Having regular colonoscopy screenings is known to be the most effective way to prevent colorectal cancer. Current federal regulations require coverage of those screenings as preventive care – meaning that commercially insured patients should pay nothing as long as their colonoscopies are performed by providers that participate in the medical insurer’s network.
For that reason, Americans who are covered under their employers’ medical plans and use the plans’ in-network providers don’t usually expect to receive a bill.
However, about one in every eight commercially insured patients nationwide who had an elective colonoscopy between 2012 and 2017 – even though they were performed by an in-network provider – received “surprise” bills for out-of-network expenses, according to a recent review. Those bills often totaled hundreds of dollars, with an average unexpected bill of $418. To get that information, researchers from the University of Virginia and the University of Michigan reviewed 1.1 million claims for elective colonoscopies from a large national insurer. They found that even when all of the endoscopists and facilities used were in-network, more than 12% of cases included out-of-network claims, because those in-network providers used the services of out-of-network anesthesiologists and/or pathologists. The bills for those services were then passed on to patients.
These findings are concerning, they said, because receiving surprise bills once may deter many people from getting recommended colonoscopies in the future. They suggested that hospitals and endoscopy centers should make sure they are partnering with anesthesia and pathology providers who are in-network for most patients. They should also consider cost saving strategies, such as endoscopist-provided sedation.