17 August 2009

You Want to Know How Much A Colonoscopy Costs?

I’m as confused as the next person about health care reform - but I know we need it; it’s completely bat-shit crazy the way it is now. In my heart of hearts, I think we should have a one-payer socialized system, and I'm disappointed that the “public option” may be dropped from the current attempt at health care reform.

You know that I had two colonoscopies done this summer. Both were done by the same gastroenterologist –but for some scheduling reason unclear to me, the first was done in the hospital, and the second was done in the doctor’s office. Mind you, it’s not a sole practitioner’s office, it’s a big clinic operation with a full scale suite for endoscopies and colonoscopies (and who knows what else). The insurance we have is the kind where you have to stay in-network, and then you pay a small co-pay. In an effort towards transparency, the insurance company sends an Explanation of Benefits out after any claims, showing what the doctor billed, and what insurance paid, and what the patient’s responsibility is.

I compiled the numbers for the two colonoscopies and I’m kind of flabbergasted.

#1 in the hospital

Charges billed by doctors and hospital $9,142.84
Amount paid by insurance$5,742.67
Co-pay due from me$125.00

#2 in the doctor’s office
Charges billed by doctors and lab $5,322.76
Amount paid by insurance$2,922.63
Co-pay due from me$30.00

The submitted charges for the procedure in the hospital were 72% higher than the charges for the scope in the doctor’s office. And the insurance company paid out 96% more for the hospital procedure. At the end of the day, my doctor got reimbursed just about the same amount – so why did he schedule one of the scopes into the hospital? It wasn't for convenience; the hospital is about a half mile from his office. Why isn’t the insurance company protesting? They had to pre-approve the procedure – why didn’t they require that the first scope be done in the office – which would have saved them nearly $3,000? Why did the insurance company pay a bigger percentage of the first scope (63%) and less for the second scope (55%)?

The thing that strikes me about all of this is the irrationality – there’s seemingly no rhyme or reason to either the pricing or the reimbursement. Why is the system so broken?

An article in the September Atlantic suggests that the way out of the mess is to put decision making back into the hands of the consumer – also known as the patients. I don't know that consumer driven health care is the answer, but if I’d known how much the colonoscopy was going to cost in the hospital as compared to in the office, I’d have chosen the office both times - even though the bulk of the cost wasn't coming (directly) out of my pocket. And I’d have saved myself nearly $100 on the co-pay in the process.

Again, I have no idea what the answer is, or how to achieve it, but there is a problem and it needs to be solved. Further, it seems clear that a solution lies in the systems in place in other first world countries. "Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken." That's a quote from Paul Krugman, in today's Times. Go read the whole piece. He ends thusly:

So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.
I don't know where this will end.



ozma said...

That Atlantic article is COMPLETELY WRONG.

How can that even work? First, health care is not a consumable. Yes, there can be competition but we cannot afford our health care without insurance and we cannot forgo our health care without dying in certain cases.

Every other industrialized country manages health care. We have the highest health care costs in the entire world with some of the worst outcomes overall. Plus, we have over 40 million uninsured and thousands of people being bankrupted every week by health care costs.

As you show, the system we have now is irrational. I can't believe that people are fighting tooth and nail to keep the current system. It's just bizarre!

painted maypole said...

i tend to find that the "explanation of benefits" just leaves me with more questions, as well.

and, like Ozma says, I don't really know ANYONE who likes their health insurance. Yet they don't want to go to a different system. Perhaps inertia truly is the strongest force.

FreshHell said...

That's crazy. I don't know what the answer is. I would love to try a big dose of "socialism". I think the fault lies with both the insurance companies, the pharmaceutical companies, and the doctors for letting it happen. Greed. Why aren't the insurance companies complaining about the cost of meds? Instead, we're the ones who pay the price, literally. Why are doctors allowing themselves to be persuaded by pharma reps? Free food and perks? Really? I don't know what the answer is and I'm really disheartened by what's been happening in Congress. I think THEY should be fired. And then start over again.

Jess said...

'Swiss-ifying' America. Huh. I like that.

I have a real fear that all of the hope and excitement that Obama set the world on fire with will fizzle over this one issue.

Thanks for writing this.

shrink on the couch said...

