How Screwed Up is our Medical Profession?

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I ran into a friend, Garth Prosser, in Breckenridge a couple weeks ago and he told me that last year he was diagnosed with Colon cancer.   I was surprised.  I remembered seeing him at the Berryman Epic last fall, but didn’t hear anything about him racing on chemo.

Anyway, after talking with him for a bit, he got me thinking and I decided that I need to get a colonoscopy.  It is way easier thinking you need one than actually getting one as it turns out.

I got on the computer and looked up all the places that do one in Topeka.  I am pretty sure my insurance isn’t going to pay for it, so I was shopping around.  The problem is that you can’t really shop around because no one really knows exactly how much it costs.  The Internet says that a cheap price in Kansas is around $500, good price $750 and expensive $1300.  I don’t know where they came up with those numbers, but the best/lowest price I could find after being on the phone for 3 hours was around $2000.  And I’m not sure that is a hard number really.

My best source of information was the billing company for a local hospital.  I told the women my situation and she seemed interested.  She told me it would be between $1200-$1600 for the surgery center, then the same about for the doctor.  But she said if I was self pay that they would reduce that amount by $600 each.  So that took the total procedure down to between $1200 and $2000.   Quite a spread there.

Then, at the end of the conversation, she told me she forgot the anesthetist charge, which would be another $600.   She said her computer didn’t show a self pay charge, so I should just wait 3 or 4 months after I receive the bill, then call them and they would come up with a reduction.  Wow.

I can’t think of another segment of our society that can’t quote you a price on something as important as this.  It is so convoluted and confusing that even reasonable thinking people can’t understand it.

I was reading that under the affordable health care act (Obamacare), that this might be covered. So I called my health insurance agent and asked her if she might know.  I’ve had the same health insurance for nearly 25 years.  Trudi and I are the only health policies the agent does still. She told me it is so screwed up and takes so much time, it isn’t worth it to her.

So she called my insurance company and talked to them.  After an hour, she called me back and said they couldn’t say if it would be covered and they needed some time to figure it out.  That each state has its own rules and they would get back to her shortly.  That was two days ago.

So I am still at square one.  I want to get this done, but don’t want to just spin a roulette wheel for the final cost.  I’m gonna get back at it today and see if I have some better luck.  Our medical system is so jacked up that I’m nearly embarrassed to be participating.  But, what choices do we have?


Tucker wants me to take him out for run I think.

Tucker wants me to take him out for run I think.

55 thoughts on “How Screwed Up is our Medical Profession?

  1. Joe C

    Just go see a gastroenterologist. They will tell you what you need to do, and get it cleared with your insurance. I missed my appointment a few weeks ago because I am out of work, but I’m on the every 3 year plan due to polyps.

    1. Steve Tilford Post author

      Joe- I am calling GI guys and asking them, up front, the costs. No one seems to know them. I don’t see why I’d make an appointment just so I can figure out how much it will be.

  2. Mr. Ed

    If you are over 50 (and we all know that answer) Colonoscopy is covered every 10 years as preventative under the AHCA. If you are at high risk you can get them more frequently.

    1. Craig

      Yep. The problem with the healthcare system in this country is twofold. 1. It is profit based so the ultimate decisions are made by the bean counters and 2. There is an excess of capacity in areas where the prices are highest.

      But as Mr. Ed says, one every 10 years after age 50 is mandated by the AHCA … you will just have to deal with your insurance company and bills for about 18 months to get it sorted in the end (pun intended)

    2. Steve Tilford Post author

      Mr. Ed – That isn’t necessarily true. From what I’ve read, if you started your insurance after 2010, then it is mandated that it be covered. Before that date, certain procedures can be excluded because the insurance was “grandfathered” in.

  3. Robyn Michelle Angeles

    You “probably” don’t need one. If you are “so-inclined,” you could ask you medical insurance company for an “Fecal Occult Blood Test.” If the test comes back positive, (a reasonably good chance, if you are a competitive athlete,) your insurance company shouldn’t have any qualms about paying for a proper Colonoscopy.

    1. jrem

      Totally agree with Robyn. Assuming you have a relatively high fiber, healthy diet and no family history, this fecal occult blood test should be sufficient.

