Columbia Endoscopy Ctr

The following is the letter I wrote to my insurance company to appeal the charges from Columbia Endoscopy Center, as well as the other services rendered during the colonoscopyThis letter explains what happened with my coverage and how the dispute came aboutMy only concern is with the billing office at Columbia Endoscopy CenterPersonal information has been removedInsurance has denied my appeal and I still owe the balance due To whom it may concern, I am writing in appeal to the charges incurred for the preventative colonoscopy I underwent on February 2, at the Columbia Endoscopy Center in Columbia, MOAt the time of my arrival and chebefore the procedure, I was told that because the reason for my colonoscopy was preventative care concerning family history, all charges were to be covered at 100%During cheand pre-procedural questioning, all information was cited to be preventative, non-symptomatic or problematic in natureMy father was diagnosed with col

The following is the letter I wrote to my insurance company to appeal the charges from Columbia Endoscopy Center, as well as the other services rendered during the colonoscopyThis letter explains what happened with my coverage and how the dispute came aboutMy only concern is with the billing office at Columbia Endoscopy CenterPersonal information has been removedInsurance has denied my appeal and I still owe the balance due
To whom it may concern,
I am writing in appeal to the charges incurred for the preventative colonoscopy I underwent on February 2, at the Columbia Endoscopy Center in Columbia, MOAt the time of my arrival and chebefore the procedure, I was told that because the reason for my colonoscopy was preventative care concerning family history, all charges were to be covered at 100%During cheand pre-procedural questioning, all information was cited to be preventative, non-symptomatic or problematic in natureMy father was diagnosed with col

We do call or check the insurance provider’s website for verification of benefits as a courtesy to our patients.  We then give the patient an estimate of what they will owe the facility for their procedure.  This is based on what our contracted rate is with the patient’s insurance company,...

why we are doing the procedure (screening or diagnostic), what their deductible is, how much of their deductible has been met, and whether they have a co-pay.  We do not guarantee coverage/payment because the insurance companies always use the disclaimer that the information we receive is not a guarantee of payment until they process the claim.  We also inform the patient that they may receive up to three additional statements from the physician, pathology, and anesthesia.  We encourage the patient to contact these providers if they have concern with cost since we do not have access to their billing/contracted rates.  We do expect the patients to have some understanding of what the insurance plan that they have chosen and pay for covers and does not cover because it is their insurance coverage, and we do encourage them to call their insurance company if they do not feel the information we were given is incorrect. The scheduling sheet we received was for Ms. [redacted] to have the procedure due to family history of colon cancer with the Z80.0 code, we did not receive anything saying this was to be a routine screening Z12.11.  In this complaint, there seems to be a couple of different issues that need to be clarified.  1)      Routine screening code Z12.11 is typically used for patients that are age 50 or older and have no family history of colon cancer, no personal history of colon cancer, no personal history of polyps, and has been at least 10 years since their last colonoscopy.  However, there are some insurance plans that will cover that code even if the patient is under the age of 50.  Some insurance companies will also change the way they pay from screening to diagnostic if a polyp is found during the procedure. Just because we submit the Z12.11 code (screening code), it does not mean that the insurance company will pay it as a screening. 2)      In January, the private paying insurance companies stopped paying for family history of colon cancer Z80.0 (the code is actually family history of neoplasm of digestive organs) as a screening colonoscopy and began paying it as a diagnostic code.  We did not receive notification of this until January claims began to come back to us the end of January/first of February with the balance being sent to the patient instead of covered by insurance.  At the time the patient was scheduled, there was confusion about how and which insurances were going to cover the Z80.0 code.  Until January 2017 this code was covered 100% as a screening by most insurance companies.  At this time, Medicare is the only payer that pays for Z12.11 (routine screening), Z80.0 (family history of neoplasm of digestive organ), and Z86.010 (personal history of polyps) as screening codes. When the patient was told it would be covered, we had not been notified by any of the insurance companies that they were no longer covering the Z80.0 code as a screening code.  This “covered” information was not based on the Z12.11 code, but rather the fact that insurance providers had been covering the Z80.0 code 100%. The Z12.11 code was added to this patient’s report because several of our payers have requested that we add it when we use the Z80.0 so they can see that it was colon cancer and not somewhere else in the GI tract.  We do not have control of how the insurance provider will cover the codes that we submit to them or the information that we receive from them.  The question the patient needs to ask her insurance company is why they no longer pay the Z80.0 family history screening code as a screening.  Another issue for the patient to understand is the way in which insurance companies are viewing the screening codes, even when she turns 50 she may not be eligible for a screening since her procedures are not scheduled 10 years apart.