My colonoscopy bill: The true cost of colonoscopy.

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Colonoscopy is a life-saving procedure but it comes with a bill. There are so many factors that influence the cost of colonoscopy. The cost of colonoscopy varies from region to region, facility to facility and provider to provider.

Components of a colonoscopy bill

1. Doctor’s visit.
2. Bowel cleansing agent.
3. Cost of missing a day’s work.
4. Facility fee. The fee charged by the facility where the procedure is performed.  This fee covers the use of the facility, equipment, and staff.
5. Professional fee. This includes professional fee for the physician (gastroenterologist), the anesthesiologist (if one is used), and the pathologist (if one is used).

 

Why colonoscopy bill may be different

1. Type of colonoscopy.  There are 3 types of colonoscopies. Screening colonoscopy, diagnostic colonoscopy and therapeutic colonoscopy. Screening colonoscopy is covered for free under the Affordable Care Act. However, if a polyp is removed, it changes to a therapeutic colonoscopy and you may have a co-pay. Therapeutic colonoscopy costs more than screening or diagnostic colonoscopy.
2. Type of facility.  There are four different facilities where a colonoscopy can be done. Hospital, hospital out-patient department (HOPD), ambulatory surgery center (ASC), and physician office. Colonoscopy is more expensive in hospital and HOPD.
3. Type of sedation.  Colonoscopy can be done without sedation but most people prefer sedation. If sedation is used, it can be minimal, moderate, deep or general anesthesia. Minimal and moderate sedation can be achieved using intravenous medications like fentanyl and midazolam (versed). Sometimes diphenhydramine (benadryl) is also used. Minimal and moderate sedation can be given by the same physician performing the colonoscopy. Deep sedation can be achieved with propofol. If deep sedation or general anesthesia is required, a separate provider (an anesthesiologist or nurse anesthetist) is usually involved. This provider charges an anesthesia fee that increases the cost of the colonoscopy.
4. Type and number of specimen (biopsies).  Any biopsy or tissue (polyp, growth, cancer) removed during colonoscopy is sent to the pathologist for analysis. The more the bottles of specimen submitted for analysis, the more expensive the procedure.

 

Fees and Charges associated with colonoscopy bill

• Technical fee. The fee charged by the facility where the colonoscopy is performed.
• Professional fee. The fee charged by the physician (gastroenterologist, anesthesiologist, pathologist).
• Co-Pay. This is a fixed amount you pay for health-care services. Under the Affordable Care Act, co-pays and deductibles are waived for preventive services like screening colonoscopy.
• Deductible. This is the amount you have to pay for health-care services before your insurance company begins to pay.
• Co-Insurance. This is your share (in percentage) of the cost of health-care services. If you have co-insurance, you usually pay this after paying your deductible.
• Billed charge. The amount the provider charges the insurance company.
• Reimbursement (Allowed) amount. The amount actually paid by your insurance company.
• In-Network. This means your physician or procedure facility already has an agreement with the insurance company to provide services for you. In-Network providers cost less than Out-Network providers.

Find out the cost of colonoscopy in your area

 

Suggested Reading

The 3 P’s of colonoscopy: Factors that determine the outcome of colonoscopy.