Chantal Panozzo and her husband, following their primary care doctors' recommendations, underwent routine colonoscopies after turning 45, the recommended age for colorectal cancer screening. Anticipating free preventive care, as mandated by the Affordable Care Act, they were surprised when bills arrived, revealing unexpected charges.
The couple, covered by Blue Cross and Blue Shield of Illinois, incurred charges of $2,034 per colonoscopy, including a mysterious $600 fee labeled as "surgical supplies." Despite normal results, this left Chantal and her husband each responsible for a $250 bill, applied to their deductibles.
The issue highlights a loophole in the law: while preventive services should be cost-free for patients, providers can bill for additional services as long as they adhere to their insurance contracts. Sabrina Corlette, a research professor at Georgetown University, notes that insurers are obligated to cover preventive care fully, but providers exploit coding loopholes, resulting in unexpected bills.
Despite BCBS of Illinois covering the screening costs, the $600 charges remained. Panozzo's attempts to resolve the issue with her insurer and the gastroenterology practice were met with conflicting explanations. The insurer cited "surgical trays" as the charge, but Panozzo struggled to get a consistent response from both sides.
Frustrated, Panozzo contested the charges by filing appeals with her insurer, complaining to the Illinois Department of Insurance, and reaching out to elected officials. Eventually, BCBS approved both appeals, absolving the couple of the $500 charges.
This situation sheds light on the broader issue of medical providers having significant billing leeway, leading to unexpected charges for patients. Private equity ownership in specialties like gastroenterology can contribute to higher costs, and federal law offers limited recourse for patients facing billing irregularities.
Patients are urged to be vigilant, as health plans may not catch billing oddities, leaving them responsible for identifying and contesting suspicious charges. Panozzo's experience reflects a sense of defeat, exhaustion, and distrust in the American health care system, emphasizing the need for increased transparency and accountability in billing practices.