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March 11, 2011


If I didn't know you, I'd suspect this is a draft script for a Saturday Night Live skit.

That is disgusting. It seems you have had a lot of trouble with them. Is any other insurance feasible in your area? I will have to look into how ours handles it although we now have Medicare with an add-on; so who knows what it would do about it. They do all seem out to get us!

Rain, pre-existing conditions are the big problem with switching insurers. We wouldn't be accepted by another insurer at a reasonable cost, and with coverage for our (minor) health problems. So we're stuck with Regence.

When the Affordable Care Act is fully implemented (2014, I believe) the pre-existing condition issue will be eliminated, since everybody in the country will be required to have insurance. But until then, it remains a barrier to switching to a different company.

We're dealing with this RIGHT now! I was told just the routine colonoscopy is considered surgery and will cost us $4,800 - $5,000!! That is absolutely asinine (and YES, I did mean the pun). I'm shopping around and trying to find a clinic that doesn't consider it surgery.

Tammy, I'm in the process of appealing my insurance company's determination. I've found some great info/links about this issue that supports our cases. If you're interested in looking at what I've found, email me (address in right sidebar under "email me").

wow, I feel very sorry for you guys. as mentioned in my other post, I just had a colonoscopy done, and also had one last year.
my cost?? $0. Why?? Because, dear folks, I live in Canada, and we have universal health care. It is so sad that your country is in the grip of insurance companies, and that your
Republicans are in bed with them. Our health care system is not "socialist", whatever that means, and is not broken. Our doctors are paid by the govt., not by the insurers. Our
hospitals are run by the govt., not the insurers. Maybe if the USA had a VAT, or
maybe a larger tax base, as we do, that would pay for your medical system. As it is, without political will, and politicians that are not pawns of your lobbyists, the USA will never get out from under the insurance companies" grip. They don't give a damn about YOU, all they care about is their profit margin!! Maybe you should check out Alberta, I know that they do have private clinics ther, it might be cheaper than the USA..meanwhile, man, I'm sorry you have to fight for every right you should have.....BC Bill

Well said Brian, What is happen in the health care business in USA is criminal. In America we have the best Government money can buy, politicians are in Gov. serving the business groups that put them in power. Legally corrupt, the most corrupt place on earth is the US of A. Wall Street, Heath Care, Banking, Insurance and all the energy companies !!!!!!!!

We just found out that ours does not pay if a polyp is removed. So tired of loopholes.
This happened with Blue Cross Blue Shield of Tx.

Did you file a grievance with your Insurance Company. I am filing one today, just found out that they say they do not cover polyp removals. They didn't wake me up to ask if I wanted them removed, So why do I have to pay for something I didn't approve.!!!!!

Phyllis, I was going to file an appeal, but then Regence of Oregon decided to pay for the colonoscopy and polyp removal. Here's a link to the post where I described what happened:

Hopefully you'll be as fortunate. You're right: it's crazy that your insurance company won't pay when the colonoscopy succeeded in doing what it is supposed to do -- find and remove benign polyps that could turn into cancer.

I live in Montreal Quebec - the home of universal medicare. Well guess what? Preventive colonoscopies are free here if you get them at a hospital but the wait lists are over 3 years long! Only recently have doctors been recommending that people go to private clinics for them. Cost is $500. No private insurer will cover this either! My husband is one of the many people who were on that wait list (wasn't told about the private clinics). Sadly, he wasn't put to the head of the list until he already showed symptoms of colon cancer and by that time it had reached stage IV. Please let me know your progress in fighting to have insurance companies cover colonoscopies. Meantime, I plan to start my own "fight" here. Best, Susan

I am now finding even worse, that a benine polyp which was removed during the draining of an anal fiscular is giving the insurance company a reason for excluding Colon Cancer from my policy due to "A history of colon polyps". So i would guess the same exclusion would apply if a polyp is removed during a colonoscopy.... ridiculous.. Better check for exclusions on your policy.

So sorry this has happened to you. You are in my prayers. I guess the insurance companies are fighting the affordable care act all the way. I was diagnosed with stage 2b breast cancer in 07 my insurance Cigna is denying me a PET scan or even CT scan. Which if I don't get at least one of these my cancer could return and I risk finding it too late. This has been going on for 20 months. I hope that you have better luck fighting your insurance than I have had. GOD BLESS

It is now May, 2013 and how things have changed. To clarify, it is NOT the insurance companies who are at fault here, which is a rare thing. It is the DOCTORS who are responsible for how a colonoscopy is coded--the insurance companies pay out according to how the doc coded it. Clinics and hospitals are aware the issue is being raised up the flagpole and are taking conservative positions where they code the procedure as screening (preventative) for the colonoscopy, but diagnostic if anything is found - and that is the point at which the insurance company considers the ENTIRE thing diagnostic and will not cover it.

