the same so I just cut the extra paper work.  And glasses the same way. Only wife wares glasses so I don't have that coverage either. Although I did get coverage one year when I had cataracts and other people at work are saying they weren't happy with the glasses they had, my wife wasent happy an they fd mine up. The Line in the glasses were not high enough and they had all this special gadgets. Cripes I had to have the damn things pressed right to my head, so after I had surgery we did away with the bs insurance and actually pay less because the wife don't need glasses every year.

good luck having the billing codes changed.  I tried that and they refused since in one instance I felt the code was wrong and they disagreed sending it to THEIR mediation dept.and 99% of the time they favor insurance side NOT patients.  I ended up not paying and never did since I felt I was right.