Tom Contos, a dedicated runner, faced a troubling health issue when he started experiencing rectal bleeding in March. Initially attributing it to his exercise routine, Contos grew increasingly concerned as the bleeding persisted over several weeks. Given his family history of colon issues, his physician at Northwestern Medicine recommended a diagnostic colonoscopy to investigate the underlying cause.
In June, Contos underwent the colonoscopy at Northwestern Memorial Hospital after prepaying $1,000 out-of-pocket. The procedure, which is a common screening method for colorectal cancer, involves examining the large intestine using a camera-equipped tube and collecting tissue samples. During the colonoscopy, the gastroenterologist identified and removed precancerous polyps, as well as diagnosed internal hemorrhoids as the likely source of the bleeding.
However, the shock came when Contos received the bill for the procedure. The hospital charged a total of $19,206, including physician fees, which the insurer negotiated down to $5,816. After insurance coverage, Contos was left with a patient share of $4,047, despite already paying $1,000 upfront and an additional $1,381 post-procedure. The confusing itemized bill revealed charges for two colonoscopies and two separate fees for the gastroenterologist, leaving Contos perplexed and frustrated.
Further investigation into the billing discrepancy uncovered that providers typically bill for two colonoscopies if multiple polyps are removed during the procedure, utilizing a modifier code to reflect the additional work involved. Despite attempts to appeal the charges with the hospital and insurer, Contos was informed that the billing was accurate. The insurance company, Aetna, confirmed that the claims were processed correctly, leaving Contos with a hefty out-of-pocket expense.
In response to the exorbitant bill and lack of clarity in the billing process, Contos expressed his dissatisfaction with Northwestern’s pricing and ultimately decided to sever ties with the health system. Moving forward, he opted to manage his symptoms with over-the-counter remedies, highlighting the significant cost disparity between medical procedures and self-care alternatives.
For patients seeking more affordable options for colonoscopies, choosing freestanding endoscopy centers or ambulatory surgery centers unaffiliated with hospitals may offer lower pricing. Research indicates that ambulatory surgery centers bill insurers substantially less for colonoscopies compared to hospitals. Patients are advised to explore price transparency tools provided by hospitals and insurers to estimate costs accurately and inquire about potential additional charges for polyp removal and biopsies.
In conclusion, the convoluted nature of medical billing underscores the need for greater transparency and clarity in healthcare pricing. Patients should be empowered to make informed decisions about their care without facing unexpected financial burdens. By advocating for improved billing practices and exploring cost-effective alternatives, individuals like Tom Contos can navigate the complex healthcare system with greater confidence and financial security.
