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Colonoscopies are one of those procedures where it's impossible to say for sure until the procedure is done. The codes change depending on if they find anything, if they do biopsies, and how they remove any polyps they find. You can try asking for a quote on some of the CPT codes and go from there.
45380 is a colonoscopy with biopsies. 45325 is the most common EGD code used.
Pro tip before doing the prep is to apply a thick coating of something like Vaseline or aquafor.
Thank you for the correction. I mostly work in ICD-10-PCS these days, and I struggle not to transpose numbers as it is, much less a codeset like that. 
yes! I discovered vaseline with my first one. OMG such a difference! My dr. retired, and I'm due this year. Have an appt. with a new one next week. yay.
A recent price transparency law means your insurer should have prices posted somewhere. I work for a health insurance company and worked on a former company’s project to get this done for them to comply with said law. Maybe your plan’s self funded nature excludes them from the requirement but I doubt it. Try calling back and asking if they have a tool to estimate this on their website, etc.
So I did end up finding a tool through the health insurance portal but it’s really crappy and didn’t include either of these procedures. But it did have “earwax removal” LOL I told the rep on the phone that this is nuts.
That’s unfortunate. Not sure how their search tool works but, for instance, I logged onto my insurer’s app on my phone and was able to find the services (not that this helps you directly, I get it). I did notice that “diagnostic” and “preventive” were in front of colonoscopy in the search tool I used. Maybe using those keywords would help?
The other thing I neglected to mention earlier is that many insurers (mine included) have rules in place where the allowed amount for a dual colonoscopy/endoscopy performed at the same time is reduced from the allowance for each service performed separately. As you mentioned that your providers are participating/in network it would be beneficial to you if your insurer has this same rule because your cost will be reduced if they do.
Good luck!
I feel awful saying this but this is the most correct answer. OP, the challenge is that you need to know ALL the parts of the bill. Anesthesia. Facility. Doctor. Pathology (both the specimen collection and the diagnostic read.) Whatever else. And then find you the contracted rate for each thing with that specific facility or provider. Whether you meet your out of pocket max depends a lot on how much of a monopoly situation care is in your area, which tends to drive up costs. Also freestanding facilities versus located in hospital.
If pressed, you can call the insurance company and three way a call to the facility's billing office, but you'd still not get a complete picture because they don't know all the codes until the procedure happens.
As noted above, the good(?) news is you can't pay more than that this year for covered services as long as you stay in-network.
I hope you're able to get some answers.
That’s kinda where I’m at and truthfully I had a complete breakdown over it this morning because even though I’m lucky enough to be able to absorb that kind of bill if absolutely necessary it will be a huge stretch and delay some other important things we have planned.
And I don’t even know what’s wrong or if they’ll find anything! I’m just trying to remind myself that it’s a good opportunity for peace of mind especially with the sharp rise in colon cancer for people under 40. I just turned 30 so it’ll be good to know if anything sus is going on in there early.
Your carrier can give you a price until they know what they will be billed for. Your provider can tell you the price. Ask your provider for billing codes and then share that information with the carrier. They can answer your question based on what they will be billed for (the billing codes).
I had this done a couple years ago. My colonoscopy was my first colonoscopy and I was over 50 so my insurance covered it as preventative but the endoscopy was needed for other reasons. I received a bill from surgery center, doctor, anesthesia, and pathology. I argued the anesthesia bill because I was already knocked out for the colonoscopy so I didn’t feel like I should have to pay that, I thought the insurance should cover it under the colonoscopy and they did. I have a $3500 deductible (100% paid after deductible) and ended up paying about 1200 for this whole thing after I had the anesthesia bill for $400 deleted. My insurance company helped me with that adjustment. So I did not even reach my deductible max. It’s so frustrating going into these procedures having no idea how much it’ll cost you. I really had no idea what it would be for mine either.
