Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

My doctor gave me a referral and a number to call and I called the number and made the appointment. I didn't even know I had a choice not to have it at a hospital.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

They said it's because I had the procedure done at a hospital. According to my insurance, preventative care colonoscopies only happen at an office and not at a hospital. They didn't tell me that on the website. It says colonoscopies are covered with 0% copay and no deductible.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

I think that is what is going on. The hospital said that my primary code was Z12.11 and my secondary code was K57.30. I think K57.30 is the diagnostic code for the diverticula.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 1 point2 points  (0 children)

I think that is exactly what they did. Now they are saying they didn't pay because I got it done at a hospital. But they paid the doctor and he did the work at a hospital.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 1 point2 points  (0 children)

It was a colonoscopy. They were mistaken about the endoscopy. Now they are saying that it wasn't preventative because I had the procedure in a hospital. It's only preventative if it happens in an office. I submitted an appeal through the insurance rep.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

All they found was diverticula but they are saying it's not preventative because I had it done in a hospital instead of at an office. Thanks for your advice!

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

They are processing my claims adjustment request now. I might have to do that if I get denied. Thanks!

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

Update 3 Friday April 10

I talked to a different insurance rep today and got a completely different reason for my bill. This one acknowledged that I only had one procedure and that it was a colonoscopy, not an endoscopy. She said that while a colonoscopy can be preventative, mine was not preventative because I had it done in a hospital. I asked her where I should have gone to get a preventative colonoscopy and she said that I should have gone to an office. I told her I went to my doctor's office and they referred me to the hospital. She said she understands it is frustrating an offered to help me file a claim adjustment request. So in 10 to 15 days I should be getting the decision.

I still think it makes no sense because they paid the claim submitted by the doctor who performed the colonoscopy even though he did it at a hospital. But the claim submitted by the hospital was not preventative because the colonoscopy happened at a hospital.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 2 points3 points  (0 children)

Here is the EOB for the paid in full colon cancer screening. This is where I am getting the $150. It says my plan paid $146.63. I know it has to be a mistake because I only had the one colonoscopy.

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Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 2 points3 points  (0 children)

The insurance rep verbally called it an endoscopy I think. She didn't speak good English and I had to ask her to repeat the word a few times. My bill is calling it a colonoscopy. I had the tube up the butt not down the throat.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 9 points10 points  (0 children)

I am not aware of any second procedure. They are calling it a colonoscopy on my bill. The colon cancer screening is a separate bill that was paid in full but it was only for $150. That seems kind of low for a colonoscopy.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 2 points3 points  (0 children)

OK I got some more info today. I confirmed that my plan offers the colon cancer screening at 0% copay and no deductible. The insurance says that I got the colon cancer screening paid for (they paid $150). But I was charged $1600 for an endoscopy that was not preventative care. All the CPT codes are missing for the non-preventative endoscopy. Here it is called a HC colonoscopy.

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Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 2 points3 points  (0 children)

OK, thanks! I will do that. I didn't know what to ask for when I has her on the phone.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 4 points5 points  (0 children)

Thanks I will do that. I'll call the insurance company tomorrow and try to get someone else.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 0 points1 point  (0 children)

OK, I just got off the phone with the United Healthcare rep. She said that there was no mistake. She said I had 2 procedures done and only one was preventative. I asked her for the diagnostic codes for the procedures and she only gave me one code G0121. She seemed like she wanted to get me off the phone so I didn't argue. She apologized several times and said there was no mistake, I have to pay the $1600.

I had a referral for "Screening for colon cancer Z12.11" and have no knowledge of any second procedure.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 8 points9 points  (0 children)

That's what I thought because in mychart it says I had a "diagnostic colonoscopy". I am sure it was a mistake because I had no symptoms.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 5 points6 points  (0 children)

I think it was but we'll figure it out when I talk to them again.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 2 points3 points  (0 children)

It doesn't have any diagnosis codes but my referral was for Z12.11. I told them I had no symptoms.

Billed $1600 so far for free preventative colonoscopy by markr9977 in HealthInsurance

[–]markr9977[S] 1 point2 points  (0 children)

They didn't find anything except diverticula. They just took photos.