[Minimizing costs of a medical procedure (Colonoscopy)]

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VictoriaF
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[Minimizing costs of a medical procedure (Colonoscopy)]

Post by VictoriaF » Fri Mar 02, 2018 11:03 am

[Moved into a stand-alone discussion from: How to Minimize Your Emergency Care Expenses --admin LadyGeek]
dm200 wrote:
Fri Mar 02, 2018 10:19 am
VictoriaF wrote:
Thu Mar 01, 2018 9:41 pm
White Coat Investor wrote:
Fri Jan 26, 2018 12:19 am

It's a hospital, not a prison. It doesn't matter what they "allow." You say, "Nope, my son is driving me, where's the AMA paperwork for me to sign?"
Our policy is to transfer every one by ambulance, but the only ones I can force to do that are the suicidal ones.
My hospital would not discharge me after a colonoscopy unless there is someone to pick me up. They would not agree for me taking a taxi. Is there a way for me to assert that it's a hospital, not a prison?
Victoria
I/we have the same requirements (Kaiser - Wash DC area) for outpatient surgery, colonoscopies, etc. Fortunately, in our case, I can be with my wife and my wife with me. In looking at the "fine print" of this requirement, it turns out that we could take a taxi home, BUT another responsible adult must also be with the patient. So, for example, if my wife did not feel comfortable actually driving me home after a colonoscopy or outpatient surgery, we could (both) take a taxi home.
My solution is to get a colonoscopy without anesthesia. It's not too bad, but I'd like to have an option to assert my right to travel on my own. I don't mind signing a dozen of disclosures, if that helped.

Victoria
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Mar 02, 2018 11:22 am

My solution is to get a colonoscopy without anesthesia. It's not too bad, but I'd like to have an option to assert my right to travel on my own. I don't mind signing a dozen of disclosures, if that helped.
While I generally tolerate medical tests/procedures well - not sure I would go that far. In addition to pain/discomfort - I would also be concerned that being "tense" (to say the least) and/or move during the procedure could reduce its effectiveness and/or increase risks of problems (such as bowel puncturing, etc.)

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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Mar 02, 2018 11:34 am

My solution is to get a colonoscopy without anesthesia.
Do you ask for (and get?) a discount because there is no anesthesia or sedation?
Last edited by dm200 on Fri Mar 02, 2018 11:34 am, edited 1 time in total.

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VictoriaF
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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Fri Mar 02, 2018 11:34 am

dm200 wrote:
Fri Mar 02, 2018 11:22 am
My solution is to get a colonoscopy without anesthesia. It's not too bad, but I'd like to have an option to assert my right to travel on my own. I don't mind signing a dozen of disclosures, if that helped.
While I generally tolerate medical tests/procedures well - not sure I would go that far. In addition to pain/discomfort - I would also be concerned that being "tense" (to say the least) and/or move during the procedure could reduce its effectiveness and/or increase risks of problems (such as bowel puncturing, etc.)
My gastroenterologist encouraged me to try it. During the procedure I was watching it as a movie and she was explaining to me what was happening. I felt that I was having a unique experience that people under anesthesia are deprived of.

Victoria
Last edited by VictoriaF on Fri Mar 02, 2018 11:36 am, edited 1 time in total.
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VictoriaF
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Re: How to Minimize Your Emergency Care Expenses

Post by VictoriaF » Fri Mar 02, 2018 11:36 am

dm200 wrote:
Fri Mar 02, 2018 11:34 am
My solution is to get a colonoscopy without anesthesia.
Do you ask for (and get?) a discount because there is no anesthesia or sedation?
The entire procedure was covered as a preventative treatment under my GEHA/HDHP insurance. I did not pay anything for it. I don't know if anesthesiology would have countered towards my high deductible.

