My colonoscopy saga-3: More discussions on the word ‘routine’

(See part 1 and part 2.)

By now I am fed up with all this back and forth and decide that I will schedule the colonoscopy anyway and deal with being charged afterwards. I call the doctor’s billing office again to get the final ok and learn something new. They say that the colonoscopy is considered ‘routine’ and thus free not only if there were no prior indications of cancer but also only if the doctor finds absolutely nothing. If the doctor finds even a single benign polyp (which is not uncommon), then it ceases to be routine (and free) and I have to pay the full amount, which is about $1,500. The insurance company had not told me this piece of interesting news nor is it spelled out in their policy. So whether I pay nothing or whether I pay about $1,500 depends not on the procedure itself but on what they find during the procedure! In other words, I have no idea going in what it is going to cost me coming out.

How crazy is this? I call the insurance company and argue that this is manifestly absurd but even after talking to the supervisor, I am told that this is what the policy is, and that’s that. However, the supervisor said that if it will put my mind at rest, she can give me an upper limit to what they will charge me, whatever the outcome. Again, like the 2-3 days rule, this seems to be one that she was making up on the spot, and I was dubious as to whether it would be honored later. It looked like the kind of answer given to pesky people just to make them go away.

I am finally fed up with the whole business, all the phone calls to the doctor’s office, the doctor’s billing office, and the insurance company. And I still haven’t spoken to an actual health care professional. This is of course the insurance company strategy all along, to wear people down so that they either go away or are willing to pay whatever is asked just to get the damn thing over and done with. Since I can afford to pay the full cost if need be, I go ahead and make the preparations and get the test.

Fortunately for me, not a single polyp is found so the colonoscopy does end up being free. But not entirely. Initially I am charged for the preliminary doctor’s office visit after all. So it is back to making repeated calls to the doctor’s billing office and the insurance company. I eventually find out that if the doctor bills me for the office visit under a difference code number from the one they originally used, the doctor’s visit is also paid for as part of the colonoscopy. So the doctor resubmits the bill with the new number and that ends that, and my particular story had a happy ending, despite all the time wasting frustrations.

But let’s take a moment to savor the absurdity of my experience. First of all, we had about six people (in the doctor’s office, the doctor’s billing office, several insurance company people, and their supervisors) involved in arcane discussions about rules for several weeks all before I even saw an actual health professional like a nurse or doctor. All the people I was dealing with were friendly and cordial and all the conversations were amicable, but we were all trapped in a maze of rules that made us go around with little progress, like hamsters on a wheel.

Furthermore, I am very fortunate. I have the time and knowledge and patience and access to the internet and phone to call people during the day, check the websites, and to do all preliminary work that I had to do to get all the information. But even with all that knowledge and after all my work, in the end, I still had to go in for my colonoscopy with no assurance of what it would ultimately cost me.

It so happens that I could afford to pay if necessary. But what if someone had taken the policy’s assurance of ‘free’ colonoscopies at face value, and the doctor had found a polyp or the insurance company had dug up one of the infamous ‘pre-existing conditions’, and then the patient had been unexpectedly hit with a large bill that he or she could not afford. This could be a serious problem for many people who live from paycheck to paycheck and do not have the savings to deal with sudden large expenses. It is this kind of thing that starts people on the slide to ruinous debt.

Or what if someone does figure all this out like I did but for whom $1,500 is unaffordable. Or what if they had some symptom that might prevent the ‘routine’ classification? There will be a strong temptation to skip the procedure, take the chance that they do not have cancerous polyps, and thus not detect the cancer until it is too late.

POST SCRIPT: Real reform or the final act of the Kabuki play?

Obama gave a strong speech last night where he said a lot of good things about what his health care plan would deliver, even though it falls short of what I would like to see. He vowed to end some of the worst abuses of the health insurance industry, such as the practice of rescissions, denying coverage due to pre-existing conditions, and putting caps on the costs of treatment, but he clearly wants to keep the fatally flawed current system in place.

He promised to vigorously fight those who oppose reform and to call out those who are blatantly lying about the proposed plans, which pretty much includes all the Republicans and many Democrats in Congress plus assorted wingnuts like Rush Limbaugh and Sarah Palin.

The eternal optimist in me hopes that he really means it and that he will not return to negotiating away even these limited improvements in order to please the business interests and its lackeys, which has been his practice so far.

The cynic in me fears that this might have been the penultimate act of the Kabuki play I described earlier and that Matt Taibbi fleshed out more fully in an excellent article, where Obama gives a pretty speech to satisfy his supporters but then acts against their interests.

What is needed now is to pay close attention to the details of the legislation that finally emerges. Real policy is not made on the floor of Congress or in public speeches but in the back rooms behind closed doors where the lobbyists exert their influence in secret.


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