Routine Health Check Results In Massive Surprise Medical Billing

Tom Contos faced jaw-dropping costs after his colonoscopy led to unexpected medical billing complications.

At a Glance

Tom Contos’ colonoscopy was billed as two separate procedures totaling $19,206.
Contos contests the charges, highlighting complexities in medical billing.
Medical debt severely affects over 100 million Americans, causing financial strain.
Consider using price transparency tools to estimate medical procedure costs.

An Unexpected Financial Burden

Tom Contos, a runner concerned about rectal bleeding and family colon health issues, scheduled a colonoscopy at Northwestern Memorial Hospital. Contos understood he’d face some costs, but a bill for $19,206 was staggering. The hospital billed the procedure as two distinct colonoscopies following polyp removal. Negotiations reduced the insurer’s bill to $5,816, leaving Contos with a $4,047 out-of-pocket expense.

“I work out a lot, But my partner said, this isn’t normal. My primary care physician said, ‘Given your family history, let’s get you in,'” said Tom Contos, highlighting the necessity of the procedure.

He Went in for a Colonoscopy. Northwestern Memorial Hospital Charged $19,000 for Two.
To get a colonoscopy at a lower price, patients should consider going to a freestanding endoscopy center or ambulatory surgery center not associated with a hospital.https://t.co/Li9Qg6RZhR

— Harris Meyer (@Meyer_HM) December 19, 2024

The Broader Issue: Medical Debt

Medical debt impacts over 100 million Americans, leading to serious financial ramifications. Many lose their homes or deplete retirement savings. Racial disparities exacerbate these challenges, with Black communities disproportionately affected by systemic discrimination. Medical debt often lowers credit scores, making secure housing or employment more difficult.

Patients undergoing colonoscopies sometimes encounter surprise bills from out-of-network anesthesiologists and pathologists. Nearly 1 in 8 insured patients face these unanticipated costs. Experts recommend opting for in-network providers and using cost-estimation tools to avoid surprises.

He went in for a colonoscopy. The hospital charged $19,000 for two.
https://t.co/latfBhrsbR

— CBS News (@CBSNews) December 19, 2024

Finding Solutions

James M. Scheiman, M.D., said, “In addition to insurance reform, which is essential to resolve this risk of cost sharing, we need tools to accurately predict out-of-pocket responsibilities for patients before the procedure is performed to allow opportunities to limit costs without impact on quality.”

The “Bill of the Month” series by KFF Health News and The Washington Post examines perplexing medical bills, assisting patients in potentially reducing expenses. Patients should consider freestanding endoscopy centers for lower costs. Understanding your rights with medical billing and utilizing available tools can circumvent hefty out-of-pocket fees.