My $17,900 Colonoscopy

Last month I had a routine colonoscopy.

If you’re not aware, colorectal cancer is the second leading cause of cancer-related deaths in the U.S., with people above age 50 experiencing the majority of diagnoses and deaths. So having a colonoscopy is a solid way to get ahead of something… if something develops early.

Before I get into details, what many of you might not know is that is ILLEGAL to buy Health Insurance, outside of ObamaCare (Health Connector in MA) if you are retired and under the age of 65. Now many of you might be fortunate enough to have health insurance provided thru your employer, COBRA, or Govt Job… and you might even be luckier to have that insurance provided to the age of 65 when Medicare kicks in… I’m not.

So, for the past 8 years, my wife and I pay between $16,000 to $20,000 gross per year in Health Insurance Premiums. Some years, I can take advantage of an Advanced Premium Tax Credit to help offset some of that cost… other years… I can’t. Keep in mind, those premiums are not even Gold Plans… We have what is called a “Basic Silver Plan”. A Blue Cross plan could run over $30,000 per year.

And what do we get for our middle of the road “Silver” plan… a $4,000 per year Family Deductible and a $17,500 Maximum Out of Pocket Coverage. What we get in exchange, is 1 annual physical covered and 1 Colonoscopy every 5 years.

So, by golly… I was getting my routine Colonoscopy. (As an FYI, usually, it’s about a 7 month wait time to schedule a colonoscopy.)

After the procedure, out of curiosity, I went to my Health Insurance Provider website to see what they were charged.

I fell off my seat.

My appointment was for 3pm. I got there an hour early and was out of the door by 4pm. The actual procedure lasted 22 minutes.

St. Vincents Hospital where the doctor had his office… tried to charge $12,183.00 for 2 hours of use of their facility.
The Doctor performing the procedure submitted 2 claims totaling $5,608 (One claim might be a resubmitted claim – I can’t interpret it lol)
And there was a $109 charge for a doctor to do a biopsy of a polyp… which turned out to be a seed. Yup. A Seed.

In total, they submitted claims to the Insurance Company for: $17,900 (See Below Explanation of Benefits)

In the end, the Insurance company paid them about $5,000

I paid nothing out of pocket.

So, you might ask… what am I complaining about?

Somebody paid! The system is broken. If I elected not to pay $16K+ in annual health premiums, I would have had to pay the entire $17K myself + a fine to the State of MA.

If someone is uninsured or under-insured… and wants to pay with cash or with credit card – they would be forced to pay $17K. That amount is simply unacceptable especially considering many at risk people need this service.. and simply would not be able to afford it. It could cost someone their life!

How can St. Vincents think they can charge 6x what the average colonoscopy procedure is in Massachusetts? (See Link)

I wonder what Medicare pays on average for Colonoscopies? Would love to know!

Bottom Line: It is ethically and morally wrong that people with insurance are billed almost 3x less than those who do not have insurance. The Facility will claim that the Insurance company has a negotiated lower rate with the hospital chain and thus get a discounted rate. I say “HOGWASH!”

Health Care Providers need to establish firm pricing… whereby everyone pays the same rate. Give ordinary people what is called “Most Favored Nation” pricing. Where everybody is billed the same amount for the same procedures. And most importantly, all Healthcare providers should have to POST their rates online based on the averages of actual billing to their customers who undertook procedures.

Remember, people who do not have insurance cannot afford the high premiums. They are struggling. Why would you charge them 3x as much for the same procedure?

In the name of Healthcare Equity… the Healthcare System has never been more unfair and unequitable!

Oh, how I long for the good old days where I could buy my own health insurance, determine my own Doctors, deductibles, and coverage levels. I could shop it and even self-insure with a catastrophic policy as a backup. But… ever since Government took over Healthcare… the entire system… and the average American Lifespan has regressed. What a horror show! Shameful.