Colonoscopy anesthesia denied

I had my first colonoscopy when I was 50 and because they found two polyps, my doctor recommended colonoscopies every five years. My first colonoscopy was performed while I was under anesthesia.

Last November, I had the next colonoscopy when I was 55. It was also performed while I was under general anesthesia.

Both times I had colonoscopies my insurance was with Anthem/Blue Cross. The first one five years ago was completely covered (other than copays and coinsurance.)

A few months ago, I got a letter saying that my anesthesia was denied and if I disagreed to appeal. Before I appealed, I opened up my EOBs and found that although they denied the claim a few times but there was an approved EOB where they paid approximately $250.

I thought it was a done deal as they paid a much lower contracted amount.

Fast forward to last week and I received a bill from the anesthesia company for the full $1200.

I contacted my insurance company to ask about it and the reply said:

“The anesthesia claim was submitted 4 times, it was paid and then adjusted to denied as not medically necessary.”

Has anyone here had a colonoscopy without anesthesia? (I wasn’t given the option.)

I have been with the same insurance company for both procedures. How is it possible that it was covered the first time but not the second?

Both procedures were performed by the same in network doctor at the same in network facility.

Thanks in advance for any insights.

submitted by /u/misterfuss
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