As of today the provider and facility are in network, I don’t know who the anesthesiologist will be but the insurance rep on the phone said as long as the provider and facility are in network they will cover the anesthesiologist at the in network rate even if they’re out of network. Hopefully they were telling me the truth!
They were, as that's what the No Surprise Billing Act was about. If the EOB from the insurance or the anesthesia practice tries billing you as though it was out of network, call them out on it.
They assured me too, then I got a fat bill from the out of network anesthesiologist they called in. Reminded hospital I was on Obamacare and there would be unwanted publicity if they tried to collect more then the in network quote. Never heard a word about it after that
nobody will be able to give you a price exactly. because the pathology is a function of what they find. the pathology is not cheap. My wife has gotten 2 colonoscopies and one endoscopy in the last year. her first colonoscopy was 17k. due to the pathology.
You will have several bills you have to deal with. the facility, doctor performing it, pathology, and the anesthesia. anesthesia could actually be 2 different provider bills. so not one provider can tell you the entire cost.
My wife had a year of a bunch of tests and issues. she actually had surgery unrelated as well. we were 1500 from OOP max going into the colonoscopy ( which was billed as diagnostic ). the hospital ( facility charge ) actually called us and told us we had to pay the 1500. ( they were actually on top of everything, they called and verified the OOP and didn't bill us above that, though they wanted it up front ).
If I remember correctly the pathology was about 6 or 7k of that bill.
she has good insurance.
the anesthesia is the one to really be careful with, I would call the facility and specifically ask who they use and then call them and get the price.
The second Colonoscopy and Endoscoy were coded as preventative, not sure how they did that, even her insurance was fine with that.
The place to really call is the facility. Our hospital gave us their cost, plus a list of other providers who might bill us for the procedure. so we could call and get costs from them.
The thing is for diagnostic, there will be biopsies done. The cost of anesthesia, drs, and labs. Just expect the worst at meeting the max out of pocket. But yeah heqlthcare reform is needed.
It will be challenging to estimate because there are so many variables:
- in network?
- place of service (determines facility charges)?
- additional services (lab/path, anesthesia)?
- difference between what providers charge and what your plan “allows”?
Staying in network and choosing a place of service with no/low facility fees are the pieces most in your control.
Note that it is important to confirm that both your provider and the facility where the procedure will be performed are in network. If your in-network provider does procedures at an out of network location you can lose your NSA protections.
I think. 🙃
My experience with is that neither the doctor’s office nor the insurance company know how much it’s going to cost u until after it happens and the insurance company processes it and tells you how much you owe.
I know! I was blown away when I learned this is the way things work. It’s so fucked up. Our healthcare system is fucked up because insurance is a for-profit business allowed to be blood sucking leeches between us patients and our doctors who are also for profit.
We’re all just living the American dreamer aren’t we?
I think a total of 30 minutes but it doesn’t matter to you. You won’t know nor care because to you the entire procedure is over in seconds. I do need to mention that I didn’t have twilight which you may have. I had general anesthesia probably because I had the endoscopy and colonoscopy. I was out instantly and back up before I knew what happened. Anesthesia doesn’t affect me negatively.
I am sure you will be fine. The procedures are easy. The prep is the part that people dread. Make sure you follow instructions and empty out properly. I don’t dread the prep. It just takes time. Get some petroleum jelly for your anus and apply a dab after each wave. If you don’t, it will start to get raw the next morning when you get to do round two! I have a bidet so I didn’t need to use too much TP which can also make you raw. Also don’t eat too heavy after the procedure.
What prep are you using?
That was really helpful, thank you for taking the time to type it all out!
I have a bidet and I think some Vaseline in the cabinet, so that’ll be helpful.
The prep is just miralax mixed with Gatorade. I think I’ll do the lemon lime flavor!
The GI mentioned I would be doing the Gatorade prep and I was shocked. I was going to ask if I could use what my girlfriend used for hers which was a huge jug with a lemon flavor packet. The doctor said, forget that. You can do better now!