Victoria
Last edited by VictoriaF on Fri Mar 02, 2018 11:38 am, edited 1 time in total.
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Fri Mar 02, 2018 11:38 am

VictoriaF wrote:
Fri Mar 02, 2018 11:34 am
dm200 wrote:
Fri Mar 02, 2018 11:22 am
My solution is to get a colonoscopy without anesthesia. It's not too bad, but I'd like to have an option to assert my right to travel on my own. I don't mind signing a dozen of disclosures, if that helped.
While I generally tolerate medical tests/procedures well - not sure I would go that far. In addition to pain/discomfort - I would also be concerned that being "tense" (to say the least) and/or move during the procedure could reduce its effectiveness and/or increase risks of problems (such as bowel puncturing, etc.)
My gastroenterologist encouraged me to try it. During the procedure I was watching it as a movie and she was explaining me what was happening. I felt that I was having a unique experience that people under anesthesia are deprived of.
Victoria
I have had 7 or 8 colonoscopies over the decades. Until the last two, even though I had the two drug IV sedation/relaxation, I was awake and remembered the whole thing. I liked watching the actual procedure on the TV monitor. The drugs must have changed for the last several, because for those I remember nothing.

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Re: How to Minimize Your Emergency Care Expenses

Post by tarnation » Fri Mar 02, 2018 6:07 pm

VictoriaF wrote:
Fri Mar 02, 2018 11:36 am
dm200 wrote:
Fri Mar 02, 2018 11:34 am
My solution is to get a colonoscopy without anesthesia.
Do you ask for (and get?) a discount because there is no anesthesia or sedation?
The entire procedure was covered as a preventative treatment under my GEHA/HDHP insurance. I did not pay anything for it. I don't know if anesthesiology would have countered towards my high deductible.

Victoria
Same insurance here. They pay for anesthesia also. When ACA first went into effect there was some ambiguity, but there was a subsequent technical correction and are required to cover it also. There is no discount as the procedure and anesthesia are coded/charged separately.
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dm200
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Re: How to Minimize Your Emergency Care Expenses

Post by dm200 » Sat Mar 03, 2018 3:11 pm

There is no discount as the procedure and anesthesia are coded/charged separately.
OK - if charged separately, then you would not get charged if no anesthesia, right? I would call that the same as a discount.

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Re: How to Minimize Your Emergency Care Expenses

Post by tarnation » Sat Mar 03, 2018 3:45 pm

dm200 wrote:
Sat Mar 03, 2018 3:11 pm
There is no discount as the procedure and anesthesia are coded/charged separately.
OK - if charged separately, then you would not get charged if no anesthesia, right? I would call that the same as a discount.
I guess so if words don't have meaning.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by likegarden » Sat Mar 03, 2018 6:58 pm

My wife and I will have colonoscopies soon. For me it probably will include removing several polyps. We will have it on different days and drive each other home. One of the challenges will be to read all paperwork, and write a comment where they ask for permission to send bills to our home. We are in an HMO insurance, and all bills will have to be sent to the insurance.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by mhalley » Sat Mar 03, 2018 7:04 pm

If you have a large deductable, then medical tourism might be an option. Looks like it runs about 500 bucks in Mexico.

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Minimizing costs of a Colonoscopy

Post by FraggleRock » Sat Mar 03, 2018 7:08 pm

mhalley wrote:
Sat Mar 03, 2018 7:04 pm
If you have a large deductable, then medical tourism might be an option. Looks like it runs about 500 bucks in Mexico.
If you have an Obamacare-compliant plan, then you need to read it. Your colonoscopy cost should approach $zero.

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Re: Minimizing costs of a Colonoscopy

Post by SlowMovingInvestor » Sat Mar 03, 2018 7:10 pm

If something is detected during a colonoscopy, and (say) a polyp has to be removed, does that convert the colonscopy from a screening to a diagnostic, and it then becomes chargeable ?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Good Listener » Sat Mar 03, 2018 7:24 pm

There are 2 issues here which have been partly resolved.
1. Sedation: I have never chosen to do these without anesthesia but it is an option to just have some gentle sedation and it is done all the time.
2. Prison: they can have any rule they want. You are a free person and can simply say that you are leaving by cab or Uber and that you have somebody waiting home for you. They cannot hold you against your will. They cannot even force you to sign an against medical advice form although I would preemptively tell them I will sign it if they have it. Without handcuffs you are free to go.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by DanMahowny » Sat Mar 03, 2018 7:31 pm

I had my first colonoscopy in January. I refused anesthesia. I did it as a personal challenge, that's all.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Carter3 » Sat Mar 03, 2018 7:54 pm

All I have to say is wow.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Jackson12 » Sat Mar 03, 2018 9:52 pm

I always get them without anesthesia. And I'm not particularly stoic or anything. It wasn't close to unbearable. The doctors explained what I was seeing on the film of my colonoscopy and it was actually interesting. They were also very careful and that was reassuring.

