If you're a regular reader of this blog, you know that it's possible - but challenging - to shop around for affordable, high-quality health care. You also know that this is becoming more of a necessity, as more people enroll in high-deductible health plans and are responsible for more of their health costs.
Knowing all that: Wouldn't it be great if there was a way that you could more easily find out what health facilities in your area charge for certain medical procedures? Wouldn't it be fun if you could contribute to that database of information?
Well, I have great news: This week, KPCC - with our friends at KQED - is re-launching #PriceCheck. As you might remember, we're crowdsourcing the cost of certain medical procedures through this project. You can search for prices in your area and you can add your own.
First up, we're focusing on everyone’s favorite procedure: The colonoscopy.
Because like it or not, virtually everyone's going to get them: The U.S. Preventive Services Task Force recommends colorectal cancer screening tests, including colonoscopies, for all adults beginning at age 50 and continuing through age 75.
The Affordable Care Act requires insurance plans to cover colorectal cancer screening tests, including colonoscopies. But while the test might be free to you, there are hidden costs you should be aware of, and larger costs to society.
A 2013 New York Times story, "The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures," dug into this issue. In the story, reporter Elizabeth Rosenthal points out that the cost of a colonoscopy has been on the rise and now varies wildly.
That's certainly the case here in Los Angeles: I searched for colonoscopies within 100 miles of the KPCC office in Pasadena. I found one for $750 at Los Angeles Endoscopy Center - that includes the initial consultation, anesthesia, facility and doctor’s fees. I found another for $3,100 at Huntington Hospital - that includes the facility fee only.
What accounts for that difference? And is there a real difference in quality?
How much should it cost?
I reached out to Dr. Jeffrey Rice for some answers. He's the founder and CEO of Healthcare Bluebook, which lists fair prices for different medical procedures.
According to Healthcare Bluebook, the recommended fair price for a colonoscopy is approximately $1,823, and will vary some based on where you live. While a screening colonoscopy should be fully covered by insurance, Rice says consumers should still be cognizant of the procedure's price.
"The patient should assume that they do have to pay for the care, and evaluate the price as if they did have to pay for that care," Rice says. "If it turns out to be free, that's great, but then when something unexpected or additional services come up, the patient will be at the right place to get a good value."
Here are some reasons your screening might not be free, according to Rice:
- You don't meet the age or other clinical requirements
- Your colonoscopy isn't preventive, it's diagnostic, meaning the doctor is evaluating certain symptoms or following up on previously discovered issues
- Your insurance has lapsed or hasn't kicked in yet
- You visited an out-of-network provider
If you're following Rice's advice, then you're going to shop around for your preventive colonoscopy.
He has a few tips for people shopping around for an affordable, high-quality colonoscopy:
1. Find a doctor that you trust. To do this, try asking a few questions, like:
- How long has the doctor been performing the procedure?
- What's his or her complication rate?
- How often does he or she find polyps?
- How long does he or she spend looking at the colon?
Make sure your selected doctor can vouch for the quality of the facility where he or she will perform the procedure, Rice says. Then, find out how much that facility will bill your insurance company. The facility, he says, is typically the largest driver of cost when it comes to colonoscopies.
2. Ask whether the gastroenterologist performing the procedure will administer anesthesia, or whether that will be done by a separate doctor.
Until recently, anesthesia was another important variable in a colonoscopy bill. Just last week, the federal government clarified that insurers can’t charge people for anesthesia administered during free colonoscopies that screen for cancer. Still, Rice says, it doesn’t hurt to ask whether there’s a separate anesthesia fee.
3. As you're shopping around, be aware that there are other parts of your colonoscopy that might not be covered. They include:
- The "fluids and potions," as Rice calls them, that you'll take to clean out your bowel in advance of the procedure
- The pathology costs for any biopsies taken during the procedure
If you’ve had a colonoscopy recently, I urge you to grab your Explanation of Benefits and head over to PriceCheck. There, you can share three pieces of information: What the facility charged, what your insurance paid, and what you paid.
Feel free to leave us comments about your experience or your bill. If you're open to speaking with me further, don’t forget to leave your contact information. (This information will be confidential, of course!)
Thanks for playing along, and happy shopping!