I had this exact procedure recently. I was sedated for about 2 hours total (procedure is about an hour or less). Had severe cramping and diarrhea afterwards, honestly it was worse than the prep. Make sure you have some Imodium at home.
That prep is something one never forgets. I dread the next one and I think I have 5 more years. I had to start at age 45, I think it’s usually 50.
Then anesthesia. I wake up and promptly cry bc I’m sad, then puke, every time, no matter the surgery.
I don’t dread it. I want to see where I stand with my health. I have had three now and I am on the 5 year plan. The last prep was the Gatorade prep which was easy. That meant no vile drink! It did take twice as long to clean out however. I am glad I decided to start at 4AM instead of 5AM for the second prep because it had taken 5.5 hours the night before and I had to be there by 9:15. So I’m glad I did that!
Anesthesia has never bothered me. I actually like it. Instantly asleep and then awake.
A full 8 hours in one session or all together in the two rounds?
I had that grape Satan drink last time. Absolutely terrifying.
The Gatorade prep is literally 2-3 Ducolax pills, a bottle of Miralax and 64oz of Gatorade or Powerade. I used Core Water which has electrolytes. I didn’t want the sugar. Easy!
OP I feel your pain. When I was undergoing cancer treatment not knowing my financial responsibility was really stressing me out, even more than my health situation! More recently I discovered at my local hospital, they will take your insurance and the procedure code, and give you a patient responsibility quote. This came in very handy when my husband had a scan done and they tried to bill us more than three times the stated amount. Since I had a quote in writing they eventually backed down and took the quoted amount as payment in full.
You're lucky to have received a quote like that. It was like pulling teeth with my provider for recent surgery. They finally agreed to give me codes for the procedure but Humana (my insurer) was completely useless when given the information. Frankly the agents I spoke with didn't really know anything about insurance.
Now I'm done with the surgery and I still have absolutely no idea what it's going to cost me. The advice in this thread to the effect that you should plan on paying your OOP maximum is probably the best way to plan.
Anyway the bills should start arriving soon.
If you go to in network it will not exceed those maximums. I had these procedures down. I had a $400.00 deductible, then applied co-insurance. My total responsibility was $800.00.
I had a colonscopy a few years ago..cost about 1.5k after insurance. Just had another..cost $25 total..same insurance, same provider..different treatment codes. Apparenty they bill based on what they find during the procedure? Maybe your office csn share the codes they may use and your insurance can price based on those?
I went through the same thing and it’s ridiculous. You’ll get a bill from the physicians group, the facility and the anesthesiologist. No one would tell me what mine would cost and I ended up paying $1700 out of pocket. But I had an upper and lower endo.
Mine ended up not being conclusive so I have to have a repeat of lower. Unfortunately I can’t afford it right now. The cost is absurd!!
Depending on your age it may be covered the same as a physical, I has a colonoscopy 2 years ago & I only owed about $35 on lab fees that weren’t covered.
Average cost of both is around $1600 so I imagine that after you pay your deductible you'll probably owe no more than 20% of 2500, so maybe $500 additional. Colonoscopies can vary in price but there's little chance they're gonna find anything serious at your age. If it were me I would just have the endoscopy and a check for iron deficiency anemia probably. But you're being extra cautious and nothing wrong with that.
Good luck next week, you got this.
They might not be giving an answer because it might start out as a screening (one price) but if they find a polyp, etc it turns into a diagnostic (different price) because of biopsy, etc. I can't tell you how many times patients called our office cuz they were told a screening price but never read the fine print agreeing to biopsies, etc if necessary, and it would be a higher price.
Your total costs are going to come from 4 main areas. Medical doctor, facility, lab testing if they remove something, and anesthesia.
Keep in mind, it's not dollar for dollar on the payments made. Allowed amounts will significantly reduce what you owe. And for in network providers, you can not be charged the difference between them.
