OT- Is Endoscopy a test or surgery? Big $ difference

I had the same issue. It ended up costing me $200. See if the doctor can rebill the procedure as "diagnostic."

I would think it would be diagnostic.

pretty sure mine was listed as surgery when I had it 6 or 7 years ago.

Makes sense since it requires sedation, biopsy, etc.

This is absolutely a diagnostic procedure not a surgical one. It would only be surgical after the test were completed and an issue was found that needed to be corrected, ie pollups or hernia etc. Your physician needs to be told that it needs to be coded as such to the insurance and if they won't find a differenct doctor. Also make it clear to your doctor that you are not approving any procedures be done until after the initial endoscopy and the results are given to you. I am very aware of this procedure since everyone in my family has had it done including myself. The only surgical procedure was done on our daughter after the initial encoscopy showed that she had a hernia precancerous barrets.

steelheadid wrote: Also make it clear to your doctor that you are not approving any procedures be done until after the initial endoscopy and the results are given to you. I am very aware of this procedure since everyone in my family has had it done including myself. The only surgical procedure was done on our daughter after the initial encoscopy showed that she had a hernia precancerous barrets.

Are you advising not to allow the gastroenterologist to biopsy on the day of the initial endoscopy even if a biopsy is indicated, but instead to schedule another endoscopy to biopsy on a different day? What is the point of having an endoscopy if you aren't going to biopsy if there is something to biopsy? There are risks each time they go in, so I don't think you want them going in more than they need to.

Or perhaps you mean that the doctor shouldn't do any major surgery/ablation without discussing it first? That would not be done during the initial pass because they would have to get the results of the biopsies to know what they need to do.

I don't know about the billing issue... It's surprising that your insurance won't cover you for a procedure you're having due to symptoms (not just a screening).

I had to cancel the "endoscopic procedure" since I truly cannot afford to spend $750 for a diagnostic test after paying $14K/year for a healty family of 4 to get coverage.
I tried to plead with the Dr.s office and they assured me they had checked with the doctor, and 'this is how they do it'. THey would not even consider a lower co-pay or any negotiation. Aetna says they can't change the way the doctor codes the procedure, so they are off the hook.

I think it is an outrage that neither the Doctor's office or the Insurace company cares that the Doctor codes it incorrectly as Outpatient Surgery. It's not,it's clearly diagnostic even if it involves a smalll biopsy. It's only about money The Doctors office excuse is that it is done in a Surgical Facililty(a little area of their office they got certified where they generate big bucks) and therefore they must charge a surgical facility charge, and the insurance company doesn't care becuase they don't have to pay it, I do. I'm sure the Doctor makes more $, and the Insurance company pays out less this way, and of course, the patient gets shafted with this little Aetna loophole.

It is abuses like this that make me wonder why people are so afraid of reform. Well, I better not get all Political, I'll aleinate 50% of the forum.
Suffice it to say that Coverage is so expensive, some of us middle class people can't afford the copay unless it's for our kids or a life/death situation.

Regarding the test itself, I'll have to find a Gastro, Hospital or testing facility that does it as what it really it, a diagnostic test, and charges for what it really is. More than likely, time will pass and condition I might have will get worse and go untreated, until it costs the insurance company a lot more to treat. It's so stupid and shortsighted, but nobody said common sense prevails in Healthcare.

What's disappointing is that I liked the Doctor, other family members use him, but he isn't interested in making it work for the benefit of the patient, just making the most money possible.

Many doctors don't have a clue how their office does billing.

Ask to speak to the doctor directly. You don't even have to give a reason--just say that you want to speak to him and for him to call you back. When you get the doctor on the phone, explain to him that you can't afford it and would be foregoing the procedure if you can't work something out. It's not ethical, but what he could do is bill the insurance as per usual and bill you the $750 copay with an understanding that you won't pay it and he won't pursue it (i.e., not send you to collections). Alternatively, the billing department should be able to work something out where you pay it off at a rate you can afford.

If all that fails, obviously don't forgo the procedure if you need it. Get it done wherever you can.

Azmanatheart, did you ever try to speak to the doctor or find some other route to getting your endoscopy?

Sometimes we have to do what we have to do.

We have free health care in Ontario. And we pay $6000 a year for mediocre health insurance on top of that. And probably another $6000 for the stuff it doesn't cover. But when (heaven forbid) you get sick... they come through (at least they did for me).