First, the Dr. Mann and the staff here are lovely. My rating comes from what happens AFTER you leave.
I scheduled a preventive colonoscopy. It's not fun, but it's important to do. The practice requires you to come in beforehand for assessment. At the end, they tell you - we will call your insurance to verify that it is covered. They called and yes, it's covered. It's preventive care. Got it. I have that message in writing.
During the procedure, Dr. Mann found two polps. Now it's no longer preventive. The procedure is now considered "diagnostic" - translation - your insurance will not cover it. Now I have a $1,200 bill that I have to pay. I called multiple times asking to speak to someone to understand this. "Your bill will be reviewed for coding, but don't count on any changes. It's going to stay diagnostic." That's what the staff person on the phone told me - the coding is what is causing your insurance not to pay, but we are not going to change it. Get over it.
This is unfortunate and unfair. Health insurance is expensive. You count on it to be there when you need it. When a doctor's office decides to label your experience "diagnostic" instead of preventive, you are screwed. Consider the testing of the polps diagnostic - that makes sense, but I scheduled this preventive procedure in the absence and signs of symptoms.
As part of the Affordable Care Act (ACA), Medicare and most third-party payers are required to cover services given an A or B rating by the U.S. Preventive Services Task Force (USPSTF) without a co-pay or deductible, but the correct CPT and ICD-10-CM codes must be submitted to trigger coverage at 100% for the patient.
Colonoscopies are an important step in preventive care, but with doctor's offices refusal to remember that the initial procedure is preventive, this will probably be my last one. read more