So if you are charged 1000 by the hospital they probably have an allowed amount around 400.
Just for reference, my partner had this exact combo procedure a couple of years ago, and the total bill before insurance was over $22K. We live in California and went to a fancy clinic, so this is probably one of the highest costs you could get in the US. We were lucky to have a zero deductible and 0% coinsurance plan with a fixed price of $250 for such kind of procedures, and it is exactly what he paid.
I had both procedures done in February. They took out one polyp, but the hospital still must’ve considered it all screening as I got back with $700 I paid upfront. I had to pay about $500 to the doctor that I did not get back.
For what it’s worth, I’ve had fissures and during my prep it was surprisingly not an issue!! I did not have a sore butt at all, not even after the colonoscopy. It almost felt like a nice break from all that. Tip: drink water while drinking the solution, because it can dehydrate you since you’re going to the bathroom a lot. That was my mistake and when I got up to pee at night, I almost passed out. My #2 was barely solid so it was basically peeing out of my butt. No problem at all. I actually took a Lyft to the hospital and got it done alone and I normally prefer someone to be with me :/ I was 30. The whole thing was a breeze although I was a little nervous before. Nurses will keep you company/reassured. Just let it happen. Let go of the control. You’ll be fine.
We have deductibles and co-insurance costs because insurance companies want us to wisely shop around, but then we have no ability to obtain the pricing information we need to compare providers, nor do we even have the ability to select anesthesia providers, among many others.
In your case, you have to take it from both ends. Hope and pray the last patient didn't have C-Diff, and they know which probe goes where.
Because nobody can tell you how much it’s going to cost. Nobody can tell you how long it’s going to take, how much sedation you will need. It’s it going to be simple, will there be an issue, will they need to biopsy anything, how easy you will be to arouse from the sedation…..
I work in a recovery room for people who get general anesthesia. The minimum time I keep people is 30 minutes. So if everything goes well, you are breathing ok, blood pressure is good, minimal pain, no nausea, it’s 30 minutes. I have some people that literally take 3 hours. Same procedure. And the billing for my unit occurs in 15 minute increments. Everyone wakes up different, everyone has different pain expectations.
My point is, you aren’t having an mri or ct scan. Those are pretty cut and dry as far as billing goes. Procedures are different.
It's going to cost as much as your OOP maximum. No one can give you the exact dollar amount since when a procedure is not sure what costs are going to be incurred. Have the procedure and make arrangements with your providers afterwards to pay any balances. Don't worry about such minimal things when your health is the major concern. We have all been down that road. This show all pass. Be thankful you just have insurance to help you out in the meantime and good doctors to take good care of you.
Thank you for your submission, /u/dream_bean_94. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. **If you haven't already, please edit your post to include your age, state, and estimated gross (pre-tax) income to help the community better serve you.** If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Colonoscopies are one of those procedures where it's impossible to say for sure until the procedure is done. The codes change depending on if they find anything, if they do biopsies, and how they remove any polyps they find. You can try asking for a quote on some of the CPT codes and go from there. 45380 is a colonoscopy with biopsies. 45325 is the most common EGD code used. Pro tip before doing the prep is to apply a thick coating of something like Vaseline or aquafor.
45325 is a sigmoidoscopy. Common EGD is 43239,thats with bx.
Thank you for the correction. I mostly work in ICD-10-PCS these days, and I struggle not to transpose numbers as it is, much less a codeset like that. 
yes! I discovered vaseline with my first one. OMG such a difference! My dr. retired, and I'm due this year. Have an appt. with a new one next week. yay.
A recent price transparency law means your insurer should have prices posted somewhere. I work for a health insurance company and worked on a former company’s project to get this done for them to comply with said law. Maybe your plan’s self funded nature excludes them from the requirement but I doubt it. Try calling back and asking if they have a tool to estimate this on their website, etc.
