Shining the Light of Reason

It turns out there is a good reason I am responsible for a few hundred dollars in connection with a preventative procedure 100% covered by the Patient Protection and Affordable Care Act.  Once it was explained to me, it became perfectly understandable.

The procedure is 100% paid for (with only a token $100 payment required from me), a $4,050 colonoscopy that was paid, on my behalf, at the contracted price of $852.  In consideration of this deep discount, the PPACA also protects the interests of doctors shorted by insurance company payments as well as the insurance companies themselves.

The PPACA requires a pre-colonoscopy office visit, something not previously required.  This visit with the specialist is subject to a $50 copay.   The doctor may charge up to $250, but the patient will only be responsible for the difference between the copay and the contracted price for this required visit, $131.   So the bill for the additional $81 is correct and the full responsibility of the patient.  The $131, which goes toward the $1,750 deductible, reflects another deep discount, almost 50% off the sticker price.

The diagnostic code 2113 was properly entered by the doctor’s office, even though no diagnosis was involved.  It’s called a diagnostic code, sir, and you chose a plan with a deductible, even if it was the only plan offered at your income level.  Pay the bill.

Procedure code 88305, level five, means that the patient, and not the insurance company, is responsible for the other half of the pathology charges related to the colonoscopy.  If the preventive procedure had not discovered any abnormalities requiring a pathologist, the patient’s preventive care would have been completely without additional cost, except for the $131 deductible and the $100 pre-colonoscopy fee.

As my father so often reminded me, I’d complain if I was hanged with a new rope.  The main thing is– what a great step forward Obamacare is for every American patient everywhere and how generous the discounts it affords.   And as President Barack Obama himself would say:  what are you going to do about it anyway, bitch?


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