For clarification purposes, our insurance would have covered the procedure 100% had it been “routine”. Since my husband was having issues (colon cancer was suspected) the procedure was considered “medically necessary” rather than “routine”. There are different co-pays for different categories. Based upon his age and medical history, a colonoscopy would not be unheard of for a yearly physical.
Also, the company my husband works for is self insured, Humana just manages the bills. The last HR director took these complaints very seriously, he and our company in general took a great deal of pride in their insurance coverage. He was on the board of our local hospital and a mistake in billing either on the part of the hospital or a miscommunication with the insurance company was taken care of immediately. We didn’t even have to call anyone, just bring him the bill and it would be corrected before the next billing cycle. Unfortunately he retired a couple of years ago and word seems to have gotten out that you don’t have to answer to Z anymore.
The customer service representative that I spoke to was able to see that my husband pre-authorized the procedure. Based upon the information this third person (1st being the one he called to pre-authorize, 2nd being the one he spoke to, and 3rd being the one I spoke to) was able to access, she surmised that the proctologist must have done something during the procedure to change the category from “routine” to “medically necessary” (her exact words), such as burn off polyps, which was simply not the case.
The medical field in general irritates me in general. The medical providers get to hide behind “we bill your insurance as a courtesy to you”, so if they make a mistake, there is no financial responsibility. The insurance company is on crack. The “reasonable and customary” costs between the doctor and insurance companies are a world apart.
The last insurance company we had stated that the “reasonable and customary” cost of a dental cleaning was $10 and they paid 90% of that. I told the customer service representative that if they could find me a dentist in the entire US that would clean my teeth for $10 I wouldn’t even use their insurance.