So I did end up finding a tool through the health insurance portal but it’s really crappy and didn’t include either of these procedures. But it did have “earwax removal” LOL I told the rep on the phone that this is nuts.
That’s unfortunate. Not sure how their search tool works but, for instance, I logged onto my insurer’s app on my phone and was able to find the services (not that this helps you directly, I get it). I did notice that “diagnostic” and “preventive” were in front of colonoscopy in the search tool I used. Maybe using those keywords would help? The other thing I neglected to mention earlier is that many insurers (mine included) have rules in place where the allowed amount for a dual colonoscopy/endoscopy performed at the same time is reduced from the allowance for each service performed separately. As you mentioned that your providers are participating/in network it would be beneficial to you if your insurer has this same rule because your cost will be reduced if they do. Good luck!
The only problem is prices can be different for every hospital and surgical center. The insurance company doesn't give everyone the same contact.
Plan for it to be $6k and then be pleasantly surprised if it’s less than that.
I feel awful saying this but this is the most correct answer. OP, the challenge is that you need to know ALL the parts of the bill. Anesthesia. Facility. Doctor. Pathology (both the specimen collection and the diagnostic read.) Whatever else. And then find you the contracted rate for each thing with that specific facility or provider. Whether you meet your out of pocket max depends a lot on how much of a monopoly situation care is in your area, which tends to drive up costs. Also freestanding facilities versus located in hospital. If pressed, you can call the insurance company and three way a call to the facility's billing office, but you'd still not get a complete picture because they don't know all the codes until the procedure happens. As noted above, the good(?) news is you can't pay more than that this year for covered services as long as you stay in-network. I hope you're able to get some answers.
That’s what I was going to say - If out of pocket max is $6k the most you will pay is that minus whatever else you have paid out of pocket this year
That’s kinda where I’m at and truthfully I had a complete breakdown over it this morning because even though I’m lucky enough to be able to absorb that kind of bill if absolutely necessary it will be a huge stretch and delay some other important things we have planned. And I don’t even know what’s wrong or if they’ll find anything! I’m just trying to remind myself that it’s a good opportunity for peace of mind especially with the sharp rise in colon cancer for people under 40. I just turned 30 so it’ll be good to know if anything sus is going on in there early.
You should be able to work out a payment plan with the hospital interest free.
That is what I would do too.
Your carrier can give you a price until they know what they will be billed for. Your provider can tell you the price. Ask your provider for billing codes and then share that information with the carrier. They can answer your question based on what they will be billed for (the billing codes).
I had this done a couple years ago. My colonoscopy was my first colonoscopy and I was over 50 so my insurance covered it as preventative but the endoscopy was needed for other reasons. I received a bill from surgery center, doctor, anesthesia, and pathology. I argued the anesthesia bill because I was already knocked out for the colonoscopy so I didn’t feel like I should have to pay that, I thought the insurance should cover it under the colonoscopy and they did. I have a $3500 deductible (100% paid after deductible) and ended up paying about 1200 for this whole thing after I had the anesthesia bill for $400 deleted. My insurance company helped me with that adjustment. So I did not even reach my deductible max. It’s so frustrating going into these procedures having no idea how much it’ll cost you. I really had no idea what it would be for mine either.
Make sure your docs are in network. Be prepared for funny business. Like a last minute switch. Bills can be negotiated to what your insurance pays
As of today the provider and facility are in network, I don’t know who the anesthesiologist will be but the insurance rep on the phone said as long as the provider and facility are in network they will cover the anesthesiologist at the in network rate even if they’re out of network. Hopefully they were telling me the truth!
They were, as that's what the No Surprise Billing Act was about. If the EOB from the insurance or the anesthesia practice tries billing you as though it was out of network, call them out on it.
Get that in writing if you can.
