High Medical Costs Shock Chicago Patient as Colonoscopy Bill Triples Estimated Price
Tom Contos, a 45-year-old Chicago health care consultant and avid runner, never imagined his routine colonoscopy would come with a staggering price tag. After experiencing rectal bleeding, he visited his doctor at Northwestern Medicine, who recommended a diagnostic colonoscopy, especially considering his family history. What followed was an experience that left Contos shocked and frustrated with the financial realities of medical procedures in the U.S.
In June, Contos went in for the procedure that is performed more than 15 million times a year in the United States, expecting a straightforward diagnostic check. However, when the bill arrived, it was nearly three times the amount the hospital had initially estimated. What started as a routine procedure quickly turned into a deep dive into the complexities of medical billing.
A Surprising and Expensive Procedure
Colonoscopies are a common procedure used to screen for colorectal issues, especially for people over 45, or those with a family history of colon cancer. The procedure is fairly routine — involving a tube with a camera to examine the large intestine, check for abnormalities, and remove tissue samples when necessary. According to Glenn Littenberg, a physician and former chair of the reimbursement committee of the American Society of Gastrointestinal Endoscopy, the procedure typically lasts less than an hour, with additional time for preparation and recovery.
But for Contos, the procedure became anything but routine. After undergoing the colonoscopy, his doctor found small polyps and large internal hemorrhoids. Thankfully, there was no sign of cancer, though the biopsy revealed that the polyps were precancerous. The relief from the diagnosis was overshadowed by the shock of the bill.
The Price Shock
The total cost of the procedure came to a staggering $19,206, including both physician and hospital fees. While the insurer negotiated the price down to $5,816, they only covered $1,979, leaving Contos with a patient responsibility of $4,047. His initial upfront payment of $1,000, along with a subsequent payment of $1,381, meant he still owed an additional $1,666.
The discrepancy between the estimated and final cost of the procedure raised a host of questions. Contos had been given an initial cost estimate through his online patient portal, but it was clear that the actual charges far exceeded what he had been told.
Colonoscopies with Polyps: Why They Cost More
One reason for the higher-than-expected price tag was the discovery of polyps during the procedure. In general, colonoscopies that find polyps tend to be more expensive than routine screenings. The removal and biopsy of polyps add additional steps to the procedure, which in turn increases the cost. For many, these added expenses can feel like a financial burden, especially when they aren’t clearly communicated beforehand.
For Contos, the lack of transparency was particularly frustrating. While he understood that polyps and biopsies would incur additional charges, he felt the communication regarding these potential costs was inadequate. It left him unprepared for the financial impact of what seemed like a standard procedure.
The Larger Issue: Transparency in Medical Billing
Contos’s experience highlights a significant issue in the American healthcare system: the lack of transparency in medical billing. Patients often find themselves facing unexpected and exorbitant bills after routine procedures, without a clear understanding of how costs were determined. Many hospitals and healthcare providers fail to communicate accurately about the potential charges beforehand, leaving patients to bear the financial consequences after the fact.
Cost Estimates vs. Reality: What Went Wrong?
So, what went wrong with the cost estimate Contos received? According to the hospital, the estimate was provided to him through his online patient portal. However, the estimate did not accurately reflect the full scope of the procedure or the potential for additional costs related to polyps. This discrepancy left Contos with a bill that was far higher than he anticipated.
The Burden of High Medical Costs
The high cost of medical procedures is an ongoing issue in the United States, and it can place a significant burden on patients, even for procedures that are supposed to be routine. For people like Contos, who already have health insurance, the financial strain can still be overwhelming. While insurers negotiate some costs, patients are often left to cover the difference — and the additional charges for procedures like colonoscopies can quickly add up.
The situation is exacerbated by the fact that many people don’t fully understand how medical billing works or how to navigate the complex system of insurance, charges, and negotiations. Contos’s experience is far from unique, and many others have been blindsided by unexpected medical bills that seem to come out of nowhere.
The Road Ahead: Advocating for Change
In light of his experience, Contos has become more vocal about the need for greater transparency in medical billing. He is not alone in his frustration; many patients across the country are calling for better communication regarding medical costs before procedures take place. Advocates for health care reform are pushing for policies that would require hospitals and insurers to provide more accurate and upfront information about the potential costs of medical care.
While the issue of high medical costs is complex, it’s clear that better transparency could go a long way in helping patients make informed decisions about their care and avoid the financial shocks that many face after a procedure.
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