I didn't want to lose a day to anesthesia and recovery, especially after seeing what the anesthesia did to my spouse's memory . It lasted a day. Didn't bother him ...and he'll never have a colonoscopy without sedation.
Last edited by Jackson12 on Sun Mar 04, 2018 1:56 am, edited 2 times in total.

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Re: Minimizing costs of a Colonoscopy

Post by Mudpuppy » Sat Mar 03, 2018 10:08 pm

FraggleRock wrote:
Sat Mar 03, 2018 7:08 pm
mhalley wrote:
Sat Mar 03, 2018 7:04 pm
If you have a large deductable, then medical tourism might be an option. Looks like it runs about 500 bucks in Mexico.
If you have an Obamacare-compliant plan, then you need to read it. Your colonoscopy cost should approach $zero.
That depends on your age and your plan. It's considered diagnostic if you are under a certain age, so it is then subjected to your standard deductibles and co-payments for an outpatient procedure. Even if you are old enough for it to be considered preventative, the preventative coverage varies by plan (edit: Not all plans have to offer this coverage under ACA, there are grandfathering provisions for older plans).
Last edited by Mudpuppy on Sat Mar 03, 2018 10:12 pm, edited 1 time in total.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by cfs » Sat Mar 03, 2018 10:12 pm

I don't have a problem with these tests, I do have a problem preparing for the test by drinking all the nasty stuff to clean the inside of my body prior to the procedure. Already had the two types listed below:

(1) Flexible Sigmoidoscopy, had this one without anesthesia, did wached the procedure on tv monitor.
(2) Colonoscopy, had this one under anesthesia, did not watch the procedure on tv monitor as I was out for the count.

Next one in about 6 years or earlier if required. Done at the Veterans Hospital, no co-payments. Good luck with your procedure, y gracias por leer ~cfs~
~ Member of the Active Retired Force since 2014 ~

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 03, 2018 10:49 pm

Good Listener wrote:
Sat Mar 03, 2018 7:24 pm
There are 2 issues here which have been partly resolved.
1. Sedation: I have never chosen to do these without anesthesia but it is an option to just have some gentle sedation and it is done all the time.
2. Prison: they can have any rule they want. You are a free person and can simply say that you are leaving by cab or Uber and that you have somebody waiting home for you. They cannot hold you against your will. They cannot even force you to sign an against medical advice form although I would preemptively tell them I will sign it if they have it. Without handcuffs you are free to go.

I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.

There is no such thing as "gentle sedation." Any dose of these meds can cause these amnestic effects.

People who believe they "watched the whole thing" despite receiving sedation are not aware of the part of the procedure through which they slept. It's *very* common for the patient to be sleeping comfortably during scope insertion, which can be completed in just a couple of minutes, then wake up as we are removing the scope. Almost every day a pt who slept through 75% of the procedure says at the end of it, "Wow. I thought I was going to be asleep for this. I was awake the whole time." That's cool, though. Our goal is comfort.

There are also two kinds of sedation. When the GI doc and RNs administer versed and fentanyl, the sedation is wrapped into the cost of the colonoscopy. When a nurse anesthetist is used to administer propofol, there is an additional charge from the anesthesiology provider.

It's my understanding that finding a polyp no longer makes the procedure a fully covered screening test (it used to trigger it being a diagnostic exam). This never made sense to me, because polyps are what we were screening for in the first place. Why should insurers punish the patient for having what the test is designed to look for? I believe this is a thing of the past: https://blog.aarp.org/2013/02/25/free-c ... olyps-too/

You will likely receive a bill from the pathology department for your polyp analysis, though.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 03, 2018 11:02 pm

Things I can think of to minimize costs of a colonoscopy:

Take the cheapest prep--CoLyte or GoLytely are often only about $10
And take it by the book. It works great if taken properly. But it really makes us all feel bad when the colon isn't clean and we have to repeat the exam sooner than would otherwise be required, or the next day with another round of prep. :oops: I know.