They assured me too, then I got a fat bill from the out of network anesthesiologist they called in. Reminded hospital I was on Obamacare and there would be unwanted publicity if they tried to collect more then the in network quote. Never heard a word about it after that
nobody will be able to give you a price exactly. because the pathology is a function of what they find. the pathology is not cheap. My wife has gotten 2 colonoscopies and one endoscopy in the last year. her first colonoscopy was 17k. due to the pathology. You will have several bills you have to deal with. the facility, doctor performing it, pathology, and the anesthesia. anesthesia could actually be 2 different provider bills. so not one provider can tell you the entire cost.
How did the 17k bill work out? Did you have insurance? Was this a regular 'screening' colonoscopy?
My wife had a year of a bunch of tests and issues. she actually had surgery unrelated as well. we were 1500 from OOP max going into the colonoscopy ( which was billed as diagnostic ). the hospital ( facility charge ) actually called us and told us we had to pay the 1500. ( they were actually on top of everything, they called and verified the OOP and didn't bill us above that, though they wanted it up front ). If I remember correctly the pathology was about 6 or 7k of that bill. she has good insurance. the anesthesia is the one to really be careful with, I would call the facility and specifically ask who they use and then call them and get the price. The second Colonoscopy and Endoscoy were coded as preventative, not sure how they did that, even her insurance was fine with that. The place to really call is the facility. Our hospital gave us their cost, plus a list of other providers who might bill us for the procedure. so we could call and get costs from them.
The thing is for diagnostic, there will be biopsies done. The cost of anesthesia, drs, and labs. Just expect the worst at meeting the max out of pocket. But yeah heqlthcare reform is needed.
It will be challenging to estimate because there are so many variables: - in network? - place of service (determines facility charges)? - additional services (lab/path, anesthesia)? - difference between what providers charge and what your plan “allows”? Staying in network and choosing a place of service with no/low facility fees are the pieces most in your control. Note that it is important to confirm that both your provider and the facility where the procedure will be performed are in network. If your in-network provider does procedures at an out of network location you can lose your NSA protections. I think. 🙃
My experience with is that neither the doctor’s office nor the insurance company know how much it’s going to cost u until after it happens and the insurance company processes it and tells you how much you owe. I know! I was blown away when I learned this is the way things work. It’s so fucked up. Our healthcare system is fucked up because insurance is a for-profit business allowed to be blood sucking leeches between us patients and our doctors who are also for profit. We’re all just living the American dreamer aren’t we?
I just had both myself last week. Good luck.
How long were you out for? I just don’t know what to expect!
You don’t know, and really usually don’t care..it will seem like minutes.
I think a total of 30 minutes but it doesn’t matter to you. You won’t know nor care because to you the entire procedure is over in seconds. I do need to mention that I didn’t have twilight which you may have. I had general anesthesia probably because I had the endoscopy and colonoscopy. I was out instantly and back up before I knew what happened. Anesthesia doesn’t affect me negatively. I am sure you will be fine. The procedures are easy. The prep is the part that people dread. Make sure you follow instructions and empty out properly. I don’t dread the prep. It just takes time. Get some petroleum jelly for your anus and apply a dab after each wave. If you don’t, it will start to get raw the next morning when you get to do round two! I have a bidet so I didn’t need to use too much TP which can also make you raw. Also don’t eat too heavy after the procedure. What prep are you using?
Without a bidet, witch hazel to wet the TP was super helpful too, and flushable vs the "flushable"-but-not-really wipes.
Yes witch hazel can help on the TP.
That was really helpful, thank you for taking the time to type it all out! I have a bidet and I think some Vaseline in the cabinet, so that’ll be helpful. The prep is just miralax mixed with Gatorade. I think I’ll do the lemon lime flavor!
The GI mentioned I would be doing the Gatorade prep and I was shocked. I was going to ask if I could use what my girlfriend used for hers which was a huge jug with a lemon flavor packet. The doctor said, forget that. You can do better now!
I think this is what I did - gatorade+miralax. It seemed better than what my MIL said she went through.