Haven't been able to get beyond the almost $10K for a colonoscopy. Effing OUCH. I am sure I will be required to pay $2500 deductable for mine. And yes, please yes to health care reform. When you and spouse are both self employed, health insurance costs bring you to your knees. The runaround after the procedure, to figure out what is owed whom, lays you flat out on the floor.

Unknown said...


I cannot string together a coherent sentence on this subject. It's just Arrgghh!

Jenn @ Juggling Life said...

Even though I've always been well-insured I've been preaching this for years. Why don't well-off people get that they can still pay extra for a private policy--they (we) will lose nothing. The whole country will gain something priceless.

mayberry said...

Like you, I feel completely befuddled by the whole thing. And how on earth would you even begin to figure it out? Who can you trust to explain it?

meno said...

Health care makes about as much sense as the cost of airline tickets, which is to say, none.

All i know is that i hope i can sit on Rush Limbaugh's "death panel."

MARY G said...

I'm a Canadian. Universal health care. It is very far from perfect, but no one has to choose between dieing and going bankrupt.
Something you may not know. Our country bleeds newly trained doctors to the USA because they can earn a lot more money there. Only, when some of them face the miserable choices allowed by health insurance, they come back home.

Melissa said...

When I had my first colonscopy three years ago, it was denied in the pre-approval stage because of my age at the time. I am lucky. We kept empty credit cards for just such an emergency as we had to pay the whole thing out of pocket. In the hospital. I now call it the invisible car since we are still paying it off.

The second one a few weeks ago wasn't as issue since I now have a "history" and only had to pay a $250 copay on the deal.

But the whole system is totally fubar. There has to be another way.

bron said...

the hospital my daughter was born in charged my insurance company $121,000 for her birth. sure, she was in the NICU for ten days but beyond the lights she had for jaundice for 48 hours, she received no special treatment. why so expensive??

Jennifer (ponderosa) said...

I work as a contractor, so I don't get insurance through my work. Even though I've been a contractor at the same company for 5 years. My husband works for a small company. That small company provides our insurance. If my husband loses his job (and in this economy it seems increasingly likely), he and I will BOTH have to start looking for new jobs, and whoever gets a job offering insurance first wins... Talk about idiotic! So I'm hoping for a public option, too.

Florinda said...

I've started feeling like "the American way" is "I've got mine, so the rest of you can go hang" - and I really hate that. Why does it seem like people want change until it actually seems like it might happen? Health care in this country is getting to be like the weather - everyone complains, but no one does anything about it. The difference is that something actually COULD be done about health care, if people weren't ranting about things like "death panels."

I think that if health insurance becomes a mandated, fundamental right, there has to be a public option. I think that consumers should get a bigger role, but only if they can actually understand what they're dealing with. And I think that the cost structure, as you've shown us here, makes no sense.

I wish I knew how this would end too - I just hope it won't be in the same place where it started.

Aurelia said...


This is the website for the Ontario government for colonsocopies and Cancercare Ontario the agency that deals with all cancer cases.

Hospitals get $320 per procedure as you can see. Out of a separate fund they get funds for capital costs, such as equipment, but that's used over and over again and all non-reusable items are included in the $320. The doctor charges $57.50 per procedure, plus add-on charges if there is anything found, such as polyps etc. Doctor fee's usually end up being around $200 per procedure. (she does around 15 at a time, all of us prepped and lined up, etc., so she still makes a good buck, plus there are consult visits before and after at 180 bucks each.

I got my referral to a GI specialist last week. I saw her today. My colonoscopy is next Tuesday. No waiting.

All of this--FREE to me.

Ok, I have to pay for parking cuz I'm lazy and refuse to take the bus or park on a side street for free.

I don't get the hysteria, or the lies the right wing are telling. And I have no idea why you all are stuck in this situation.

Jennifer (ponderosa) said...

I just now paid what I believe is the last bill for my husband's recent operation. I talked over and over to everyone to make sure I understood the costs & wouldn't get surprised by anything.

For a 1hr planned outpatient operation, I was billed (each separately) by the doctor, the doctor's PA, the anesthesiologist and the hospital.

The hospital & the doctor were really good about explaining everything --- however! My husband has had a series of follow-up treatments whose costs they did not explain to me and neither he nor I anticipated. I just today got a $186 bill from a lab for one of those extra appts.

