No Photos! (And good health)

A letter arrived, saying, “It’s time for your colonoscopy!”  The way it was worded, it seemed very much like, “It’s time to go to the amusement park!”  Even though it was unlikely any amusement would be directed my way, the appointment was made, and the prescription was issued.  Hey, occasionally one needs to endure aggravation for the sake of better health, right?

At the pharmacy, the $129 kit appeared on the counter.  “Huh?” I blurted. “The last time I had this done, it was about ten dollars of over the counter stuff.  Is this kit guaranteed to give me a healthy colon?”

“No sir.  Would you like the less expensive and marginally more painful option?”

“Well, how are you measuring painfulness?  One hundred dollars more painful?”

“I’ll get you the low cost option.”

Regardless of the cost of the prep, the drill was the same.  Don’t eat anything and stay within a 4 second run of the toilet.  Be at the hospital in the morning.

Of course, the procedure was great fun.  Routine check behind me, I forgot all about it.

Until six months later, when the Colonoscopy Bill arrived.  It provided pertinent facts.

Responsible Party - John R Fredlund

Patient ID# - 1234567    Excellus Member ID - VYU M911911911 (Because I’m old, I had the pleasure of changing to Medicare in April of 2018)

Statement Date - 7/10/2018    Due Date - 8/7/18

Payment Due $565.28

Aren’t routine procedures covered?  It was time for a phone call. Or two.  After hanging up dissatisfied, it became time to draft a letter to the hospital.

Dear Sirs,

Upon receiving this bill, I was unable to understand the charges.

Customer service (6-AUG-18) for both Rochester Regional Health and Excellus was contacted to try to determine the reason for the charges for a routine colonoscopy.  As the result of these calls, I learned that during the procedure, when I wasn’t paying full attention, and sometime after the good Doctor informed me that I had a nice young-looking anus, he determined that there were abnormalities that deserved further investigation.  Thus at this point, what I thought was to be a routine preventive colonoscopy changed to become a diagnostic procedure.

This may be somewhat plausible, though it minimizes the definition of "preventive."  It appears that the preventive procedure is free as long as it really doesn’t need to prevent anything.  Even so, it makes sense that the Doctor would augment the procedure without my knowledge to provide the best care possible.  To disagree would confirm the doctor’s previous observation on a less literal basis. That there might be additional charges due to the diagnostic augmentation is understood, if not fully embraced.

So a little over 6 months after the procedure, a bill is generated stating that payment is due in less than 30 days.  Surprise! Though the timing and subsequent deadline is not exactly equitable, this is not the subject of this communication.

What I wish to know is how the $565.28 figure was calculated.  By looking at the bill from Rochester Regional Health, it is impossible to tell, even with the 10 lines of itemization.  I am unable to make any combination of the numbers tally to $565.28.

Can you please let me know how this number was determined?  Neither the Rochester Regional Health support person or the Excellus support person was able to tell me.

The issue is not that the bill should be paid.  The issue is that determination of the amount is not transparent.  It is difficult to put pen to check for an amount that appears arbitrary.  Currently, I envision an employee with a tall conical cap and long robe waving a magic wand over his monitor to make a number rise from the bubbling pot beside him.

Can you provide figures that will dispel this image?

Thank you for your help.  I look forward to your reply.

John Fredlund

Weeks later, I received a call from the hospital.  Essentially, the voicemail said, “We have no idea how they came up with that number.  Call the Insurance company.”

As instructed, the call was placed and another conversation ensued which supported the notion that for this and probably many other colonoscopies, they had pulled the uncovered amount out of their asses.

But another call yielded slightly better results.  The new bill received, though still less than satisfactory, was much closer to answering my questions.  I even received an email with somewhat less cryptic line items.

After one more call with the intent of understanding the descriptions of more granular charges, I realized that further investigation would very likely result in little benefit and also much additional aggravation. So I paid the bill.

Why?  Because further combat with the healthcare industry was likely to negatively affect my health.

And yes, that was the actual letter, and thankfully, the tests were negative.