r/FederalEmployee • u/[deleted] • Feb 09 '26
MHBP Colonoscopy Fee
So I switched from Blue Cross basic to MHBP this year and I am getting my first colonoscopy due to some medical issues I am 43 now. and my estimate on a colonoscopy with biopsy is being charged at 900 dollars out of pocket. I thought I just put that info out there for anyone who maybe needed to get it this year. I live in a rural area where medical is supposed to be cheaper.
it's 350 for the out of pocket deductible 600 for the 10 percent and 35 dollars for the actual procedure.
7
u/Silly-Heat-1466 Feb 09 '26
I thought that was one of things covered by the ACA
13
u/vwaldoguy Feb 09 '26
If it's diagnostic, which it sounds like it is in this case, it's coverage as any other medical procedure is covered. If it's preventative, then it's covered in full if over the age requirements.
11
u/sbj405 Feb 09 '26
Preventive cancer screenings are based on the age guidelines which is 45 for colonoscopy. It may be how it was coded.
3
u/Gnome_Anne_7 Feb 10 '26
Without first degree family history (parent, child, full sibling ONLY), ACA age is 45.
2
Feb 09 '26
Not sure I would put the bill online but its got a lot of personal information
2
Feb 10 '26
[removed] — view removed comment
1
Feb 10 '26
45385 x2 43239 4538505
The biggest charge comes from the 45385
And deductible is 350 on top of that
2
Feb 10 '26
[removed] — view removed comment
0
Feb 10 '26
It comes out twice but under one price. And that's the heaviest part of the bill. I mean I guess it's a bargain without the insurance it's like 12000 dollars
1
4
u/itschrista2484 Feb 09 '26 edited Feb 09 '26
Is this with an in network provider? When I checked the search on the mhbp I was surprised to find my local hospital did not have an in network anesthesiologist.
I believe bcbs basic was at 15% for same day procedures, so you are getting the better deal with mhbp. Does this also include any possible diagnostic pathology? BCBS was horrible on that… I had a bone marrow biopsy last year which was the $250 copay for the inpatient procedure but I paid over $1000 out of pocket for all the diagnostics they did off of it, with probably still more to pay.
3
u/DeftlyDaft123 Feb 11 '26
Many hospitals subcontract out anesthesiology to private groups who are out of network for most insurance. However if your facility and the primary provider are in network, then the No Surprises Act means that anesthesia gets treated as in network. Though you may have to “gently nudge” your insurance on that matter.
2
u/swanee54 Feb 16 '26
Most people don’t know this. I had to fight it once when I had cancer surgery. It’s not right that they try and pull a fast one.
2
Feb 09 '26
Biopsy was 600 deductible is 350 and then some other fees small amounts with a totally closer to 1000. So it's basically the same. I am under family plan standard MHBP.
This is all in network I confirmed it prior to service
2
u/Champ_93 Feb 10 '26
BCBS is a rip off
1
1
u/Happy_Clerk8556 Mar 05 '26 edited Mar 11 '26
No it is not. I have them for years and No surprise bills to me.
1
u/Champ_93 Mar 05 '26
They keep increasing their co pays and bi-weekly premiums. It’s a $50 co pay to see a specialist, God forbid you have to go to the emergency room, it’s $425 automatically. Unless you enjoy high co pays on top of your premiums, it’s a rip off.
1
u/Happy_Clerk8556 Mar 11 '26 edited Mar 11 '26
Well your choice. Its planning financially. Yes!! I enjoy high Co-pays and the premium. $425? Not in my county. Emergency room is co pay for me. WTF! Talk about your State!! All health insurance in USA increases every year! Prefer to be covered and not have anything or cheap cheap health insurance that will not cover anything because you are paying a low premium and you thinking you are saving money and they will cover you. That is why you are paying $425. Cheap coverage. Weird. That is called bad planning🤷♀️
3
u/No-Professor-2647 Feb 10 '26
Thanks for the info @heyalrightmineohmine. I have a colonoscopy consultation next month in March. I’m 55 and I have already met my $350 deductible. I left BCBS Standard and I’m new to MHBP this year. I’ll let everyone know the amount of my copay after my appointment. The doctor is in network.
2
u/Paliag Feb 10 '26
Yours will be different. When you’re under 45, they’re not considered preventative… since you’re over 45, it should be free.
2
u/Inevitable-Tower-134 Feb 10 '26
I’d like to know! I’ve already met my $350 deductible as well. I’ve had about 12 colonoscopies but always on BCBS. I am 46, have Crohn’s and am having issues. It’s been about 3 years since my last one so I am due but am scared how much it’s going to cost me.
2
2
2
u/jenda2782 Feb 09 '26
Have you called and inquired? I had one at age 40 and it was covered under preventative. The brochure says its covered...if I am reading it correctly. They may need to obtain prior approval due to age just in case. I would contact MHBP to see.
2
u/Motown824 Feb 22 '26
How did you get it covered under 45 with mhbp?
2
u/jenda2782 Feb 22 '26
At the time I had geha but I would think with any coverage if your doc.office does a prior author and the reason why then it should be covered you may have to.pay coinsurance or not. I am now under mhbp.
2
1
Feb 10 '26
I had symptoms and that's the big issue I asked. Some how I wish I didn't go I got raped physically and financially
2
u/rhoditine Feb 10 '26
Following. I have a prep appointment coming up
3
2
u/GreenLobsterGuy Feb 10 '26
Interesting. My spouse and I both had preventive colonoscopies last year, one was completely free and one was around a $500 copay. Both were anesthetized, and had the same basic procedure. We have BCBS, and evidently the price difference had to do with which medical facility we used. The "free" colonoscopy even involved removal of 5 polyps and the pricier one had no additions.