    2. Larry T

      Do a little research on the value of this test. it’s real easy to get the old “they caught it just in time” routine that’s used to justify countless tests and procedures that are proven to be a huge waste of time and money. The US healthcare system is a for-profit business that thousands of lobbyists spend full-time on, creating laws and loopholes to further enrich the providers at the expense of the general public.

  4. Emil Gercke

    You also might look into doing this while awake, I have a friend who does this to avoid the anesthesia. I don’t know if you would still have to incur the charge for the Anesthesiologist (they might have to ‘Standby’).

    1. Barb

      My experience is that health care providers don’t listen to anything a patient tells them, they’d have to do a stool sample test before they’d listen. The problem is because of Obamacare adding so many people to the rolls, the system is completely overburdened to the point where all systems are just pushing people through like cattle (appointments are designated at 15 min long), so you’re probably going to get a much better level of service paying cash. Also, selling an anaesthesiologist is just that, selling more services to make money. A colonoscopy doesn’t feel all that good, but if you stitch up your own wounds, you don’t need to be put under for this procedure. They gave my 80 year old mother a colonoscopy without one and while she didn’t like it, she didn’t complain that it was excruciating.

  5. pizza

    My last visit to a vet they had a price sheet for all kinds of procedures, some of them quite complicated.

    Too many people making money in the current human medical care industry to get to simple price discovery.

  6. Barb

    Personally, I’ve encountered little but incompetence in my experiences with the health care field. Last year I went through a year of hell related to gross misdiagnosis and indifference to actually doing a good job and almost ended up with spine surgery that wouldn’t have even addressed my problem, which turned out was temporary. A good comparison would be like they wanted to cut a leg off to heal a head cold. I would not get any kind of invasive screening procedure, unless it was absolutely indicated by some kind of outwardlyu obvious symptoms that required further examination. I’d be more inclined to make dietary changes to a much more high-fiber diet than eating a lot of red meat or refined white flower products.
    Here you go:

  7. Mike

    What you are talking about will only happen when we either have 1) a single payer system like most of the rest of the developed world or 2) a system with price controls like Japan. As long as each individual insurance agency has the ability to negotiate it’s own rates of reimbursement, this will continue. What am I talking about?

    I had to get a procedure called a marsupialization after I got a nasty infection in my index finger nail bed (cracked the nail really low when a tool broke in my hand). The outpatient surgery center’s charge for the procedure was $980. What were they paid? The $45 dollars that Blue Cross Blue Shield had negotiated with them for the procedure. The reason they had to charge $980 in the first place…because the largest insurance provider is only paying them $45. If we can’t have single payer, then we need price controls so crap like that doesn’t happen.

  8. Robert E

    You forgot to add in the facility fee toward your total cost. That’s usually a fee that the “not for profit” hospital adds in.

  9. Robert E

    Also, if they remove a polyp you will owe the pathologist money for interpretation of the slides. Despite all that I would get one. Yon can swing it.

  10. Telford

    My insurance covers it after age 50, no issues, no argument. Colon cancer is a silent killer as it can grow and spread without much of a sign or symptom. In the scheme of things preventing colon cancer vs. treating colon cancer…saves the insurance company lots of money.

  11. MR

    Steve, a colonoscopy is quite hard on your body and they are being actively discouraged for screening nowadays. They got really popular when Katie Couric got one on live tv. Less famously she went back on national television a month later to retract most of the glowing praise and medical advice she had offered. In most cases, inconclusive findings, the test has a negative effect which outweighs the risk of health problems it screens for. Getting a finger up your ass during the yearly physical is bad enough.

    There are a number of fecal collection tests your GP can order and have shipped to a lab for examination. A very good option for you would also be to get in contact with a Gastro dr’s nurse to ask for advice based on your lifestyle and concerns. Based on that they may ask you to come in and have the dr. spend 10 minutes pressing on your stomach (Amazingly effective with the right brain connected to those hands.) IF any red flags pop up they might order any number of tests such as a colonoscopy, flexible sigmoidoscopy, or a CT scan with oral and intravenous contrast.