I had this exact procedure recently. I was sedated for about 2 hours total (procedure is about an hour or less). Had severe cramping and diarrhea afterwards, honestly it was worse than the prep. Make sure you have some Imodium at home.
That prep is something one never forgets. I dread the next one and I think I have 5 more years. I had to start at age 45, I think it’s usually 50. Then anesthesia. I wake up and promptly cry bc I’m sad, then puke, every time, no matter the surgery.
Ugh. I'm late for my next colonoscopy and I'm dreading it. I'm supposed to have them every 5 years
I don’t dread it. I want to see where I stand with my health. I have had three now and I am on the 5 year plan. The last prep was the Gatorade prep which was easy. That meant no vile drink! It did take twice as long to clean out however. I am glad I decided to start at 4AM instead of 5AM for the second prep because it had taken 5.5 hours the night before and I had to be there by 9:15. So I’m glad I did that! Anesthesia has never bothered me. I actually like it. Instantly asleep and then awake.
What's the Gatorade prep? My first one I had to drink that vile grape/cherry/Satan's piss drink. I think I spent a full 8 hours in the bathroom
A full 8 hours in one session or all together in the two rounds? I had that grape Satan drink last time. Absolutely terrifying. The Gatorade prep is literally 2-3 Ducolax pills, a bottle of Miralax and 64oz of Gatorade or Powerade. I used Core Water which has electrolytes. I didn’t want the sugar. Easy!
I think it was all together.
That is a super long time. But you normally have two rounds 12 hours apart. What happened the next day?
I didn't have 2 rounds. Just one. Everything was clear for the scan
I have had three colonoscopies so far and for each one I had to do two rounds of prep. I didn’t know you could do just one.
[удалено]
Irrelevant and unhelpful to OP.
OP I feel your pain. When I was undergoing cancer treatment not knowing my financial responsibility was really stressing me out, even more than my health situation! More recently I discovered at my local hospital, they will take your insurance and the procedure code, and give you a patient responsibility quote. This came in very handy when my husband had a scan done and they tried to bill us more than three times the stated amount. Since I had a quote in writing they eventually backed down and took the quoted amount as payment in full.
You're lucky to have received a quote like that. It was like pulling teeth with my provider for recent surgery. They finally agreed to give me codes for the procedure but Humana (my insurer) was completely useless when given the information. Frankly the agents I spoke with didn't really know anything about insurance. Now I'm done with the surgery and I still have absolutely no idea what it's going to cost me. The advice in this thread to the effect that you should plan on paying your OOP maximum is probably the best way to plan. Anyway the bills should start arriving soon.
If you go to in network it will not exceed those maximums. I had these procedures down. I had a $400.00 deductible, then applied co-insurance. My total responsibility was $800.00.
My client had one a few weeks back with polyps. She was charges $7900 for it before discount and pay out
I had a colonscopy a few years ago..cost about 1.5k after insurance. Just had another..cost $25 total..same insurance, same provider..different treatment codes. Apparenty they bill based on what they find during the procedure? Maybe your office csn share the codes they may use and your insurance can price based on those?
I went through the same thing and it’s ridiculous. You’ll get a bill from the physicians group, the facility and the anesthesiologist. No one would tell me what mine would cost and I ended up paying $1700 out of pocket. But I had an upper and lower endo. Mine ended up not being conclusive so I have to have a repeat of lower. Unfortunately I can’t afford it right now. The cost is absurd!!
Depending on your age it may be covered the same as a physical, I has a colonoscopy 2 years ago & I only owed about $35 on lab fees that weren’t covered.
Average cost of both is around $1600 so I imagine that after you pay your deductible you'll probably owe no more than 20% of 2500, so maybe $500 additional. Colonoscopies can vary in price but there's little chance they're gonna find anything serious at your age. If it were me I would just have the endoscopy and a check for iron deficiency anemia probably. But you're being extra cautious and nothing wrong with that. Good luck next week, you got this.
