I had a colonoscopy two weeks ago. In February, I called Anthem to find out the cost or maximum cost allowed for the procedure so I could prepare. The Anthem rep told me my cost would be 0 - fully covered, 0% coinsurance, 0 deductible, 0 copay. Her exact wording. She said she couldn't even give me an estimate of the maximum cost allowes since their system just spits out those numbers.
I just received an EOB saying the maximum allowed cost was 4200, insurance paid half, and I owe 50% coinsurance for "surgery - abdonimal."
I have the rep's name, the date of the call, and a reference number bc fuck these companies. Is there a fight here? I'm so angry that I did everything I could and this still happened.
ETA: I am 26 - it was definitely a diagnostic colonoscopy - but the CPT code I was given by the doc and shared with insurance was 45378 which IS a diagnostic colonoscopy WITHOUT bopsisies/samples which they did end up taking.
So I gave a diagnostic CPT code when asking insurance for an estimate and they still said 0 - so the "samples/biopsies" might be the issue.
My big questions:
- Is it worth it to call my doctor's office and discuss the discrepancy in the CPT codes I was given and the procedure I received? How am I supposed to confirm coverage if these things aren't properly communicated? Could I push them for financial adjustments?
- Can I tell insurance I'll specifically cover 50% of the biopsy cost but push back against the larger bill? Why does one extra step suddenly mean I'm responsible for the entire bill? They specifically confirmed full coverage for a diagnostic colonoscopy?