    One largely ignored source for discovering general health concerns is the eye dr. Eyes are the window to the soul and everything that is currently wrong with you. No kidding.

  12. Cranky

    I’m spending today drafting the second letter in an appeal to Medicare to urge them to reconsider the denial of coverage for a colonoscopy. Denied on the basis that it was second in 10 years. Interestingly, they accepted the charges of the physician and the anesthesiologist, but denied the “Facility Charges.” These amount to over $7,000!

  13. rob walker

    The plan I am on covers the colonoscopy procedure 100%. However, if they find a polyp (or whatever) and remove it, it becomes a “surgery” and I am liable for all those costs.

    So beware the bait and switch, and make sure they detail that difference to you.

  14. frank

    The same industry that has effectively sold you on the importance of screening, will not quote you a price. It does not sound dysfunctional. It sounds like the best salespeople on earth.

  15. Jon Hirsch

    OMG, this thread is exhaustingly confusing and reflective of how messed up our system is.

    The findings of Steve’s research are troubling. The price disparity and the openness that if your self pay the rates will be lowered and the known fact that if the bills being paid by insurance it will be at an inflated rate is troubling. In what world is this fair to anyone?

    This story mirrors a report I heard on NPR today about the price of epipens. They used to sell for around $100 for a pack of 2. Today, due to the marketing efforts of the company who owns Epipen, they’ve created increased demand and awareness of the products. Today they’ve driven the price for an epipen 2 pack to $600. In the news report they stated that people who are self pay can get a coupon from epipen to lower the price by $200. So, it’s interesting that the rates grossly inflated if the bills being submitted through an insurance provider. At the end of the NPR report they said that due to public pressure the epipen company is now offering a bigger discount to people who self pay to get the price closer to the old rate of $100.

    Steves story certainly makes one wonder about the rates we pay for medical treatment. When and how can we get some transparency and consistency and fairness in our current system? With that said, I also appreciate the quality of medical care we get here in the states. we are fortunate to have access to some of the best care in the world.

    Thanks for keeping things interesting Steve! Your blogs always full of surprises. Keep them coming!

    1. Craig

      Oh, you mean the company that bought the rights to the Epipen product. A product that was developed using government (read taxpayer) grants to help save lives. Then they lobbied (essentially the media but lets pretend) congress to require them to be kept in schools which drove up demand. So to meet this new demand, they repatriated their headquarters overseas to avoid tax liability? You mean that Epipen…. yep the healthcare industry is doing a bang up job of maintaining their financial health ….

  16. Bluebagger

    In Australia, if over 50 you get a blood test kit every 5 years. Organized by the government , so our taxes at work . great preventive medicine project , but less than 50 % sent back . More education and advertising needed, but like real estate it all about location , location.

  17. Choppy Warburton

    Don’t believe anyone that says this procedure isn’t important or needs to be delayed until after 50. I’ve buried 2 very good friends from colon cancer in the last decade. Both were 40 at the time of death. My own procedure found and removed 8 significant growths. I need to go back every 2 years now. PS: my diet is also that of most elite national class athletes.

  18. Mike Fox

    Always remember insurance companies are in business to be profitable. That doesn’t happen when they pay on all claims. The most ridiculous aspect of this to me is where the insurance companies loyalties are: to the shareholders, not the policy holders.
    One can always request a preauthorization large procedures. Still, every preauthorization (which would seem like a promise to pay) includes a statement reminding you that just because the insurance company says they will pay on your behalf, they are not obligated to actually do so, they may change their mind after the procedure is completed and a claim submitted. So sad.
    I had a much better experience than you with my recent colonoscopy. My insurance considered the procedure preventive, covered it all with no deductible. I got to pick my doc, surgery center and anesthesiologist.

  19. Fausto

    No family history, 45 yrs old, routine physical with fecal test found trace blood. Colonoscopy, found the cancer. Surgery and chemotherapy, celebrate 5 years remission in a few weeks. The prep for the test is worse than the procedure. Work with your doctor to get it done. Taking a foot of colon out isn’t something you can stitch up on your own. Riding during chemotherapy sucks but so does dying young.

