Surprise Billing Seen Likely for Many Colonoscopies

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And would be illegal for uncomplicated procedures.

Nearly one in eight commercially insured patients undergoing elective colonoscopy with in-network providers incurred out-of-network costs, researchers found — potentially leading to illegal “surprise bills.”

In an analysis of a national claims database, and among 118,769 elective colonoscopies with in-network endoscopists and facilities, 12.1% (95% CI 11.2-13) involved out-of-network claims. The median potential surprise bill was $418, according to James M. Scheiman, MD, of the University of Virginia in Charlottesville, and colleagues (“potential” because the investigators didn’t have access to actual bills, but instead made estimates based on records of in- versus out-of-network coverage).

Of particular concern was that one in 12 procedures without an associated intervention still had an out-of-network claim, they explained in a brief research report in the Annals of Internal Medicine.

“This outcome is disconcerting because Section 2713 of the Patient Protection and Affordable Care Act [ACA] eliminates consumer cost sharing for screening colonoscopy and because a recent Federal Reserve study reported that 40% of Americans do not have $400 to cover unexpected expenses,” the investigators wrote.

Moreover, out-of-pocket costs are well-established deterrents to evidence-based care and fuel patient dissatisfaction, they noted. They urged endoscopists and their facilities to partner with anesthesia and pathology providers who participate in their insurance networks.

“In the short term, endoscopists should also consider using established cost-saving strategies, such as conscious sedation and the ‘resect and discard’ approach, to biopsy specimens,” the authors wrote. “In the longer term, we must enhance ongoing reform efforts to remove consumer cost sharing for all clinically indicated care associated with colonoscopy.”

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