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#PriceCheck: The high costs (and horrors!) of colonoscopies



Monash University via Flickr Creative Commons

Several Southern California residents expected their colonoscopies to be unpleasant. But they say they never could have predicted the high costs associated with the procedure.

That's what I heard when I reached out to several people who shared their colonoscopy costs with our #PriceCheck project. (Aside: If you've recently undergone the procedure, please share your costs with us! Just grab your Explanation of Benefits and go here.)

While they were grateful that their insurance covered most of their bills, two people told me that they were shocked by the prices charged by the facilities and then negotiated down by their insurance companies.

And each of them had the same takeaway: It's important to #JustAsk in advance how much a procedure will cost. Sometimes, it’s worth asking if there's a cheaper option.

Bonus: Listen to our song about the importance of asking about the cost of colonoscopies, written and performed by the one and only Levi Petree (KPCC employee by day, The Radio Publica band member by night). It's called "#JustAsk", based on "Ask" by The Smiths. We hope you'll remember this next time you go to the doctor.

 

Their stories are below. I hope you'll share yours as well!

Colon prep: There are options!

Before undergoing a colonoscopy, you have to clean out your colon. There are several colon prep methods out there and, from what I hear, none of them are particularly enjoyable.

Janith Johnson, who lives in the San Bernardino County community of Crestline, was prescribed different preps for the two colonoscopies she's undergone.

One, she says, was an over-the-counter laxative called magnesium citrate. She recalls that she paid about $3.50 for a treatment she describes as soda-like. The other, she says, was a prep kit called Suprep. It was marked up above $100; her co-pay was less than $10, she says.

Even though her share of the cost was similar for both medications, she told me she's annoyed that there was such a huge variation in the overall cost of these treatments.

"The results seem to be the same no matter how much money is spent – you get cleaned out either way," she says.

From now on, "if I'm given a prescription for the expensive stuff, I'll definitely ask if I can take the other one," she says. "We as consumers, as patients, could lower our medical costs, but we're not given the choice to do so."

The procedure: A 95% discount?

Following the dreaded prep is the actual procedure: A doctor uses a thin, flexible tube to look inside the colon for ulcers, polyps, tumors and areas of inflammation or bleeding.

Christof Schroeder of Los Angeles had a screening colonoscopy in August and recalls: "It was very standard and what I expected… I went into the treatment room, was prepped for the procedure, had the procedure, went to recovery, and left. There was nothing unusual or out of the ordinary."

What he did find unusual was the amount that Specialty Surgical Center in Beverly Hills billed his insurance company, Anthem Blue Cross: $12,094. The insurance company negotiated the payment down a whopping 95 percent, to $633.

In the end, the insurance company paid just $167, because Schroeder had to meet his deductible. After paying his share of the physician, pathology and anesthesia bills, his total was $466. 

Schroeder says he wasn't informed of the inflated charge price in advance, and he acknowledges that he didn't ask about it, on the assumption that it would be hundreds, not many thousands, of dollars. He now realizes that was a naïve assumption.

"It's troublesome when you see such a large figure that's reduced to such a small figure," he says. "It makes one wonder where they came up with that number and how it would impact someone who doesn't have as good of insurance as I have, or doesn't have insurance at all."

He says the experience taught him to always ask about the cost of a procedure before undergoing it.

"It is my responsibility clearly to do that kind of research before I consent," Schroeder says. "I will in the future ask up front (about the cost) if I don't know going in."

Join the #PriceCheck movement

Did you recently undergo a colonoscopy?

Then grab your EOB and head over to #PriceCheck. You can anonymously submit three different figures: The price charged, what insurance paid, and what you paid. You can also leave a note about your bill. If you share your e-mail address, there's a good chance I'll call you and ask more about your experience.

By playing along, you can help bring more transparency to our crazy and confounding system of health costs.