At my yearly physical, my primary care doctor recommended a colonoscopy since i'm 54. After scheduling it, I looked into my (Anthem BC/BS HMO) benefits. While it clearly states that I am entitled to a once a year colorectal examination as part of preventive services with a $25 co-pay, they say a colonoscopy is not a preventive screening but outpatient surgery with a $400 co-pay.
Has anyone else run into this? Seems to me that the insurance company is simply trying to avoid the costs by reclassifying a preventive screening into another category.
A quick google seems to indicate this may be going on elsewhere since it looks as if Texas (?) may have passed a law to get insurance companies to cover colonoscopies.

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1977 300d 70k--sold 08
1985 300TD 185k+
1984 307d 126k--sold 8/03
1985 409d 65k--sold 06
1984 300SD 315k--daughter's car
1979 300SD 122k--sold 2/11
1999 Fuso FG Expedition Camper
1993 GMC Sierra 6.5 TD 4x4
1982 Bluebird Wanderlodge CAT 3208--Sold 2/13

What a PITA.

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Never a dull moment at Berry Hill Farm.

That's ridiculous. It's preventative. The amount you shell out for insurance it should be covered. It's once every ten years for chrissake.

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You don't need a weatherman to know which way the wind blows - Robert A. Zimmerman

It's a costly procedure and, typical of the insurance companies, they attempt to minimize expenditures.

My own company, HIP of Greater NY, has put the colonoscopy in the "preventative" category...........they figure that catching a pre-cancerous polyp before it causes catastrophic problems ($$$$ for the insurance company) is a good investment.

Not all of them think in similar vein. Not a damn thing you can do about it........as usual.

A colonoscopy is an outpatient procedure according to my insurance (Blue Shield) and is subject to a $100 co-pay. Doesn't matter what we call it, the insurer holds the money here.

Have you checked with them on the discrepancy? Could they be talking about a virtual colonoscopy in one case and an actual colonoscopy in the other?

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01 Ford Excursion Powerstroke
99 E300 Turbodiesel
91 Vette with 383 motor
05 Polaris Sportsman 800 EFI
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03 SeaDoo GTX SC Red
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Thought it was 5 years?

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01 Ford Excursion Powerstroke
99 E300 Turbodiesel
91 Vette with 383 motor
05 Polaris Sportsman 800 EFI
06 Polaris Sportsman 500 EFI
03 SeaDoo GTX SC Red
03 SeaDoo GTX SC Yellow
04 Tailgator 21 ft Toy Hauler
11 Harley Davidson 883 SuperLow

Kerry,

although contracts differ I am sure with your attention to detail that you are correct.

The only thing you should have in your ass is the sigmoidoscope and $25; not the $400 bill.

"The average age of onset for colorectal cancer generally is 70 to 75 years."

I'm guessing that's why insurance companies don't really care whether you get the colonoscopy or not. At 65, you're no longer paying their premiums, you're on Medicare. The insurance companies only want to keep you alive and healthy (ie not having to pay out benefits) until you're eligibile for Medicare. Past that age, you're of little benefit to them. I'm sure the actuaries have crunched the numbers.
I'm paying $1043 per month for this. Capitalized medicine at its finest.

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1977 300d 70k--sold 08
1985 300TD 185k+
1984 307d 126k--sold 8/03
1985 409d 65k--sold 06
1984 300SD 315k--daughter's car
1979 300SD 122k--sold 2/11
1999 Fuso FG Expedition Camper
1993 GMC Sierra 6.5 TD 4x4
1982 Bluebird Wanderlodge CAT 3208--Sold 2/13

Here's what (last year's) policy says:
Preventive Care Services:
"One colorectal cancer examination and related laboratory tests are covered per Benefit Period regardless of age, or in accordince with the frequency determined by your provider."

On a separate page entitled Cancer Screenings, it says:

"Colorectal Cancer Screenings
Several types of colorectal screening methods exist. All plans provide coverage for colorectal cancer screenings, such as colonoscopies, sigmoidoscopies and fecal occult blood tests. Depending of the type of colorectal cancer screening received, payment for the benefit is based on the plan's provisions for laboratory servies, preventive care office visit services or other medical or surgical services. Our plans do not provide coverage for preventive colorectal cancer screeings involving invasive surgical procedures and DNA analysis."

The question is: What does this mean? One the one hand it says it provides screening coverage for colonoscopies, on the other hand it says it doesn't provide coverage for invasive procedures. On the phone they say a colonoscopy is an invasive procedure. My PCP ordered a preventive screening.

I've beaten them once before on the wording of their policy once I pushed the issue to an external review board. I've got to try to figure out what are the possible interpretions of these paragraphs. It seems to me that one could construe the first part of that paragraph to say that they do cover a colonoscopy as a screening procedure and not an invasive procedure.

They must be aware of the ambiguity because on the phone they are very touchy about discussing the issue.

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1977 300d 70k--sold 08
1985 300TD 185k+
1984 307d 126k--sold 8/03
1985 409d 65k--sold 06
1984 300SD 315k--daughter's car
1979 300SD 122k--sold 2/11
1999 Fuso FG Expedition Camper
1993 GMC Sierra 6.5 TD 4x4
1982 Bluebird Wanderlodge CAT 3208--Sold 2/13

The amount 'shelled out' is hardly 1/10 to 1/1000 of what will be 'spent' during the time of coverage once any real procedure(s) are required.

Some companies try to limit procedures in an effort to keep costs from spiraling out of sight. It is futile, like sweeping the ocean back with a broom, but you can't blame them for trying.

The other, even less-attractive option is to become self-insured and pay your own way.

I have Kaiser, they pay for everything...

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"It's normal for these things to empty your wallet and break your heart in the process."
2012 SLK 350
1987 420 SEL

Kerry, they make money by screwing you, I went through hell with my insurance company because of my neck because they wanted the VA to pay for it, I had to pay for epiderals (and you know how much they cost) out of pocket for 3 years until each of them coughed up their share.

File a complaint with you state insurance office and you will get results, if I had done that in the first place my case would have been resolved in weeks not years.

What you need is your doctor to write a letter saying the you NEED(ed) the colonoscopy, I'm no expert but in my experience the doctors note trumped the insurance companies BS.

Good luck!

My HMO, CareFirst, covered mine. It seems like prevention is always preferable to inter-vention.

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" We have nothing to fear but the main stream media itself . . . ."- Adapted from Franklin D Roosevelt for the 21st century

OBK #55

1998 Lincoln Continental - Sold
Max 1984 300TD 285,000 miles - Sold
The Dee8gonator 1987 560SEC 196,000 miles - Sold
Orgasmatron - 2006 CLS500 90,000 miles
2002 C320 Wagon 122,000 miles
2016 AMG GTS 12,000 miles

For both the patient and the insurer.

__________________
" We have nothing to fear but the main stream media itself . . . ."- Adapted from Franklin D Roosevelt for the 21st century

OBK #55

1998 Lincoln Continental - Sold
Max 1984 300TD 285,000 miles - Sold
The Dee8gonator 1987 560SEC 196,000 miles - Sold
Orgasmatron - 2006 CLS500 90,000 miles
2002 C320 Wagon 122,000 miles
2016 AMG GTS 12,000 miles