Sunday, December 14, 2008


[Originally posted at "Down With Absolutes" on 12/14/2008]

Oh, no! Another TMI post from Leo?

During the past decade or so of biannual checkups, my general practitioner had been warning my wife and me that, after we reached the half century mark, we should have a colonoscopy. So after I turned fifty this year, we decided to go through this rite of passage together. We called the gastroenterologist recommended by our G.P., and he arranged everything, pre-certifying the insurance coverage, and we were scheduled for back-to-back days at a nearby hospital.

Those of you who have already had the pleasure know that the worst part of a colonoscopy is not the procedure itself, during which you are mercifully under sedation, but rather the preparatory phase. This involves a day of fasting, with nothing but liquid intake the day before the procedure, including a gallon or so of a foul tasting solution specifically designed to clear out your intestines. Needless to say, this causes a significant deterioration to your social life and mobility, keeping you no more than two meters from the nearest bathroom.

Other than that, the procedures were uneventful. My wife drove me to and from my appointment the first day, and I returned the favor the next day. The only odd thing I remember was on the second day when the gastroenterologist informed me that everything went okay, and that neither my wife nor I had any polyps or signs of colon cancer, but he also added:

“You know, your wife’s colon is twice as long as yours.”

“Oh, that’s nice,” I wanted to reply. “And your point is?”

I wish I could say that it all ENDed there, but alas it did not. A few weeks later, I got a statement of benefits from my insurer indicating that everything was paid according to the amounts negotiated with preferred providers, EXCEPT the anesthesiology services. What?!?! (Actually, I had read somewhere that some insurance companies were starting to balk at covering anesthesia for routine colonoscopies, claiming it is not medically necessary. Of course, technically speaking, anesthesia is never medically necessary, but it sure is nice to have for most surgical procedures.)

I fired off a letter to the insurer, indicating that my physician had pre-certified everything. The insurer wrote back and said that (1) the presence of an anesthesiologist is not necessary, (2) the gastroenterologist is supposed to be trained to provide the minimum amount of sedation necessary, and (3) any charges related thereto should be part of his “global fee”.

“But I did not ask for the full services of an anesthesiologist!“ I protested. “I went to the procedure in good faith, believing everything was pre-certified. I would not have done this if I had known we would have to pay approximately $500 each out of pocket. We were just following doctor’s orders. It’s not that either of us was anxious to get a colonoscopy!”

During the next few months while I got repeated bills from the anesthesiologist, I tried a couple more direct appeals to the insurer, but to no avail This past October, it occurred to me to write a letter to the gastroenterologist. After all, he was the one who arranged everything and called all the shots. I told him the onus was on him to either appeal and provide further documentation to the insurer, or settle up with the anesthesiologist himself. I cc’d everyone and their sister, including the anesthesiologist and the insurer. This apparently had the intended effect, because the insurer finally decided to consider an appeal and requested further information from the gastroenterologist and anesthesiologist, including an anesthesiology report. The former sent a letter stating the anesthesia was necessary because I have a “low pain threshold” (Far be it from me to argue with that, but it does sound pretty lame.) The latter sent nothing.

With that, I felt I was home free and could continue to ignore the anesthesiology bills and past due notices, until…. Early this month, I got a notice from a collection agency. Despite the fact that the insurance claim was still under appeal and the anesthesiologist still had not sent them the requested reports and documentation, they turned the account over for collection. I immediately called the collection agency and said I had no intention of paying the bill, and I certainly was not going to pay the $200 collection fee they tacked onto the bill for the wonderful “service” they were providing me! The less than amicable agent to whom I spoke advised that if I did not pay by January 5, the past-due account would show up on my credit report.

The other day, I fired off a nasty letter to the collection agency, again cc’ing everyone and their sister, indicating that the medical provider had no right to turn the account over for collection before exercising all due diligence to provide the information requested by the insurer. I further intimated I would take legal action if they did anything to inappropriately mar my otherwise perfect credit record. The jury is still out on what will happen next. Somehow, though, I think I am about to receive yet another colonoscopy.

What would you do?

[Addendum:  All is well that ENDs well.  After finally receiving the requested documentation, the insurance company eventually paid up.]

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