[ed. I think the take-away here is that medical billing is simply a starting point for negotiations between insurance companies, medical facilities and medical practitioners. The final payment will likely be significantly different than the original bill. Of course, along the way the patient gets caught in the middle - subject to exorbitant initial co-pays, bill collectors and other unpleasant surprises - and is the funding source of both first and last resort. What a system.]
Patients who undergo colonoscopy usually receive anesthesia of some sort in order to “sleep” through the procedure. But as one Long Island couple discovered recently, it can be a very expensive nap.
Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. But in both cases, the gastroenterologists chose full anesthesia with Propofol, a powerful drug that must be administered by an anesthesiologist, instead of moderate, or “conscious,” sedation that often gastroenterologists can administer themselves.
And in both cases, the gastroenterologists were assisted in the procedure by anesthesiologists who were not covered by the couple’s insurance. They billed the couple’s insurance at rates far higher than any plan would reimburse — two to four times as high, experts say.
Now the couple, Lawrence LaRose and Susan LaMontagne, of Sag Harbor, N.Y., are fending off lawyers and a debt collection agency, and facing thousands of dollars in unresolved charges. All this for a cancer screening test that public health officials say every American should have by age 50, and repeat every 10 years, to save lives — and money.
“Doctors adopt practices that cost more, insurers pay less, and patients get stuck with a tab that in many cases is inflated and arbitrary,” said Ms. LaMontagne, whose communications firm, Public Interest Media Group, is focused on health care. “I work on health care access issues every day, so if I’m having a hard time sorting this out, what does that say for other consumers?”
by Roni Caryn Rabin, NY Times | Read more:
Illustration: Scott Menchin
