State:: GA

Occupation:: Physician

Devil is in the Details: Devious Practices by the Insurance Companies Regarding Coverage of Colonoscopies as Colon Cancer Screening.

Everyone agrees that a colonoscopy for colon cancer screening is an important potentially life saving procedure. It’s main role is to detect polyps and remove them before it can progress to cancer. Medicare pays for it and many states mandates insurance companies to cover 100% for it as “preventive” procedure and many companies sell policies on this feature. However,many patients and doctor’s offices are surprised when a claim is made for a colonoscopy and a polypectomy by their gastroenterologist is denied by the insurance company and falls to patient’s deductible.

According to the insurance companies, “preventive” exams are only “preventive” if the results are normal. If something is discovered, eg Polyp, then it is no longer preventive and patient has to pay the deductible first.

What a non sense! The whole rational for doing preventive colonoscopy is to find polyps and remove them. Giving false impression that a certain service covered and then denying it, is fraudulent. However insurance companies can get away everyday by stating that what they say on the phone is not a guarantee of coverage.

This is just a small example of needless complexities and fine prints used by insurance industry to generate profits.

There is just no accountability.