A.I.T.A?

Beer & Queso
1

I see this type of post on social media, and figured I might as well start a thread here to get some group perspective on things that are burning you up but you’re not sure if it’s you, not them. I’ll start:

I was referred by my GP for a colon cancer screening - at my age it’ll be my first and it’s long overdue. I do not have any issues in that area (although I’m sure many would argue that I’m full of shit). The clinic to which I was referred called me to set up a consultation that they said is required before the screening. That visit was yesterday.

Firstly, the doctor’s office to which I was referred was an administrative clusterfuck, and I know that my anger at them for burning through three hours of my life that I will never get back is definitely a factor here. However…

When I finally got to see the doctor, she explained that she was going to submit a claim to my insurance company for this visit, stating that I was complaining of mild constipation. She explained that, if she did not, my insurance might not cover the visit. I asked why this appointment is not covered as part of the screening ordered by my GP, to which she waffled that she was just making sure that I didn’t pay for it.

The visit, boiled down to actual things done, was for me to complete various forms, be asked by multiple people - including the doctor - some of the same questions on such forms, have my temperature and blood pressure checked, be embroiled in an insurance fraud by the doctor, and have an appointment set for my procedure.

As far as I can tell, the entire purpose of that visit was so the clinic could bill my insurance for make-work costs, because there was nothing there that had not already been done by my GP or which could have been done online. They actually have an app - which they drive you to use - that does all that.

Colon cancer screenings are paid for by the insurer as preventative treatment, but actual care is subject to my deductible, which I am nowhere near fulfilling. So any bill submitted to my insurance for a visit for me requiring care is going to boomerang back to me. Further, now that the colonoscopy is now for care, not cancer screening, I am worried that I’ll end up paying for that too.

I’ll spare you a rant about how insurance fraud is a fraud on us all. My plan today is to cancel the procedure with this clinic and call their office to let them know that: (1) if I see a bill hit my insurance I will file a complaint with my insurer against the clinic, and (b) if I get the bill, I will sue them.

Am I the Asshole?

2

I’ve had three colonoscopies by the same doctor over a 17 year span. The last time, the third time. They had me come to the office for a pre-screening. They didn’t do that for the second one but they did for the first. And I didn’t even meet with the Doctor this last time, it was his PA. I’m sure this was to make more money. It was a total waste of my time. But I just rolled with it, like I do most things that used to piss me off.

I would recommend you get the procedure for your own health and any other doctor is likely to be the same or worse.

The prep for a colonoscopy is the worst part.

3

A friend got up in the middle of the night before her colonoscopy, fell, and spent the next six months with her jaw wired. Before she got the broken jaw treated though she went through with the colonoscopy. She didn’t want to have to go through the prep again.

4

My brothers first colonoscopy discovered his cancer. Suck it up buttercup and get it done.

ETA I’ve already had two. I had one consultation and one not. I usually ask extra questions to get my moneys worth out of a doctor visit.

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5

What works for me on the prep:

-Go slow. As much as it feels like you’ll want to throw up, the only time I’ve actually chucked is when I drank too much too fast.
-Get that shit as cold as possible, and keep it cold as you go.
-Suck on a lemon after taking a drink. Saw that as random advice online and tried it last time. Out of all the things I’ve tried to mask the taste, the lemon works best.

Also, for the love of god, baby wipes.

6

A bidet is nice too.

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7

I think this was supposed to be an insurance thread. Colonoscopies though, they’re special.

8

I know I have to get the screening done, and I will. That’s not what this is about. This about about me being upcharged for unnecessary medical costs in advance of the procedure, and my very deep concern that they will pad the bill for the procedure - which again may fall on me as it would be in addition to the screening which is covered by my insurance.

9

Part of the problem with medical billing is it’s baffling level of particularity: I assume you’re paying for a screening with your doctor, a screening with the colonoscopist, the knock out doctor, the film developing, and the jug of stuff. They’d likely charge you for the tp by line item if they could figure out how. Part of the problem is a records problem and a liability problem. Your GP talking to you doesn’t really protect the proctologist. You are going to have to consult with the proctologist. Your insurer should cover that consultation. You might as well bend over and take it.

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10

Prep is way, way easier and better now. The first one I had was awful. The procedure itself is a piece of cake.

11

They prefer the term colorectal surgeon, lawyer.

12

Again, having the procedure is not the issue. I am not trying to avoid it and I would not have gone to the proctologist in the first place if I was.

The insurance company is happy to pay for all those people you describe, and all the elements you describe, as that is cheaper in the long run than paying for colon cancer treatment. What happened here is that the proctologist invented a healthcare issue in order to bill my insurance for something that I understood to be part of the covered screening.

That action takes those costs out of what my insurer will pay for as prevention, and changes them into health care costs which are subject to the deductible. She joked about the fraud - laughing as she asked me if I work for an insurance company - but this fraud is against me, not the insurer, because of the deductible.

13

Yes, prep now is so much easier. The first time was pure horror.

14

Given the responses, I’m guessing most don’t share your outrage about this. Perhaps because this is the fucked up state of healthcare in the U.S., which offends your NHS sensibilities, not to mention your honesty and practical nature, but I think most of us have experienced similar things. It’s just the way the system works, unfortunately.

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15

Yes, and she roped you in to participate. It’s pretty awful of her. You could have responded that you work in insurance and have watched her squirm. I would have been mightily tempted to do so.

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16

To be honest, I was so shocked at the time - already being dialed up to 11 because of her staff’s incompetence - that I didn’t fully process what had just happened until I was driving home.

I have copies of my original referral for cancer screening, and I now have copies of my electronic declarations that I was not experiencing any health issues upon arrival. Appended to those declarations are the doctor’s notes that I said I was experiencing mild constipation. As if that is (1) something to go to the doctor about and (ii) worth of a colonoscopy as the first treatment response.

This isn’t a case of padding time or the number of swabs used; this is clearly a systemic and routine effort to defraud insurance companies. I am looking forward to the callback from the clinic to discuss this very subject with them.

17

Just contact your insurance company and ask them if a diagnosis like that would change your out of pocket expense for the procedure.

Even if you choose to go with another provider, you would at least have that question answered for the next one.

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18

Right, no outrage here. I have had at least three and was not charged a dime for any of them.

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I’m going to talk to the clinic first; insurance company is the call immediately after that. If the clinic doesn’t call me back before noon, then I’m going to out them to the insurer.

I am definitely not using those people. I have already talked to my doctor about getting referred to someone else. I have to do a hard reset on this because I have no faith that I won’t be told everything is ok and then be whacked with a huge bill afterwards.

20

Oh, and I’m not being coy about the dodgy doctor. It’s:

Dr. Marianne Cusick of the Colon & Rectal Clinic.

I googled them this morning and they have a single review on there: 1 star.

They now have two 1-star reviews.

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