Medical Insurance Question (colonoscopy)

Is this normal?

For my insurance:
1. Colonoscopies are covered 100% because it is considered a preventative procedure.
2. The GI doctor said "You have to see me first before the colonoscopy" (I met with the doctor, she explained whats involved, etc, etc and scheduled the colonoscopy)
3. Insurance is saying the visit to the doctor is not the colonoscopy so its not covered (have to pay everything until I hit my deductible)

Are #1-#3 standard?

#3 seems weird to me.
If colonoscopies are covered, but you can't get to the colonoscopy without seeing the doctor and the doctor isn't covered, then how can you say colonoscopies are covered? (not allowed to just schedule the colonoscopy, have to see the doctor first)

Shouldn't the initial doctor visit should be considered part of the colonoscopy since its an initial step before the colonoscopy.

Right?

Message edited 2/8/2022 4:52:18 PM.

Re: Medical Insurance Question (colonoscopy)

1-3 are standard because no doctor is going to want to do a procedure without meeting you first and going over procedure and risks. I would think maybe the only way "around" this would be if your internal medicine doctor happens to also be a GI dr (which my dad's was). So my dad would see his primary care doctor and then this same doctor would do his colonoscopy when necessary and also did an endoscopy.

Medical Insurance Question (colonoscopy)

Did you have (or need) a referral from your PCP for the colonoscopy? I have a PPO so I don't need referrals for specialists but most of the time I still get one.

Re: Medical Insurance Question (colonoscopy)

Ok just handed this situation for my husband. If you are being referred to a GI because of an issue and this is not your you need a colonoscopy at age 45, then the doctor wants to meet you. That would have a regular copay. Not all gi doctors do the routine colonoscopy. So you need to find the guy that does the routine versus the specialist who is treating a GI issue. So the routine one has you fill out the paperwork and then does the colonoscopy. The GI doctor is for someone already experiencing problems.

Medical Insurance Question (colonoscopy)

>>standard because no doctor is going to want to do a procedure without meeting you first and going over procedure and risks.

Exactly, so my point is "If a colonoscopy is considered preventative and is covered 100%, then why do I have to pay for the office visit since it is required before I can get the colonoscopy" ?


>>Did you have (or need) a referral from your PCP for the colonoscopy?

No.


>>LSP2005

The GI doctor I went to is the one doing the colonoscopy.
The ONLY reason I went there is because my PCP said its time for a colonoscopy and told me to call her up.
Her office said "You need a colonoscopy? you have to come in first and see the doctor"

This is such BS.
The billing place said everything is billed right, you have to pay.
My insurance said "This is an office visit, not the colonoscopy so you have to pay"
WTF - I didn't want to go there, but I had to before I can get the colonoscopy

Message edited 2/9/2022 8:54:11 AM.

Medical Insurance Question (colonoscopy)

I would think the office visit for pre scope conversation is a specialist co pay. It's not a what they call a bundle price. But to me that pre visit is like a consult and you pay co-pay.
To be clear are they charging you the cost of the visit? if so that doesn't make sense to me either

Medical Insurance Question (colonoscopy)

My husband just had his .
He called the GI and asked for the script for meds to take pre colonoscopy and they scheduled it without him seeing him this year ( just bec of the problem u mentioned )
He actually saw the GI earlier once last year.
My insurance still asked him to pay 25$ for the covered procedure!!

Imsurance sucks

Medical Insurance Question (colonoscopy)

so I had my colonoscopy in early April.
I refused sedation/anesthesia did not want to "go under". I had told the doctor that when I had the first visit (which I have to pay for, which I still disagree with) and I mentioned it to the intake nurse the day of.

When I got the EOB guess what - there's a charge for anesthesia lol. Its fully covered so nothing out of my pocket, but still - this is why insurance rates are so high because of false charges.

Called the doctor's office 10 days ago and told them that I never got it and the charge is incorrect, they said they will investigate, never heard back.
Just called my insurance company and told them the same.
What they'll do is up to them, but I got the feeling they didn't care too much.

Oh well

Message edited 5/3/2022 10:21:32 AM.

Re: Medical Insurance Question (colonoscopy)

Re: Medical Insurance Question (colonoscopy)