  20. Jay

    The healthcare system as it is today sucks and seems to be worsening with the current “government solution.”
    I’ve not heard of colonoscopy’s being discouraged that MR speaks of, didn’t feel the procedure was “hard” on me. I’m not a nurse however, so perhaps they know something I don’t. I do work in healthcare on inpatient floors and patients do have colonscopy’s performed as prevention or otherwise.
    Bottom line don’t mess with something as potentially serious as colon cancer. The “prep” is the worst part of it, but it’s really not that big of a deal frankly. My experience with the procedure was sedation, not anesthesiology, and more/less waking up from a nap. Other than some bloating afterwards that resolved with a trip to the RR, it was not a big deal. Definitely worth the peace of mind of knowing it’s all good : )
    BTW, I lost a good cycling buddy/local bike shop owner to colon cancer a few years ago, because he didn’t go to a physician when it might’ve been able to be treated effectively. I miss him to this day.

  21. KrakatoaEastofJava

    What you REALLY need to get is a relationship with a doctor. One who knows your history, etc. Then, when it’s actually appropriate, he or she will order tests you need.

    You treat medical care like you treat auto repair. You get these ideas about what’s wrong with you, then you call up a racing fan who’s either a dentist, vet, orthopedic surgeon, etc and load up your van for very haphazard medical care in some far-off place. But usually for treatment after you’ve decided what’s wrong. Heck, you probably already have offers to shove a scope up your ass already. But you never seem to have a doctor who actually knows you.

  22. Luigi

    The medical PROFESSION is admittedly not perfect but most physicians are decent people working hard to do the right thing. Your well-founded frustrations are with the medical SYSTEM (ie, health care payment in the USA). Most docs share your frustration. It’s a byzantine, unfair system to both patients and providers and adds enormous overhead to the costs of care . BTW, screening is absolutely indicated at your age. Don’t believe the conspiracy theorists on this one – this is solid, evidence-based data. In the future, CT colonography (CT scan without inserting a scope) will probably become the norm, but it’s not quite ready for prime time in 2016.

    Also, unrelated, please try not to lap me at Cross Nationals this year.

  23. darkcloud

    I had a colonoscopy performed two years ago at age 52. Three polyps found. Two were pre cancerous. Removed during the procedure.
    The prep was easy. The procedure was painless.
    Steve, take the bull by the horns and visit the Gastrointerologist. Schedule the procedure. It’s only money and you really can’t place a price on your health.

  24. KrakatoaEastofJava

    Another thought: People don’t just call colonoscopy places and price them out piecemeal. This isn’t a machine shop and you ass ain’t a set of brake rotors. Cs’ are arranged via a doctor’s referral. That’s why you’ve got everyone scratching their heads when you call. Just like people don’t call around for prices on hip surgery. It all comes through the doctor, as he/she orders the procedure.

    Yeah, being in your fifties, you should probably have one. But dude, you really need a PCP (primary care physician) from here on-out. So many of your worst fears give off advance warning signs that can be picked-up in standard tests that get done during the annual physical. What if you get the colonoscopy, pass with flying colors, but then miss something else that could kill you just as certainly as colon cancer?

    But you’re still living in the mindset of “I’m a bike racer. I’m healthier than 99.9% of people”. We’ll, now you’re an “aging” bike racer. You need a doctor. The kind that you can ask “Hey, do you think it’s time we put the camera up my ass?” when you go see him.

    1. Steve Tilford Post author

      Krakatoa – This is one of the problems with medicine. Patients can’t “order” their own tests and get them read by someone that is knowledgeable about the subject. I had a pretty good primary care doctor, but he got sick of it and started doing rounds at the hospital. Next time I went there, I was pushed off on some physician’s assistant that knew less about medicine that I do, which isn’t that much.

      So I went to a different internal medicine place. Same deal, PA that had been out of medical school for a week. Shopping around for a new primary care doctor? How exactly do you do that? Make an appointment and do an interview.

      I think the days of having a “relationship” with your doctor is over. This has become a business for most of them and they have surrendered to the turmoil. Try getting a doctor to call you back? If you don’t have a personal relationship with them, you might get a nurse to call if you’re lucky.