Find out if your provider uses a separate anesthesia service / if you will receive a bill from them as well. See if that anesthesia is medically necessary, or the way that practice does it. (Please keep in mind if you have certain medical conditions, your sedation will be done more safely using this anesthesia provider. There is a risk of being penny wise and pound *less wise*)
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Re: How to Minimize Your Emergency Care Expenses

Post by nedsaid » Sun Mar 04, 2018 12:17 am

VictoriaF wrote:
Fri Mar 02, 2018 11:34 am

My gastroenterologist encouraged me to try it. During the procedure I was watching it as a movie and she was explaining to me what was happening. I felt that I was having a unique experience that people under anesthesia are deprived of.

Victoria
Uh no. Speaking for myself, I took the anesthesia. No big deal. When it came time for the procedure, I rolled on my side and saw the TV screen. I thought to myself, "I don't want to watch this." I closed my eyes, and the next thing I knew, I was waking up in recovery.

And yes, I had a family member take me down to the clinic, take me to lunch afterwards, and then take me home. The unique experience of having a nice lunch after not eating for 24 hours was good enough for me. I didn't want the experience of well, you know, being probed and watching it on the screen.

The experience of preparation was plenty for me. The feeling of having the runs was not something I really enjoyed very much.

I guess each to his or her own. Good thing these are recommended only every 10 years. I am 58 now, I suppose I will need another one in two years. Ughhh. I went through it because I figured it was better than cancer. Bowel cancer not a very good way to go.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Epsilon Delta » Sun Mar 04, 2018 12:42 am

woof755 wrote:
Sat Mar 03, 2018 10:49 pm
I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.
So why don't they brief the driver that they are expected to be more than a chauffeur?

Or perhaps more to the point. As a driver what should I know that nobody has told me?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by catdude » Sun Mar 04, 2018 1:33 am

I've had five colonoscopies. I'm on the three-year cycle... each time they find one or two small polyps, so they tell me to come back in three years. Last time (about a year ago) one of the polyps they removed was pre-cancerous. So I'm definitely glad I had the colonoscopy.

The prep is the hard part. You take industrial-strength laxatives and run to the bathroom every 15 minutes. I've always slept thru the procedure itself, I never remember anything about it after it's over.

ned is right, it's no fun but it sure beats getting colon cancer.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Mudpuppy » Sun Mar 04, 2018 2:43 am

Epsilon Delta wrote:
Sun Mar 04, 2018 12:42 am
So why don't they brief the driver that they are expected to be more than a chauffeur?

Or perhaps more to the point. As a driver what should I know that nobody has told me?
They did inform the driver for my procedures (when other family was the driver) and for my relatives' procedures (when I was the driver). If you feel they haven't given you enough information, ask them about it. Everyone can have different reactions, so make sure to ask something along the lines of "what should I expect" (e.g. range of normal behaviors) and "what should I call you about" (e.g. abnormal behaviors that might warrant further medical attention).

Personally, I've had a couple of colonoscopies and an endoscopy for diagnostic reasons. I just need to nap for a couple of hours afterwards and then I'm pretty much back to normal. The family member helping me usually sticks around for the afternoon to make sure I don't wander off while napping or some such silliness. But other people don't bounce back as quickly and might need supervision for longer.

You never know how someone might react, so it's best to ask questions of the medical personnel if you have questions. When it comes to the health of you and your family, ask all your questions even if you think you're getting to the point of annoyance rather than stay politely quiet and not ask something vital for health.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by rcsracing » Sun Mar 04, 2018 3:42 am

As an expat in Slovakia, I'm exposed to the healthcare norms of Europe. Due to high risk for colon cancer with family history, I need to get one every 5 years well below the normal age. I just had one done in January and my American-trained (but Slovak nationality) doctor asked me to consider the procedure without anesthesia. Very common here. I read up on it and decided to give it a go. 30 minutes, some discomfort (mostly from the air used during the procedure), and I was able to fully function the rest of the day. I'd 100% do it that way again, compared to feeling lousy after sedation.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by stats99 » Sun Mar 04, 2018 6:44 am

I used Cologuard.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by carolinaman » Sun Mar 04, 2018 7:09 am

