30 July 2015

PSA: Scope Update

By Pulmonological (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia CommonsYou probably don't remember this, but back in 2009, I had two colonoscopies in one summer. And because the pricing was radically weird, because one of them happened in the hospital and the other in the doctor's office, I had to write about it. Go on, read about it. Come back when you're done.

A couple of years later, Elisabeth Rosenthal (a writer for the Times) started a series of investigative articles about medical care pricing, called Paying Till It Hurts. Her first piece was about ... colonoscopies, and my expensive hospital based scope made it into the second paragraph. It is probably the last time I will be on the front page of the New York Times.

Sometime last summer, I got a note from the gastroenterologist reminding me that my five years were up and it was time for another. Oh the joys!

I duly scheduled an office visit, and had the scope, only to be told - when the propofol wore off - that I needed to have another in six months. So, if you're keeping track, this is four colonoscopies in about five years.

Since 2009, the Affordable Care Act has come into play, and my office's insurance carrier has changed, and my co-pays and deductibles have skyrocketed. But at core there's this: the doctor's office charges some wackadoodle number, and gets paid a negotiated rate. So, as a public service, and to aid in transparency in health care costs, here are the prices for my four colonoscopies:

#1 - 2009 - in the hospital

Charges billed by doctors and hospital $9,143
Amount paid by insurance $5,743
Co-pay due from me $125
TOTAL PAID TO MEDICAL PROVIDERS $5,868

#2 - 2009 in the doctor’s office
Charges billed by doctors and lab $5,323
Amount paid by insurance $2,923
Co-pay due from me $30
TOTAL PAID TO MEDICAL PROVIDERS $2,953

#3 - 2014 - in the doctor’s office - diagnostic
Charges billed by doctors and lab $9,022
Amount paid by insurance $2,812
Co-pay (deductible) due from me $1,243
TOTAL PAID TO MEDICAL PROVIDERS $4,055

#4 - 2015 - in the doctor’s office - screening
Charges billed by doctors and lab $7,711
Amount paid by insurance $3,995
Co-pay due from me $75
TOTAL PAID TO MEDICAL PROVIDERS $4,070


So what have we learned? In five years, the contracted rate for a colonoscopy at the medical practice I visit has gone up by a third (from $3K to $4K). What else? Even though the Affordable Care Act and the insurance companies make a distinction between a diagnostic colonoscopy and a screening one, the doctor ends up getting paid the same amount. Screening scopes are supposed to be covered in full under any ACA compliant insurance; diagnostic ones are subject to deductibles and co-pays and what not, so the patient ends up paying more. [I'm not sure why both #3 and #4 weren't coded as diagnostic...that may have been a coding error. However, since I'd met my deductible by the time #4 rolled around, it may not have made much difference in my co-pay.]

The issue of medical billing, and the prices paid, is an interesting one, which is why I am putting this out there.

If you too are interested, the New York Times series spun off into a Paying Till it Hurts Facebook group - "a forum for conversation, analysis and insight into health care pricing and costs in the United States".

And, by the way, I'm fine. I just seem to have a propensity towards polyps.

4 comments:

Sarah said...

A polyp propensity! Psigh.

Jocelyn said...

It hurt me to read $1243 as a co-pay.

This is fascinating stuff. You're teaching me a language I don't speak.

slow panic said...

I'm ashamed at how little attention I pay to all of this. Which is probably why it's such a mess. Most people are like me - head in the sand and just pay the copay.

I need to pay attention to this stuff.

leanne said...

Sorta in the same boat as slow panic. I read things here and there -- the Time article called Bitter Pill comes to mind. But I don't take it much further than that -- taking what I have for granted. Insurance has been there when I needed it, thank goodness. But it's all a bit of a mystery to me.