Colonoscopy & Endoscopy Cost (desperate for help)
Hi all,
I am a 28 yo male getting a colonoscopy and endoscopy in about one week. I have no idea what kind of bill I’ll be slapped with. If it’s likely to be super high, I won’t get these done.
As of today, I have called my health insurance company SIX times in an attempt to crisp up my understanding of the possible financial burden I will experience. I’ve never been so confused about anything in my life, and have never failed so epically in my effort to understand something. Each time I call, I speak to representatives who offer vastly different answers on the topics of prior authorization, deductible, co-payments, “allowed” amounts, and co-insurance.
Here are some specifics to hopefully help you, help me
Procedures: colonoscopy & upper endoscopy
Insurance plan: CareFirst BlueChoice HMO (offered through Maryland marketplace)
Premium: $320/month (luckily I am now employed and won’t have to pay this starting in June)
Deductible / Out of Pocket Max: $1,000 / $6,650
Reached Deductible? No, nothing has gone towards deductible yet
Facility type: free standing ambulatory surgery center
Some additional info – I spoke with CareFirst today and received what I expect to be the most helpful info. to date (the guy seemed conscientious and asked lots of specific questions like the name of facility, name of doctor, etc.
They said:
Colonoscopy
Authorization: not required
Deductible: yes
Copay: $30
“Allowed amount”: $215 (estimate)
Co-insurance: considered at 100% of allowed amount
Endoscopy
Authorization: not required
Deductible: yes
Copay $300 (???)
“Allowed amount”: $161.70 (estimate – a very specific one)
Co-insurance: considered at 100% of allowed amount
I guess my biggest questions are:
Can I expect to pay close to the $1,000 (my deductible) + some copayments? Or is the bill going to run up to my out of pocket maximum ($6,650)
I’m alright paying around $1,000 for these procedures but not above $2,500 honestly, rather wait and see if I have cancer in a few years
Do I have to beg the facility to code these procedures a certain way or will they do it automatically?
Why isn’t the facility’s billing department responding to my request for the prices of the procedures? Literally answering all my other questions but that.
Am I going to get slapped with some ridiculous anesthesia (propofol) bill?
Do I have to confirm the anesthesiologist is in network or something ridiculous like that
What is an “allowed amount”?
Happy to answer any other questions and excuse any etiquette errors as I’ve never posted to Reddit. Thank you!
