Insurance problems getting a colonoscopy at 39 years old

Jan 10, 2019

  1. Satellite_Beacj
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    Satellite_Beacj New Member

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    I am 39 years old and have Cigna HRA/OPEN ACCESS PLUS insurance through my employer in Florida with an $8500 in-network deductible. If I pay the first $1500 then I have an HRA that can help out with the next $2100, then I'm back on my own until I reach the $8500. When I check my contributions to Cigna for 2018, it looks like I contribute just under $4K for my family and my employer paid Cigna just under $14K. Recently I started experiencing some symptoms. I went to my primary care physician and she referred me to a local gastrointestinal specialist. Both doctors agreed that they think I should move forward with a colonoscopy to find the cause.

    Cigna is telling me that if I was 10 years older that this procedure would be covered at100% and coded as Preventative. However, even though I am exhibiting symptoms that something is not right, it will have to be coded as Diagnostic and I will most likely have to pay $1200-2000 out of pocket to receive this routine procedure. (CPT 45378, Diagnostic K62.5) I have been told that even if they perform the procedure and find major issues that I will still need to pay the $1200-2000.

    If my wife wasn't pushing me to do this, due to an experience of a family friend, then I probably just wouldn't go through with the procedure. It isn't anything I'm looking forward to, so the price tag isn't helping. I'm paying Cigna about as much as I am paying on my car loan each month. I can go see a doctor anytime I want for $25 a visit to get a Z-pack or whatever the 2-3 times a year when I need it but when I really need insurance, it doesn't really seem to help all that much.

    Is there a better way to have this procedure covered by insurance? This doesn't seem right. Do I just have bad/catastrophic insurance? I don't feel like I'm paying bottom of the barrel prices, yet that's the kind of coverage it feels like I have. Any advice would be greatly appreciated.

    Thanks,
    Nathan
     
  2. Yagents
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    Yagents Guru

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    $330/mo for a family on that plan is a great price, and it's a more than decent plan.
    Yes, due to your age, and the medially diagnostic procedure, it is subject to deductible.
    It's not preventative, because you are having medical symptoms.
    You will get the network discounted rates if you stay in network, and that pricing is about right.
    Having the HRA is an added bonus, thank your employer.
    There is no better plan, and there is no magic pill to solve your problem.
    If you actually need to have your colon removed, you'll be thankful for many reasons.
    That you sought care, you have an out of pocket max, and you lived to see another day.
     
    Yagents, Jan 10, 2019
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  3. Chazm
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    Chazm Guru

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    Insurance is there to keep you from spending $100k. Not from spending $1200
     
    Chazm, Jan 10, 2019
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  4. fed up
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    fed up Guru

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    My neighbor complained about a colonoscopy which his wife said he should get as he passed age 50. They removed 2 feet of colon due to his stage 3 cancer with no symptoms. He b..ched about needing to take a blood thinner for the rest of his life because of clotting problems. maybe if he had opted to get a colonoscopy at age 39 he would not have had a year of chemo. i have had 2. the prep work is unpleasant the day before. I had 6 polyps removed. Get the damn test and hope that they don't find anything. Money can be replaced.
     
    fed up, Jan 10, 2019
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  5. Satellite_Beacj
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    Satellite_Beacj New Member

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    When I say family plan, it is really just me and my two kids. We moved my wife to her own plan, through her employer, before we had our daughter, so that we would only have to pay around $4,500 out of pocket for the birth of our daughter, instead of the $8K+ that it would have cost us if she had stayed on my plan with our son. We just haven't moved her back. It all just seems a bit expensive to have to be $1200-2K out of pocket for a routine procedure that takes 20 minutes or so. Makes me concerned what it will cost when anything major happens.
     
  6. NewbieNewbie
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    NewbieNewbie Super Genius

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    I had a very close friend diagnosed with colon cancer at 37 and sadly after going into remission twice she passed at 41. She had health insurance but her bills were almost 1mm. Sadly she passed, thankfully she was only oop 5k a year.
     
  7. Yagents
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    Yagents Guru

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    Routine does not include a surgeon, anesthesiologist, nurse, facility and tools for the job. Roto rooter has 20 min special deal maybe, but not USA healthcare. Shop around within the network. Zip code matters, each provider charges different
     
    Last edited: Jan 10, 2019
    Yagents, Jan 10, 2019
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  8. somarco
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    somarco GA Medicare Expert

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    Since you are having symptoms

    I doubt it would be coded as preventive at any age.

    Nope.
     
    somarco, Jan 10, 2019
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  9. adjusterjack
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    adjusterjack Guru

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    Get the test and quit kvetching about the money. Pray they only find benign polyps and a hemorrhoid or two.
     
  10. Chazm
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    Chazm Guru

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    If he takes his time and makes it an hour, will you feel better about the cost?
     
    Chazm, Jan 11, 2019
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