I have had several colonoscopies and always with sedation. I did not know there was an option to not do sedation. I always have my wife with me but once I awake, I feel fine and able to function normally, although I comply with their directions (no driving, etc.). I did have a sigmoidoscopy one time. Pumping air into my colon was pretty uncomfortable. I would not like that experience for the entire colon. My fear of doing it without anesthesia would be making a sudden movement and cause puncture of colon.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by kmurp » Sun Mar 04, 2018 7:14 am

Just make sure that the anesthesia group participates with your insurance.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sun Mar 04, 2018 9:09 am

woof755 wrote:
Sat Mar 03, 2018 10:49 pm
Good Listener wrote:
Sat Mar 03, 2018 7:24 pm
There are 2 issues here which have been partly resolved.
1. Sedation: I have never chosen to do these without anesthesia but it is an option to just have some gentle sedation and it is done all the time.
2. Prison: they can have any rule they want. You are a free person and can simply say that you are leaving by cab or Uber and that you have somebody waiting home for you. They cannot hold you against your will. They cannot even force you to sign an against medical advice form although I would preemptively tell them I will sign it if they have it. Without handcuffs you are free to go.
I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.
There is no such thing as "gentle sedation." Any dose of these meds can cause these amnestic effects.
People who believe they "watched the whole thing" despite receiving sedation are not aware of the part of the procedure through which they slept. It's *very* common for the patient to be sleeping comfortably during scope insertion, which can be completed in just a couple of minutes, then wake up as we are removing the scope. Almost every day a pt who slept through 75% of the procedure says at the end of it, "Wow. I thought I was going to be asleep for this. I was awake the whole time." That's cool, though. Our goal is comfort.
There are also two kinds of sedation. When the GI doc and RNs administer versed and fentanyl, the sedation is wrapped into the cost of the colonoscopy. When a nurse anesthetist is used to administer propofol, there is an additional charge from the anesthesiology provider.
It's my understanding that finding a polyp no longer makes the procedure a fully covered screening test (it used to trigger it being a diagnostic exam). This never made sense to me, because polyps are what we were screening for in the first place. Why should insurers punish the patient for having what the test is designed to look for? I believe this is a thing of the past: https://blog.aarp.org/2013/02/25/free-c ... olyps-too/
You will likely receive a bill from the pathology department for your polyp analysis, though.
My experience (as a patient) - Because of family history, I have had 8 or 9 colonoscopies over the last 35+ years. The first one was outpatient - hospital, next ones (four) were in Gastroenterolgist's office procedure room, and last few healthplan outpatient facility. The ones (four) in the Gastroenterolgist's office procedure room(s) were the simplest. It was just the Gastroenterologist (who did the dedation himself) and a nurse/assistant. Just two of them. It is my clear recollection that I was awake during the entire procedure - chatted with the Doctor and watched the screen. In talking to others who had the procedure - most said they were "out". I asked the Gastroentrologist about that and he said they were probably not "out" - but just remembered nothing. I think there were two drugs back then - one (like Valium) for relaxing and one for pain suppression.

The last two have been in the Outpatient healthcare facility - Gastroenterologist, anesthesia person (not sure exact title) and assistant. For these, I believe the drugs are different now and I remember nothing. I actually liked being awake and watching the screen,

Yes - makes ZERO sense for insurance to pay less if there is something wrong with you (polyps)??

My most recent gastroenterologist insists on a longer (one more day) preparation. He says good preparation is the key to lower risks AND better results.

My (as a patient) opinion is that the real cost risk and medical risk is that you have a punctured colon or blood vessel. Then, you life is at risk and it will cost a lot. To save such costs - eat healthful food, lose or maintain body weight, do a full and complete prep. The high costs will come from getting colon cancer - not from the colonoscopy.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Yooper16 » Sun Mar 04, 2018 9:42 am

Have it done in the hospital in Soo Mi. My last one( I'm one a 3 year schedule) was approx. 2500 total----everything. The Dr.- gas passer- pathologist- surgical room etc all came on one bill all billed as in- network.

My last one in Toledo Ohio was around 5K. Had separate bills for DR., gas passer, facilities charge, pathologist. The doctor and the facility were the only in-network charges. I am sure the Dr. was a partial owner of the facility. Forget to add a delivery fee for the specimen to the path office.

