JM Scheiman et al. Annals of Internal Medicine. 2020; https://doi.org/10.7326/M20-2928. Surprise Billing for Colonoscopy: The Scope of the Problem

Background: “Federal law eliminates consumer cost sharing for multiple methods of colorectal cancer screening, including colonoscopy when done by an in-network provider. However, some patients having screening incur considerable out-of-pocket costs because out-of-network bills are not included in federal mandates. “Surprise billing” articles are widespread in the research literature and lay press . To date, the frequency of unexpected patient costs for screening colonoscopy have yet to be rigorously quantified.”

This study with ~983,000 procedures, which was conducted between 2012-2017, shows that it is common to get additional charges from a screening colonoscopy (which is supposed to be covered). Despite using an in-network physician, these charges can be due to “out-of-network” costs from anesthesia or pathology. This can also occur when anesthesia bills the colonoscopy as a diagnostic procedure rather than as a screening procedure.

Related blog posts:

• Why Surprise Billing Still Exists
• Surprise $urgical Billing Affects 1 in 5
• Healthcare: “Where the Frauds Are Legal”
• NY Times: What’s Behind $urprise Billing