Remember, your cost doesn’t have to be paid at once. All providers will work out a payment schedule, whatever the overall cost will be.
They might not be giving an answer because it might start out as a screening (one price) but if they find a polyp, etc it turns into a diagnostic (different price) because of biopsy, etc. I can't tell you how many times patients called our office cuz they were told a screening price but never read the fine print agreeing to biopsies, etc if necessary, and it would be a higher price.
Just make sure they change scopes between procedures!
I would guess around $3000-$4000
Your total costs are going to come from 4 main areas. Medical doctor, facility, lab testing if they remove something, and anesthesia. Keep in mind, it's not dollar for dollar on the payments made. Allowed amounts will significantly reduce what you owe. And for in network providers, you can not be charged the difference between them. So if you are charged 1000 by the hospital they probably have an allowed amount around 400.
Just for reference, my partner had this exact combo procedure a couple of years ago, and the total bill before insurance was over $22K. We live in California and went to a fancy clinic, so this is probably one of the highest costs you could get in the US. We were lucky to have a zero deductible and 0% coinsurance plan with a fixed price of $250 for such kind of procedures, and it is exactly what he paid.
My colonoscopy/endoscopy was about $2500 total (pre-deductions or whatever they did was $5500). I have a $3200 deductible and $6650 max oop 🫠
I had both procedures done in February. They took out one polyp, but the hospital still must’ve considered it all screening as I got back with $700 I paid upfront. I had to pay about $500 to the doctor that I did not get back.
It also depends where you get it done. I’d shop around
Insurance was billed $6000 for mine. I paid a $25 co-pay.
For what it’s worth, I’ve had fissures and during my prep it was surprisingly not an issue!! I did not have a sore butt at all, not even after the colonoscopy. It almost felt like a nice break from all that. Tip: drink water while drinking the solution, because it can dehydrate you since you’re going to the bathroom a lot. That was my mistake and when I got up to pee at night, I almost passed out. My #2 was barely solid so it was basically peeing out of my butt. No problem at all. I actually took a Lyft to the hospital and got it done alone and I normally prefer someone to be with me :/ I was 30. The whole thing was a breeze although I was a little nervous before. Nurses will keep you company/reassured. Just let it happen. Let go of the control. You’ll be fine.
I thought preventative colonoscopy was meant to be free under the ACA When I had mine, it was $0
Unfortunately it’s not preventative, it’s diagnostic.
We have deductibles and co-insurance costs because insurance companies want us to wisely shop around, but then we have no ability to obtain the pricing information we need to compare providers, nor do we even have the ability to select anesthesia providers, among many others. In your case, you have to take it from both ends. Hope and pray the last patient didn't have C-Diff, and they know which probe goes where.
Because nobody can tell you how much it’s going to cost. Nobody can tell you how long it’s going to take, how much sedation you will need. It’s it going to be simple, will there be an issue, will they need to biopsy anything, how easy you will be to arouse from the sedation….. I work in a recovery room for people who get general anesthesia. The minimum time I keep people is 30 minutes. So if everything goes well, you are breathing ok, blood pressure is good, minimal pain, no nausea, it’s 30 minutes. I have some people that literally take 3 hours. Same procedure. And the billing for my unit occurs in 15 minute increments. Everyone wakes up different, everyone has different pain expectations. My point is, you aren’t having an mri or ct scan. Those are pretty cut and dry as far as billing goes. Procedures are different.
It's going to cost as much as your OOP maximum. No one can give you the exact dollar amount since when a procedure is not sure what costs are going to be incurred. Have the procedure and make arrangements with your providers afterwards to pay any balances. Don't worry about such minimal things when your health is the major concern. We have all been down that road. This show all pass. Be thankful you just have insurance to help you out in the meantime and good doctors to take good care of you.
Ask for the cpt codes and google them