And.. it's not just about finding polyps that shifts the coding to diagnostic. If they find internal hemmorhoids and diverticulosis...neither of which have anything to do with cancer risk...that too will be considered diagnostic, thus insurance companies will not pay. In addition, if either are found, you are now considered 'high risk' going into your next one. Turns out 95% of the population have internal hemmorhoids and most of us over 50 have diverticulosis (diverticulitis if inflammed).

The volume on this issue is being raised, so hopefully it will be resolved soon. Until then, I encourage everyone to take the time to write a letter to the Oregon Insurance Commissioner (Louis D. Savage) to say life saving procedures such as initial colonoscopies need to be covered 100% no matter what. And, to talk with the person at your insurance company who handles claims disputes, to voice your opinion there as well. We all pay hefty premiums with high deductables (ours is $7k), and absorb virtually all health care costs out of pocket simply to not have coverage the few times we need it!!!

I am seriously contemplating canceling a scheduled colonoscopy for next week because I am so freaked out by the potential costs. I have no symptoms and am doing this just because I am trying to do the smart thing... it was purely by fluke that I found out about this whole polyp issue. Aetna, my insurance carrier, keeps telling me it depends on how it is coded, however at the same time, tell me if 'anything' is found it will be coded as medical. Who is the best person to 'complain' to... the insurance commissioner in my state or the cancer society, etc>

I had the same refusal to pay because of the coding issue. I had a polyp removed ten years ago. I checked ahead of time and both the doctor and the insurance company said it was covered 100%. The procedure was completed, nothing found and a month later I got the bill in full for the colonscopy. Oh the doctor and insurance company said we didn't know you'd already had a polyp taken out in the procedure ten yeas ago, that means all procedures after that are coded as diagnostic. six months later I got fed up with their bad treatment and denial and what was obviously a scam. I called the attorney generals office. one week after I sent the relevant papers to the attorney generals office, I received an apology from the hospital, the doctor and the insurance company, with paid in full. My insurance company,Regence Blue (double)Cross. class action suit anyone?

I have a meeting scheduled with stakeholders representing various interests to identify loopholes and solutions to cost-sharing, and would love to hear from folks in Oregon who have been billed for their first colonoscopy because something was found. I called 5 facilities and all of them said they'd code my first colonoscopy as "diagnostic" if something was found. Clearly, miscoding is still an issue in Oregon and I'd like to get a sense of how pervasive it is. Thanks

Insurance refuses to pay for mine. My mother had colon cancer my doctors informed me to get checked every 5 years. Insurance refuses to cover preventative care till I am 50!

Insurance companies are evil. They need to be eliminated.

my husband is going through the exact same thing right now , how dare they not cover this , we have been appealing this also , a third party is getting involved now , they will be investigating this , i will take this to rob wolcheck on national news if I have too . wish you the best of luck ,

I had the same problem of being charged for my "preventive" colonoscopy on both of my procedures because of polyp removal. I went round and round with my insurance company on the first one, jotting down names, dates, times, and taking detailed notes. After 6 months of this, while on the phone I said in total disgust, "This is ridiculous. I can't be the only guy you people are jacking around like this. I'm going to get a hold of an attorney and file a class action lawsuit on this." With that, the person on the phone with me said "Oh, Mr. _______, I think we have enough information to settle your case right now!" I nearly fell out of my chair! The insurance then paid for the procedure.

My second colonoscopy was a little easier because I called for pre-authorization. I kept calling in and getting different agents until I got one that told me the procedure would be covered at 100% if a polyp were found and removed, including all the lab costs. I jotted down his name and the date and time of the call. Sure enough, the insurance company tried to charge me for the procedure, but after I provided the pre-authorization info and told them they may be in violation of the Affordable Care Act, I got it covered at 100%.

I agree that the problem is the physicians and them changing the coding of the procedure from preventative. I don't know how or why they are in bed with the insurance companies with this. I think before my next colonoscopy I'll be asking the physician some detailed questions about this specific issue and how they do their coding.

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