Same insurance-- pretty much the same reimbursement but it was less OOP for me.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Good Listener » Sun Mar 04, 2018 3:39 pm

woof755 wrote:
Sat Mar 03, 2018 10:49 pm
Good Listener wrote:
Sat Mar 03, 2018 7:24 pm
There are 2 issues here which have been partly resolved.
1. Sedation: I have never chosen to do these without anesthesia but it is an option to just have some gentle sedation and it is done all the time.
2. Prison: they can have any rule they want. You are a free person and can simply say that you are leaving by cab or Uber and that you have somebody waiting home for you. They cannot hold you against your will. They cannot even force you to sign an against medical advice form although I would preemptively tell them I will sign it if they have it. Without handcuffs you are free to go.

I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.

There is no such thing as "gentle sedation." Any dose of these meds can cause these amnestic effects.

People who believe they "watched the whole thing" despite receiving sedation are not aware of the part of the procedure through which they slept. It's *very* common for the patient to be sleeping comfortably during scope insertion, which can be completed in just a couple of minutes, then wake up as we are removing the scope. Almost every day a pt who slept through 75% of the procedure says at the end of it, "Wow. I thought I was going to be asleep for this. I was awake the whole time." That's cool, though. Our goal is comfort.

There are also two kinds of sedation. When the GI doc and RNs administer versed and fentanyl, the sedation is wrapped into the cost of the colonoscopy. When a nurse anesthetist is used to administer propofol, there is an additional charge from the anesthesiology provider.

It's my understanding that finding a polyp no longer makes the procedure a fully covered screening test (it used to trigger it being a diagnostic exam). This never made sense to me, because polyps are what we were screening for in the first place. Why should insurers punish the patient for having what the test is designed to look for? I believe this is a thing of the past: https://blog.aarp.org/2013/02/25/free-c ... olyps-too/

You will likely receive a bill from the pathology department for your polyp analysis, though.
I understand what you are saying. Now, let me ask. When you say that you won't let somebody go, do you mean you would physically restrain them? How would you hold them? There are AMA forms for somebody to check out of hospitals against advice and they cannot be held against their will unless I suppose a judge's order was obtained.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sun Mar 04, 2018 4:54 pm

In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Lynette » Sun Mar 04, 2018 5:42 pm

dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
That is also my experience with my hospital. When I check in, I'm asked who is with me. No person - no procedure. A doctor goes and chats up that person who came with me before the procedure begins and gives them some information. Generally I am in excellent health and don't care if I am put under or not. What irritates me is that I cannot take a taxi home. I do not get the opportunity to act as an adult human being.

This may indeed be for the patient's benefit but I am cynical and think that 90% of this is for the hospital to avoid medical liability.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by ResearchMed » Sun Mar 04, 2018 6:10 pm

dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
We also need to agree to this when we have the pre-procedure meeting with the gastroenterologist.
We sign a form agreeing to have someone there who will accompany us home, along with the other "don't sign legal docs... etc..."

RM
This signature is a placebo. You are in the control group.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by 2b2 » Sun Mar 04, 2018 6:32 pm

If I remember correctly, the cost for the prep stuff for my last colonoscopy was around ninety bucks! Thought that was nuts.
Next time I'll ask for a less expensive product.

2b2

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by InMyDreams » Sun Mar 04, 2018 10:35 pm

woof755 wrote:
Sat Mar 03, 2018 10:49 pm
.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.
Thank you. I've discharged many people after same day procedures. My institution informs that it against my state law for someone to drive after they've had anesthesia. In addition, my institution became quite concerned about discharging someone to a "responsible person," apparently because people have gone to gambling halls and blown thru a good portion of their savings after anesthesia, and then try to recoup losses from the institution where the procedure was performed.

I usually had the "responsible person" sign the discharge instruction sheet after reviewing it and answering any questions.

On the other hand: I haven't had a colonoscopy without joy juice, but I did do a cataract surgery without sedation (local only). The institution charged for the anesthesia equipment, and the anesthesiologist, standing by in the OR, charged for his 24 minutes. It took him the same amount of time whether or not I was awake, so that was no surprise. But the moral is: if you want to avoid an anesthesiologist/anesthestist's bill, be clear that you want no anesthesia provider during the procedure. They're still going to use a monitor, etc, so I don't think you can avoid the institution's charge. And, of course, no anesthesia means no charges for anesthetics. But they're pretty cheap compared to the other items, so no huge savings.

