u/Dominatrix13

I had to get a diagnostic colonoscopy to check for Crohn's, Ulcerative Collitis, and Colon Cancer. Very scary stuff, I'm only 31, and I've never had to get one before.

Four days before the procedure, I get the good faith bill estimate for the procedure...

$5179.09 up front.

No way could I even begin to pay for that. I went to my insurance and did some digging. Turns out, my first colonoscopy, whether preventative or diagnostic, is FREE!! $0 copay! So I reached out to insurance, to the hospital where the procedure was being done, and to my gastro to clarify how it was coded to the hospital for the procedure. I was on the phone for 4 hours between the two days before the procedure (because of course they sent the bill on Saturday when the billing office was closed for the weekend).

Insurance says, "Yes! That is correct! $0 copay! You should not have to pay anything up front! Call the hospital and relay your benefits to them!"

Hospital says, "Mmm, no. Unless it's a preventative screening, deductibles and Out-Of-Pocket applies for a diagnostic procedure. Call the doctor who scheduled it and have them submit a change of code to us."

Gastro says, "That's not a thing we can do based on the fact you have symptoms. This is diagnostic. We can't help you."

I called the hospital again to relay this, and a kind woman from the billing department offered her direct line and said, "Call me first thing tomorrow morning with your insurance representative on the line. If she can relay your benefits on a recorded line and provide a reference number, we will adjust the good faith estimate."

The next morning, I call my insurance just before the customer service office opens and explain everything that's happened and been discussed with me at this point. This rep also confirmed $0 copay and set up the conference call. The two reps spoke for all of 5 minutes, confirmed my $0 copay, and my bill adjusted from $5.1k to $0!!!

It sucked that I had to be on the phone for so long, but the fight was worth it. Always always always check your insurance benefits and the wording. If I hadn't pushed back to correct this, I would have been in serious financial trouble.

Obviously the biggest issue here is the state of American Healthcare and the scam that it is, but I will take whatever victories I can find. Fingers crossed I get my diagnosis and can start treatment and management ASAP.

For context, I am 31 and have a number of concerning symptoms that has pushed my GP to fast track this procedure to check for Crohn's Disease, Ulcerative Collitis, and Colon Cancer.

I got a good faith estimate from the hospital for the colonoscopy I am scheduled to do later this week. The estimate quoted me $5,179 for the following medical codes: 45380, 73062, 82947, 88305, J2704, and J7120. It also stated I should have received the estimate within 3 days of scheduling the procedure, but it was scheduled nearly 2 months ago. It did not explain what these codes are.

I called my insurance (UHG) first, and the rep informed me that my first colonoscopy is $0 copay. Okay, great! Why is the hospital quoting $5.1k? The rep told me to share my app benefits analysis with the hospital and that should clear up the confusion.

I call the hospital, and they stated that due to the coding sent by my provider, it is a diagnostic colonoscopy and costs more due to my deductible and OOP maximums. I tried to explain that it didn't matter what kind of colonoscopy based on my insurance benefits, but they wouldn't listen to me. They said they could only change info if provided by insurance or a health care provider. They asked that I call the health representative who ordered the procedure and have them add this code: Z12.11. They said it would change the type of colonoscopy to a screening instead of diagnostic.

I call the gastroenterologist who scheduled the procedure. They said that they cannot add codes once the referral/recommendation has been sent to the hospital. They also said they included these codes which were not on my good faith estimate: K92.1, R19.7, and K59.01. They recommended I speak to insurance to verify my benefits, which brings me back to square one. No new information to receive about my benefits as far as I was able to find.

I then chatted with a UHC rep and they said they would reach out to the hospital to confirm my benefits and copay expectations, so I am waiting on that now.

My next step if I don't hear back from UHC is to go to the hospital in person to negotiate the estimate down once I am free tomorrow morning.

What else should I do? Am I asking the right questions, reaching the right people? I am so frustrated that they sent the estimate on the weekend when no billing representatives would be available for me to speak with right away. I have less than 48 hours before my procedure as of now, and I can't afford $5k out of pocket. I also don't qualify for financial assistance because I make too much for their program to help me. (41k/year)

Any advice and kind words are appreciated, thank you.

Edit: thank you for all the insight and additional information. It looks like I may have been given false information. Right now, I have a hospital rep who has given me her direct line to add her to a three way call with another insurance rep first thing in the morning. I appreciate all the help!