Jim Robinson
Posted on 02/15/2012 3:18:25 PM PST by qaz123
BOSTON (CBS) – The national health care reform law requires insurance companies to cover 100% of the cost of screening tests for dozens of potentially deadly diseases. But thousands of patients are finding out the hard way that free doesn’t always mean free.
When Jim Dungee had his first colonoscopy, doctors found several polyps, which are a precursor to colon cancer. “Therefore, I had to come back in three years,” he said. The three year mark was back in December. Knowing the test could save his life, Jim did not hesitate to make an appointment. He even called his insurance company to make sure it was covered. “I was told as long as it was put in as a preventive procedure, it was covered 100%,” he recalled.
(Excerpt) Read more at boston.cbslocal.com ...
I'd love to see Jim Dungee's voting record.
Next appointment they will find out that he & a few million in the Boston area are missing a chromosome.
Perhaps he would prefer the clinician leave the polyps in place.
Paging Dr Romney
so prevention is only prevention if it is a negative result?
that is unconscionable.
ANY insurance program that does that should be sued for wrongful denial.
it smacks of sleazy car repair services.
Seems pretty reasonable to me. What is the total cost to go into a hospital, use the operating room, have an anesthesiologist, a surgeon, and probably a couple of nurses? I would guess thousands of dollars in a place like Boston. So he's being asked to pick up maybe 10 or 20 percent? Sounds like a deal to me.
$452 to remove potentially cancerous polyps while undergoing a colonoscopy?
They should have immediately awoken him while the hose was still up his ass then have him wait the 2 to 4 hours until the anesthesia wore off then ask him if he wanted them removed.......Wonder what his answer would have been then?
Funny how people are so damn willing to have their medical conditions taken care of immediately then piss and moan when they get the bills........
i believe it's all spelled out in his insurance policy, at least it is in mine...(BlueCross/BlueShield) that's why i told the doc NO polyp removal during the screening procedure when i had mine done
i think most carriers have the same view of screening vs diagnostic procedures
it really does pay to read the policy
Yes.........
And surgery is surgery
You go to your dentist to have a toothache diagnosed, are you going to deny him payment for the services required to fix the tooth?
” What is the total cost to go into a hospital, use the operating room, have an anesthesiologist, a surgeon, and probably a couple of nurses? I would guess thousands of dollars “
My hospital bill was $3,800. For about 1 hour. Doc’s bill was$650, which I thought was reasonable.
Hospital? Operating room? Surgeon? This was a colonoscopy, not surgery. Almost certainly done in an outpatient medical facility. Do you not think his doctor was obligated to discuss the potential extra costs before performing the procedure?
What a real pain in the ass!
I’m sorry I couldn’t help myself.
But seriously, what do people want. These doctors aren’t doing these things pro bono. It all cannot be completely free. If you choose a crappy plan(no pun intended) you are going to get crappy coverage.
Gee, it seem Jim may be a perfect Masshole, but he doesn’t have a perfect @$$hole.
No. Doctors do not have any idea which insurance carrier each patient uses, which combination of policy options he has, what is covered and what is not. HOW could a doctor possibly be expected to be familiar with the vagaries, ins-and-outs, exclusions, provisions, and fine-print details of each of the constantly-changing policies of each of his thousands of patients? Every single policy is different, depending on the individual choices each patient makes for himself and his family. No, doctors have absolutely no idea.
It's the patient's responsibility to understand the terms of his policy. In this case, however, it seems you'd have to be a reimbursement expert to know about nasty little tricks of this sort.
If you're not concerned about polyps and the potential risk of cancer then why have the colonoscopy in the first place?
In order to wake people up to the actual cost of the benefits they receive from their employers or healthcare plans, the hospitals and doctors offices need to start sending the actual bills to the patients for their viewing then let them submit them to their carriers......
I was a benefits rep for my company for over 30 years and had to deal with the complaints and problems of these folks who were basically clueless on what our benefit plan provided them. There were of course legitimate problems with the insurance carrier but those were usually due to the billing mistakes from the hospitals or doctors offices.......
You man Romneycare doesn’t cover removal of polyps?
This actually happened to my wife - fortunately, everything was OK and we could (with regret) afford it.
Obamacare is a bad idea, but we can’t go on the way we are going either. Any republican going with “the status quo” isn’t going to get my vote. We are taking it up the @#$#, figuratively as well as literally.
I don’t know about most doctors, but our pediatrician knows the ins and outs of our insurance. She keeps her referral drawer organized by what physicians are covered by what insurances. She always takes care of referrals right away even when we don’t come into the office. She calls us or has her nurse call us to make sure we know what is what. She is great and the most competent physician I know. Maybe she limits her patients to those who have certain carriers. I don’t know. She is not part of a giant practice—as in, she has her patients and her patients only. She shares an office but not patients. Prior to living here, our children went to a large pediatric practice. Some of the physicians were very familiar with each carrier. Some weren’t. The person who handled referrals did so for the entire practice of at least 12 physicians. She was extremely competent and always handled our needs in a timely manner. I am sure she picked up the slack for the physicians who were not as well versed in each carrier for the region.
Our experiences with specialists is that they are not as familiar with the ins and outs of various policies. That’s why they hire someone to deal with it for them.
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