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Two Doctors for a Colonoscopy; Maximizing the Bill for Medical Services

Posted Jun 07 2012 12:00am

We are going to have a tough time restraining the cost of healthcare despite our good intentions. One of the reasons is that physicians and hospital executives can decide exactly how various types of services are delivered. If one component of reimbursement is squeezed by the government or insurance plans, there are often other ways to compensate for the financial loss. Patients often end up paying for the additional services. A recent article detailed how this works for colonoscopy (see: Waking Up to Major Colonoscopy Bills ):

“Doctors adopt practices that cost more, insurers pay less, and patients get stuck with a tab that in many cases is inflated and arbitrary,” said [a spokesperson for] Public Interest Media Group, [which] is focused on health care....More than 20 million outpatient endoscopy procedures are performed in the United States each year, and the number is growing. A few hardy patients decide that they do not need anesthesia at all. Most receive conscious sedation, a combination of drugs that block pain and help patients relax while remaining conscious; three gastroenterology societies recommend this option as adequate in cases where there are no complications.

Still, a growing number of patients appear to be receiving full anesthesia. Some gastroenterologists say that patients recover more easily after full anesthesia and that the exam is better. But there is no clear scientific evidence to support this, and critics say that an extra pair of hands in the room simply allows the doctor to perform more procedures. According to a study by the RAND Corporation, published this year..., use of anesthesia administered by an anesthesiologist or nurse anesthetist during outpatient gastroenterology procedures, mostly colonoscopies, has more than doubled in recent years, to more than 30 percent in 2009 from 14 percent in 2003.

Most of the increase occurred among low-risk patients who could do without the expensive service. But the practice varies from region to region: Only 13 percent of gastrointestinal procedures in the West involved an anesthesiologist or nurse anesthetist, compared with 59 percent in the Northeast, the study found. As much as $1.1 billion spent on anesthesia for gastrointestinal procedures each year may not be medically necessary, the researchers concluded. Insurers often foot the bill for full anesthesia, but not always.

For me, the most significant point made in this article was the following: critics [of general anesthesia for colonoscopy] say that an extra pair of hands in the room simply allows the doctor to perform more procedures. Insurance companies and the federal government continue to ratchet down reimbursement for common diagnostic procedures like colonoscopy. Gastroenterologists then have an incentive to perform more of them to maintain their expected incomes. One way to achieve this goal is by having another physician in the procedure room to increase productivity. Since many insurance plans will refuse to accept the charges for this additonal set of hands, the patient may be stuck with the bill for the general anesthesia.

The bottom line here is that the patient needs to discuss with his or her gastroenterologist the cost of colonoscopy prior to the day of the procedure. Some may plead ignorance when asked, saying that insurance plans may differ. It's certainly worth while, armed with the information above, to ask if general anesthesia will be used for the colonoscopy and, if so, why. Then and to obtain more information, the next step is to call one's health insurance company and ask about reimbursement for colonoscopy. This is particulary important for the uninsured and for those with high deductible insurance, as discussed in a recent post (see: High Deductible Health Insurance Plans Becoming the Norm in Large Companies ).

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