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Negotiating Colonoscopy Costs

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Ulcerative Colitis
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Posted 11/7/2012 5:24 PM (GMT 0)
I am shopping around for the cheapest option due to having a high insurance deductible. I live in a major metroplex so I have tons of options.

Any tips for getting the best possible price? I know paying upfront helps, anything else that can be said to lower costs? Also, I'm having trouble getting this info out of offices unless I come in for a visit, anything I should say to get the prices over the phone?

Thanks!
Posted 11/7/2012 6:10 PM (GMT 0)
Well, it helps to speak with the right person at the hospital to start. I'd recommend calling and asking for the hospital's billing/accounts payable office (rather than the endoscopy people who just do the procedure). Tell the billing people you are paying for the procedure out of pocket and you must therefore know the cost up-front before the procedure is done (I think it would be easier to get an answer out of them that way). The different anesthesia options might change the price too.

The hospital I use told me that they have a discount for those who are paying for procedures out of pocket (not sure if this is typical or not).

Not sure if your insurance company's negotiated rate for the colonoscopy procedure would be given to you as well? You could certainly ask as that negotiated rate might be cheaper that the cash discount rate.

Certainly do your homework and good luck,
Posted 11/7/2012 6:40 PM (GMT 0)
Ask the dr that will be doing your scope to do the anesthetic also. Anesthesiologists charge a boatload
and is a totally different charge.

I changed GI's for many reasons, but a good point was he also did the anesthesia himself, saving me nearly a grand since my insurance didnt believe it was necessary for a scope... seriously.

Carlie
Posted 11/7/2012 6:50 PM (GMT 0)
I certainly understand about needing to save money so if this is a case of you wouldn't get it done vs. getting a price you can afford then go for it. But...all doctors aren't the same, all endo centers aren't the same and all anesthetists aren't the same.

This is your precious body and you need a good doctor doing the job, taking biopsies.
So I hope you are choosing the doctors you want and then getting the best price from those good doctors.

Do you already have a diagnosis of UC? Because if you do not have the diagnosis then colonoscopies are usually free even with high deductible insurance (this is US). My DH's colonoscopy will be free to him (non-UC) but I had to pay the deductible for mine in October and yes the anesthesiologist was the highest part of the bill but it was reduced without my asking. I was surprised at how little the insurance company paid my GI.

There are many parts to a c-scope bill: the facility, your GI, the anesthesiologist are the biggies. You can't generally get an answer without calling each person/facility since they bill separately.
Posted 11/7/2012 10:30 PM (GMT 0)
no diagnosis yet
Posted 11/7/2012 10:40 PM (GMT 0)
I think it Texas you have to be 50 or older to have the insurance company cover
Posted 11/8/2012 1:27 AM (GMT 0)
Ask if you can get the best price negotiated with the insurance companies. Be armed with an understanding of how that works. For example, my GI's charge for Remicade is $8K. My insurance company's negotiated rate is between $2K and $3K. (Then I pay my co-insurance, e.g., 20% after deductible met, based on that amount --but that's not relevant to your negotiation with the doc).
So there is lots of room for negotiation. Doesn't hurt to ask.

Also, would a flex sig work well enough, under the circumstances??
Posted 11/8/2012 3:32 AM (GMT 0)
A family member told me to pay for my procedure in cash and the total out of pocket expense would be half (after submitting it to insurance, which will never pay it, etc.).

I called my GI doc's billing dept. and turns out my relative is correct.

You tell the receptionist you are : "self paying". For example, my procedures are usually around $1500.00 after insurance rejects the bill, the doctor then reduces the amount.

To compare my self pay amount is approx. $740.00.

That's a big difference. I'm due for one soon so this is the route I am taking.
Posted 11/8/2012 5:57 PM (GMT 0)
$740 sounds quite reasonable to me, that's everything including anesthesia?
Posted 11/8/2012 8:03 PM (GMT 0)
It's crazy that we have to pay for this. Lets charge the sick money, hopefully Obamacare helps with this
Posted 11/8/2012 9:48 PM (GMT 0)
Yes approx. $740 was my amount, one amount was $350ish for 1 part of the bill, another amount was slighly higher, I forget what the billing clerk said specifically but when we concluded our convo, I made sure to ask - so such and such ($740) will be my total out of pocket expense? She said yes.

Now bear in mind, should they find a polyp, then the amount goes up. And then my husband pointed out at that point, if there's a concern, maybe we would bill it to insurance.

I never did ask if I can wait until the procedure is over, to either pay with cash or bill insurance. That would be an important question to ask.

Since I haven't had a benign polyp since 1997 and a malignant tumor since 1999, most of my procedures are clear and negative.
Posted 11/8/2012 9:55 PM (GMT 0)
Well I met w/ my GI today and he wants to schedule one if my stool cultures come back negative.

The Dr. portion alone is $640 before the anesthesia and "facility" charge, so I might be looking elsewhere.
Posted 11/9/2012 2:58 AM (GMT 0)
Yep, you can shop around! Most people dont know that.
Did you do any negotiating?
We have to be our own good advocates, when you live with chronic disease.
Posted 11/9/2012 3:02 AM (GMT 0)
I didn't do any negotiating today, they told me my discounted insurance rate was $640 vs. $1,100 out of pocket, couldn't believe that.
Posted 11/9/2012 11:22 AM (GMT 0)

mattcs said...
The Dr. portion alone is $640 before the anesthesia and "facility" charge, so I might be looking elsewhere.

Make sure you have a pathologist charge included as well.

I don't have high deductible insurance. My doctor, facility, and pathology charge this year was $3566 and was reduced by insurance to $2354 (doctor $1268, facility $704, pathology $382). My doctor does the anesthesia.
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