PS - bisacodyl and miralax prep was pretty cheap, but I gather it's no longer approved?
http://www.baylorendoscopycenter.com/Do ... ep-ALL.pdf

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by saltycaper » Sun Mar 04, 2018 10:57 pm

dm200 wrote:
Sun Mar 04, 2018 9:09 am

The last two have been in the Outpatient healthcare facility - Gastroenterologist, anesthesia person (not sure exact title) and assistant. For these, I believe the drugs are different now and I remember nothing.
Probably propofol. It's usage for endoscopy procedures grew in the 2000s I believe. I've always had it for my procedures and wouldn't go without by choice. Not worth the savings to me.
Quod vitae sectabor iter?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by SlowMovingInvestor » Sun Mar 04, 2018 11:03 pm

One point worth mentioning is that some practices allow direct access colonoscopy -- i.e. you can have the screening colonoscopy without a previous Gastroenterologist visit. Even a referral from your regular primary doctor may not be needed if you meet the screening colonoscopy criteria.

This saves you the specialist's fee -- which could be around $200 or so for a HDHP plan.

[I am not sure if an office visit is scheduled after a screening colonoscopy if the results are normal, or if the office just calls you with the results.]

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Scrapr » Mon Mar 05, 2018 12:15 am

Lynette wrote:
Sun Mar 04, 2018 5:42 pm
dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
That is also my experience with my hospital. When I check in, I'm asked who is with me. No person - no procedure. A doctor goes and chats up that person who came with me before the procedure begins and gives them some information. Generally I am in excellent health and don't care if I am put under or not. What irritates me is that I cannot take a taxi home. I do not get the opportunity to act as an adult human being.

This may indeed be for the patient's benefit but I am cynical and think that 90% of this is for the hospital to avoid medical liability.
Let me tell you my story. I am Dx w/Crohns so colonoscopy is a regular deal. Most times by my GI doc, not the factory lines ones. Although I have had a couple there. One was in a hospital w/my GI doc. I get out and into recovery and I'm not doing great. Coughing and cold. We discharge and Mrs Scrapr drives me home. I go up to bed and can't get warm. Fast shallow breathing. Call to the advice nurse and off we go to urgent care. Where I could not stand for a chest x ray. So ambulance ride to the ER. I had aspirated some vomit in the procedure into my lungs. Which caused pneumonia. 3 days in the hospital. If Mrs Scrapr had not been there I think there was a better than even chance I'd be dead

True BH fashion I negotiated the cost to be free :D

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Mudpuppy » Mon Mar 05, 2018 2:17 am

2b2 wrote:
Sun Mar 04, 2018 6:32 pm
If I remember correctly, the cost for the prep stuff for my last colonoscopy was around ninety bucks! Thought that was nuts.
Next time I'll ask for a less expensive product.
My last prep was relatively cheap (less than $40) and it contained what felt like ALL the colonoscopy prep meds (Dulcolax, magnesium citrate, GoLytely, and enemas). So the prep costs depend a lot on how much your insurance covers for the prescription items and how much the pharmacy charges for the over-the-counter items.

Edit: This table in a journal article has relative costs of the various preps in 2016 (when the article was published): https://www.ncbi.nlm.nih.gov/pmc/articl ... /table/T1/

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Mon Mar 05, 2018 9:00 am

SlowMovingInvestor wrote:
Sun Mar 04, 2018 11:03 pm
One point worth mentioning is that some practices allow direct access colonoscopy -- i.e. you can have the screening colonoscopy without a previous Gastroenterologist visit. Even a referral from your regular primary doctor may not be needed if you meet the screening colonoscopy criteria.
This saves you the specialist's fee -- which could be around $200 or so for a HDHP plan.
[I am not sure if an office visit is scheduled after a screening colonoscopy if the results are normal, or if the office just calls you with the results.]
Good point. Since I have regular colonoscopies (family history), in one previous plan/insurance and my current one - I do not normlly have a visit/charge for prior specialist visit.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Mon Mar 05, 2018 9:04 am

Without getting too deep into the forbidden medical topics -

Are there differences in costs for different physicians that do colonoscopies? All of mine, as well as those of everyone I know in this area, have been done by Gastroenterologists. My brother, however, who still lives in the area where I grew up, told me his colonoscopies are done by a surgeon.

