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Can someone explain how colonoscopies for UCers are covered under Obamacare?

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Ulcerative Colitis
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Posted 6/5/2013 8:47 PM (GMT 0)
From my understanding, since it's a preventive procedure, it should be covered under Obamacare. I had a colonoscopy a couple months ago to make sure I wasn't flaring, and I was billed $250 (In total, it was a few thousand but I had to pay $250). According to the ACA, the cost-free preventive procedures went into effect in 2010. Do you think it's because of my deductible? I'm probably in the wrong here but I thought I'd ask. Thank you... :-)
Posted 6/5/2013 8:52 PM (GMT 0)
Obamacare is not in effect yet as far as I know, except for certain provisions (like reducing the amount you can put in a Flexible Spending Account, for example). I'm not aware of any controls yet placed on deductibles, insurance plans or reimbursements. I think a lot of that starts in 2014.

I don't know what a "cost free preventative procedure" is in this country, LOL, nor what the ACA is.
Posted 6/5/2013 9:17 PM (GMT 0)
It is not considered preventive for UCers. Colonoscopies are considered preventive and therefore free if they are for colon cancer screening only. Since you're "already sick" the colonoscopy is not preventive treatment.

I didn't make the laws, I just explain them on the internet.
Posted 6/5/2013 9:24 PM (GMT 0)
My last insurance plan was like that, things were free unless you NEEDED them. If they were for the purpose of diagnosing, there was no or low charge. Anything outside that "preventative" title required that you pay in full until you meet your deductible and after that you would pay 20% of the total until you hit your out of pocket max. The max was about 5k. When you think about all that money you have to spend, plus the money deducted from your check each month and the deductible (~2K), it's unaffordable, even if you work fulltime and make a decent salary. These insurance plans don't make sense.
Posted 6/5/2013 10:52 PM (GMT 0)
That makes sense. Thank you very much.
Posted 6/6/2013 12:36 AM (GMT 0)
I don't think Obamacare has anything to do with insurance and colonoscopies. This is a very evolving and difficult issue because it is only covered 100% if it is actually preventative. If it is not preventative, which is the case in almost all of our colonoscopies, then it is not covered 100%. They have identified a problem with how Obamacare defines this procedure but I don't know if it is ever going to be fixed. It's kind of crazy because if you do a colonoscopy to search for polyps which could turn cancerous, and they don't find any then it is called preventative and covered 100%. If they find something and remove the polyps during the procedure it is called a procedure and not preventative anymore so therefore you would be charged.
Posted 6/7/2013 12:10 AM (GMT 0)
i have never had to pay for a colonoscopy before but they used propofol this time for sedation for the first time and I just got a bill for 400 bucks.....insane
Posted 6/7/2013 12:22 AM (GMT 0)
I paid $388.... not for the procedure with Kaiser but for the biopsies/lab work.
Posted 6/10/2013 7:35 PM (GMT 0)
"the colonoscopy is not preventive treatment."

Hmmm.

I think a *very* strong case could be made that cancer surveillance colonoscopies are *very much* a preventive treatment. Over time, UC hikes colon cancer risk.

Considering how lucrative C-scopes are for gastros, I wonder if something else is going on here...
Posted 6/10/2013 8:37 PM (GMT 0)
I'm not sure c-scopes are that "lucrative" for gastros unless they do 40 a day. I looked at her negotiated fee (private insurance) and she got less than $200. I think doctors who own the scope centers make out pretty well when other docs use the facilities but they have a lot invested too.

Now anesthesiologists? They make out like bandits but they would say they have to charge a lot because they have very high malpractice insurance. That was the highest charge on my bill.

Surgery is also a bigger expense, luckily I haven't needed that.
Posted 6/10/2013 8:42 PM (GMT 0)
ues, but cancer prevention recommendation is for yearly or every other year starting 5 to 0 years after diagnosis. so it is hard to apply this to several in the 1st few years of treatment.

Anyway Gary is right. The Affordable Healthcare Act does not have anything to do "directly" with colonscopies. It does mandate some preventative screenings/services at 0% co-pay. Colorectal cancer for people aged 50+ is one recommendation. Scoping is generally how this screening is done.

GI's generally recommend scoping for cancer prevention reasons, starting about 10 years after 1st diagnosis (some say 5 years).

Not every colonscopy is a cancer screening. If you have symptoms and the scoping is done to see what is wrong, or you have a UC diagnosis and the scoping is done to check on change in inflammation, than it is diagnostic not preventative, and you are committing insurance fraud if you try to claim otherwise.

Also scoping is generally done with a sedative. If you get general anesthesia, expect to pay for that separate. Biopsies are often taken along the colon as part of scoping and may be covered. As Gary noted, any pathology report on removed tissue is not part of scoping, and you pay of that.
Posted 6/10/2013 9:43 PM (GMT 0)
kff.org/health-costs/report/coverage-of-colonoscopies-under-the-affordable-care/

There is complete paper at this link just hit "report". I will summarize and say maybe or maybe not covered. Pretty confusing. Seems like if you should really get one then they don't pay. Sort of typical.

My current policy covers preventive colonscopies but you have cost share for diagnostic but they paid for most of my diagnostic one anyway. I am hoping to just switch to a lower deductible plan when the market places open.
Posted 6/10/2013 10:52 PM (GMT 0)
my UC -I blame Obama
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