      I view medicine as anything else. There are good doctors and bad doctors. There aren’t enough smart people in the world to fill all the smart people jobs, so you’re going to only get good guys so often.

      I think to be healthy and live a long, healthy life, you need to be on top of your own medical issues. I don’t think today’s doctors are the doctors of old.

      1. KrakatoaEastofJava

        You’re right to take a leading, non-passive role in your own health. Few do. I feel the same way.

        And true, many GPs practice Assembly-line medicine. Yeah, you’ve gotta shop. Refuse to be treated by PAs, and insist on seeing one (“your”) doc. MAKE the relationship. Bring it to THEM. Be needy. Don’t let them treat you like a cog. Don’t be faceless or nameless. Make them work for you. Yeah, they used to just “do” that, but they don’t anymore. But don’t ever think you have anything close to the skillset they’ve got, cuz you don’t. Yeah, get your own brake rotors machined, but for chrissakes, trying order-up your own colonoscopy? That’s some real fucking hubris.

  25. John Vance

    Yes. Absolutely it is covered as a preventive and not diagnostic test.

    100% covered at no cost to you under the Affordable Care Act. If you’re over 50 it’s a preventive (screening) test. Go do it.

    “All ACA-compliant private Major Medical plans (including Marketplace plans) cover the costs for colonoscopy as a screening test, patients may be charged for some services. You may have to pay part of the costs of anesthesia, bowel prep kit, pathology costs, and a facility fee (where the procedure is performed).”

    1. Conrad

      But the problem is that all the fees associated with the procedure are probably not covered, substantial, and nobody can tell what they cost.
      Our health care system is broken. Even if you have health insurance, a major illness can be a financial catastrophe. Health problems are number one cause of bankruptcy in the U.S. I have been told. I have health insurance but I won’t go to the doctor unless I have an unstable fracture or I am hemorrhaging. I know that afterwards, we will be literally crying tears of frustration trying to iron out all the billing errors. Better just to take good care of yourself and hope you don’t get cancer.
      I am a veterinarian. I can present someone with a reasonably accurate estimate for services in about 5 minutes. I know that veterinary care is expensive too, but everything is these days, and I don’t think any of us are getting amazingly wealthy. I know we don’t have any wealthy insurance executives on payroll anyway. If I can make a living at it I am happy though. The sad thing is that a new graduate probably can’t. You can not take on that much student debt with a veterinarian’s salary. Oh, by the way, that is why you don’t have a primary care doc. You can’t take on that much debt with a primary care physicians salary. I guess that is another topic of discussion though!

  26. FSonicSmith

    Steve-please get the colonoscopy. They are completely painless and not “hard on the body” as someone posted above with no support. Colon cancer is preventable. Which leads to Garth Prosser. I am from Central Ohio and have ridden with Garth. Shocking, huh. Not only is he funny and super-cool laid-back dude, but the guy eats right, lives right, and looks incredibly healthy. Colon cancer can get anybody. Not having a family history helps but is no guarantee. Get the test.

  27. Peter W. Polack

    One of the most educational and enlightening comments sections I’ve read anywhere in a long time.

    Not to get too far off topic, but here’s the humorous side of colonoscopies, by columnist Dave Barry.

    P.S. I’ve had 2 colonoscopies and I’ll echo the other comments; the preparation is much worse than the procedure. The 2nd time I was told to drink a combination of Miralax and Gatorade, which tasted much better than the “brand name” solutions such as Moviprep, GoLYTLEY,, etc. and it likely cost less, too. The procedure, under sedation, is the best nap I’ve ever had. Bonus- the staff even ENCOURAGES you to fart afterwards!

    1. The Instigator

      I was thinking the same thing myself. Lots of information, varying opinions and few snarky comments. At least there’s one topic that almost everyone can align on.

  28. FSonicSmith

    Like it or not, the best way to get the best price is to get the procedure, let the insurance you do have work it’s way through the system, and then if the providers come after you for a balance, you can negotiate the amount to be paid back.

  29. jake

    Steve, you are thinking too 1 dimensionally.

    Take a vacation. Google “medical tourism” to see why.

    You can get much better service for a much lower price. Line up some races and other tourism on your trip and enjoy.


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