Health care is a black box.

kathy a. said...

pretty much what everyone said. the system makes no sense. i don't think most doctors are particularly happy with it -- they [or at least their offices] spend insane amounts of time dealing with the various insurance rules and refusals and such.

i have to go for a followup mammogram soon -- there were suspicous tiny cysts last time, and my sister has stage II breast cancer, a very hard-to-treat kind. it was insane setting it up -- needed a new referral from the GP [even tho the radiologist said i needed to go back in 6 months], and *then* i was instructed to have the GP re-write the referral with specific language that the ins.co. wants, and THEN i found out that i have to go to the hospital because the imaging center no longer has radiologists there for the more intensive followup mams. gah.

KC said...

Okay, I have to say something.

The commenter above asked, Why are doctors allowing themselves to be persuaded by pharma reps? Free food and perks? Really?

I don't understand this comment. What??? Why is it assumed that doctors are in it with pharma? It's totally insulting.

I went into medicine believing that I have a calling to serve others, regardless of payment. I picked a specialty knowing it involved working the most and making the least - internal medicine - because I love practicing internal medicine.

What I don't love is that so many are uninsured and it seems that a big chunk of America doesn't care.

I also don't love people assuming that doctors are in it for the money.

Our current health system is broken. The insurance situation is a nightmare. Business people run medicine, not doctors.

kathy a. said...

i don't think most doctors are in it for the money. i know a good many doctors who have struggled with going broke while trying to do the right thing.

InTheFastLane said...

And why does the procedure cost so much, but the insurance doesn't pay the whole thing, and neither do you. And that other charge, just disappears. But, what if you didn't have insurance? Would you have been charged the total amount instead of only what the insurance pays?

And then, there is this...I went to the ER, with my boys, twice and the hospital was covered, but the doctor was not. What? You don't really have a choice of a doctor in the ER. How can that not be covered?

I believe in doctors, but there is a problem with making sure that ALL people have access to appropriate medical care. And that is a cost/insurance issue.

Cold Spaghetti said...

WOW. I vaguely remember my 'scopes being in the $3000 range in 2000. The biopsies ran another $1000 or so, though... especially due to the physician time in reading them.

CRAZINESS. Thank you for sharing.

Angeline said...

I was hospitalised twice, a total of 13days for the month of July.
Total bill added up to almost $7000.
I didn't have insurance (stupid me), but our government forced every citizen to put aside a percentage of our income for hospitalisation bills.
Now I've exhausted mine.
The damn thing is, they still can't find the cause of my pain!
And I'm still undergoing tests... as outpatient... *eyes rolled*

I look at your bill!
What would you do, if you hadn't had the insurance!!!

Kyla said...

What KC said. Yup.

Suzanne Lainson said...

The idea of asking consumers to make the proper decision for health care tends to go out the window when it involves their kids.

Here's a typical case. The kid gets sick. You think it will pass on its own, but you call the doctor anyway. The doctor says, "Come in for an appointment." You guess that you'll get there, the doctor will look at the kid, say it's a virus, and won't prescribe any medicines.

But you're afraid you're a bad parent if you don't take the kid in. So you do, the doctor says it's a virus that will pass without treatment, you go home after you've paid your co-pay, and you wonder why you bothered.

abby said...

why can't we understand that taking care of ALL the citizens is good for each individual? we have become a society so focused on individualism that much needed health care reform is causing riots. totally agree with daysgoby. this is insane and I wish we could just pass the stinkin' bill and get on with our lives.

nonlineargirl said...

My favorite topic! I was glad to see that you reported the amounts billed as "charges" instead of "costs", as there is a big difference between the two (and a lot of people don't get that). No one - except some self-pay people - pays the billed charge, but hospitals (and other providers) always report charges so they can cry about how they are getting screwed by insurers.

In related thoughts, part of what your insurance company paid - in both cases - was not for the cost of your services but to reimburse the hospital or doc for "free care" they give to the uninsured. About $2500 of your annual health insurance premium, on average. How's that for a hidden tax? People who oppose subsidizing health insurance for low income people don't realize that we already do subsidize it, but in a sneaky way that doesn't show up on your Explanation of Benefits.

Oh I could go on...