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Re: How to Minimize Your Emergency Care Expenses

Post by Dottie57 » Mon Mar 05, 2018 9:08 am

VictoriaF wrote:
Fri Mar 02, 2018 11:34 am
dm200 wrote:
Fri Mar 02, 2018 11:22 am
My solution is to get a colonoscopy without anesthesia. It's not too bad, but I'd like to have an option to assert my right to travel on my own. I don't mind signing a dozen of disclosures, if that helped.
While I generally tolerate medical tests/procedures well - not sure I would go that far. In addition to pain/discomfort - I would also be concerned that being "tense" (to say the least) and/or move during the procedure could reduce its effectiveness and/or increase risks of problems (such as bowel puncturing, etc.)
My gastroenterologist encouraged me to try it. During the procedure I was watching it as a movie and she was explaining to me what was happening. I felt that I was having a unique experience that people under anesthesia are deprived of.

Victoria
My last colonoscopy - I was lightly sedated. I watched a good bit of the procedure which I thought was very interesting. Fell asleep during the middle, but not a bad experience.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by 2b2 » Mon Mar 05, 2018 9:28 am

Thanks for that info, Mudpuppy.

2b2

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Mon Mar 05, 2018 9:33 am

My last colonoscopy - I was lightly sedated. I watched a good bit of the procedure which I thought was very interesting. Fell asleep during the middle, but not a bad experience.
Were you given a choice of the type of sedation?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by midareff » Mon Mar 05, 2018 10:08 am

Have had several over the years from an in office 20 years ago to a recent in hospital combo colon/endoscopy with anesthesia. Took out lots of polyps with none cancerous or pre-cancerous. All good news since I have been through prostate cancer radiation treatment in 2012. Bills were > $5K for both physician and anesthesia. Medicare and AARP United.... no co-pay and no charges to me but of course I pay a pretty good amount for insurance. I have had quite a few surgical procedures in my life and have a toleration of anesthesia after effects. Walk out and drive home although I am using Uber/Lyft more and more to come go to medical procedures.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by kmurp » Mon Mar 05, 2018 3:29 pm

midareff wrote:
Mon Mar 05, 2018 10:08 am
Have had several over the years from an in office 20 years ago to a recent in hospital combo colon/endoscopy with anesthesia. Took out lots of polyps with none cancerous or pre-cancerous. All good news since I have been through prostate cancer radiation treatment in 2012. Bills were > $5K for both physician and anesthesia. Medicare and AARP United.... no co-pay and no charges to me but of course I pay a pretty good amount for insurance. I have had quite a few surgical procedures in my life and have a toleration of anesthesia after effects. Walk out and drive home although I am using Uber/Lyft more and more to come go to medical procedures.
Wait, what? You aren’t driving yourself home right?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by midareff » Mon Mar 05, 2018 4:11 pm

kmurp wrote:
Mon Mar 05, 2018 3:29 pm
midareff wrote:
Mon Mar 05, 2018 10:08 am
Have had several over the years from an in office 20 years ago to a recent in hospital combo colon/endoscopy with anesthesia. Took out lots of polyps with none cancerous or pre-cancerous. All good news since I have been through prostate cancer radiation treatment in 2012. Bills were > $5K for both physician and anesthesia. Medicare and AARP United.... no co-pay and no charges to me but of course I pay a pretty good amount for insurance. I have had quite a few surgical procedures in my life and have a toleration of anesthesia after effects. Walk out and drive home although I am using Uber/Lyft more and more to come go to medical procedures.
Wait, what? You aren’t driving yourself home right?
Yes

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Epsilon Delta » Mon Mar 05, 2018 4:42 pm

Since I am FIRE I do a fair amount of driving for friends and family when they need help with medical and other appointments. I don't always know (and would not ask) the reason for every appointment.

I have driven at least three people to and from colonoscopies at least four separate occasions. On no occasion did I do more than wave at the receptionist. I was never briefed by anybody in either the medical office or by the patient. I never signed anything or went beyond the waiting room. In one case I left for about 20 minutes to visit Starbucks.

It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.

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