Dr’s office told me it would be $0. Insurance told me it was only covered 80% after deductible. So which is it?

Navigating Conflicting Medical Billing: A Patient’s Dilemma

As a patient preparing for a colonoscopy this week, I found myself in a frustrating situation that many others may relate to—conflicting information regarding the cost of my procedure.

When I contacted my doctor’s office to confirm the expenses involved, they assured me that my out-of-pocket cost would be $0. They provided me with a procedure code for verification with my insurance company, which I gladly followed up on.

Upon reaching out to my insurance provider, Aetna, I learned a different story. According to them, my colonoscopy would only be covered at 80% after I meet my deductible. The representative explained that while this procedure is considered preventative care, it’s fully covered only for individuals over 45. Unfortunately, being 35 and having a family history of colorectal issues means that my doctor has recommended screenings every five years rather than the standard schedule.

This discrepancy left me puzzled. Why did my doctor’s office initially claim there would be no charges when my insurance provider painted a contrasting picture? They even mentioned that my call had been recorded for quality assurance, which I hope could work in my favor if there’s a mistake.

After discussing this conflicting information with the doctor’s office, they have since reached out to Aetna for clarification. As I wait for their return call, I can’t help but feel anxious. There’s a nagging fear that they might backtrack and inform me that they mistakenly informed me the procedure would be free of charge.

This situation raises a crucial question: What recourse do I have if the office indeed made an error? Am I left with no choice but to pay the unexpected out-of-pocket expenses?

Unfortunately, many patients find themselves in similar predicaments. Here are a few steps to consider if you find yourself in a comparable situation:

1. Document Everything: Ensure you keep records of all communications. This includes dates, times, and names of the representatives you speak with, as well as any relevant procedure codes.

2. Reach out for Clarification: Continue discussing the discrepancy with both your healthcare provider and your insurance company until you have a clear understanding of the billing situation.

3. Utilize the Recordings: If the call was indeed recorded by your doctor’s office, request access to that recording, especially since it can potentially support your case.

4. Explore Options: If you find that you’re being charged unexpectedly, inquire about any