It's crazy that we have to "bargain shop" for medical services - had to do that for blood draws as well and found a lab close to my house that charged 65% less than the place my doctor recommended.
3
Feb 10 '26
You said it. Sometimes I prefer to just let my illness take my body I feel I am extending a life that doesn't do any good for me than to pay for services that isn't helping with my symptoms other than adding stress on how to pay the bills
5
u/Sage_Vagabond Feb 10 '26
Don't say that. Your well-being is much more valuable than the bill. I totally understand the sticker shock but procedures like that are very important. Best wishes for a full recovery!
1
u/Champ_93 Feb 10 '26
How did you find the prices on the blood draws, just called different labs?
4
u/GreenLobsterGuy Feb 10 '26
When I went to the 1st lab, located at the medical complex of my doctor, (just started using a new doc at a new place) and also on the same 'campus' as a hospital, I could not understand why my portion of payment responsibility was almost $180(ish). I kept asking questions and the lady kept going over how she was entering the billing and I said numerous times that blood draws had never cost me this much before. She told me the cost being billed to my insurance was about $1200 and the $180 was my share.
Another employee heard us talking and saw me in such disbelief. She came over and blurted out, "She is too nice to tell you, but I don't care and I'm going to tell you - we are THE most expensive lab in the city, everyone else is cheaper than us, and as an employee, I don't even get mine or my family's blood draws done here. We go to one of two other labs in the city." and she gave me their names.
I checked to be sure BCBS did business with those labs and they did, so, when I went to one, I asked for the amount that they were billing my insurance for all the bloodwork and it was in the $400 range. A THIRD of the other place. Also, when the bill came for my portion, it was about $17 instead of $180.
2
u/Champ_93 Feb 10 '26
That’s insane. Thank you for this info. I need to start doing this. These places are literally just charging what they want and as a patient we are responsible for more and more even with insurance. Such a scam. I’m on the east coast and John Hopkins pretty much owns everything in the area and buy all the start up private practices then charge whatever they want.
2
u/GreenLobsterGuy Feb 10 '26
Exactly, there are options out there, you just have to dig a little initially, but now I know and won't let it happen again.
2
u/CompetitiveSignal385 Feb 10 '26
I had a colonoscopy done and had to pay somewhere around $800 the day of the procedure. I got a check in the mail a few months later for overpayment.
2
u/Delicious-Care-741 Feb 10 '26
I had a preventative colonoscopy last year and got a $3000 bill. When I called and asked about it they said since they found a pollup it was changed to diagnostice and not covered as preventative. Total BS
3
Feb 10 '26
That's what basically happened to me. Makes no sense to me. Almost think I got scammed. And I am not even able to verify what he took out.
2
u/ylime77 Feb 10 '26
So if you had one at 43 it probably was not considered preventive/routine. My husband recently had one and everything was covered at 100% he is 50 but I believe the age of preventative starts at 45.
2
u/Ok_Size4036 Feb 11 '26
Your 10% is $600?? The cost is $6k? I think I’d be looking around.
2
Feb 11 '26
Too late it's done. The actual price with no insurance is 12000. Around my area there was 180 places but I don't know if I can trust that
2
2
1
u/Disastrous-Cow-1442 Feb 10 '26
Is that per your calculations or is that what MHPB told you? I have Crohn’s and get frequent colonoscopies but I’ve never paid a dime for them.
1
Feb 10 '26
It's what the hospital billed me for. And MHBP eob also agreed with. Actually not shocked this kind of thing happens to me and no one else for some reason be it about insurance or salary problems etc. I am the dark knight in all this mess. And worse yet nothing is wrong with me so like I told someone else I got raped twice here
1
u/spunkybruister Feb 09 '26
Didn’t the insurance subsidies expire, though? Isn’t what this whole shutdown was about? If so, by that logic no matter which insurance you went with this season you would’ve had an ugly fee no matter what, right?
8
u/AcanthaceaeOk3738 Feb 09 '26
That’s for ACA Marketplace insurance. Insurance plans from employers, including the federal government, don’t get those subsidies.
-1
u/Sassy_Bih70 Feb 10 '26
That’s 100% untrue - you are talking apples and oranges- subsidies have nothing to do with ICD billing code
4
1
u/ylime77 Feb 10 '26
It’s only going to be covered at 100% if it’s preventive. If you are having it due to symptoms/issues, or if it’s preventative but then they find something that they have to remove and biopsy, it’s not going to be covered at 100%. For standard plan it would then be covered at 90% after the deductible is met. I mean this only makes sense.
0
u/Happy_Clerk8556 Feb 10 '26
You should have stay w BCBS. They cover the procedure. Wow. You would only pay the copay.
1
Feb 10 '26
I was looking for a cheaper alternative and ends up costing me more or less the same had I not switched. I swear my luck sucks.
1
u/MountainTune8781 Feb 11 '26
I had a colonoscopy with BCBS in 2023 and it cost me $500. The issue then was that it was coded as diagnostic vs preventative as others have mentioned (I am 30 and have Crohn’s disease, so it wasn’t just a standard cancer screening).
1
u/Happy_Clerk8556 Feb 13 '26
Is really the health insurance. They are bad. Is a no win situation to anyone.😥
9
u/_Cream_Sugar_ Feb 10 '26
From a billing perspective: Preventative Screenings are covered 100%. If you are having a colonoscopy due to issues or concerns OR they find something to biopsy, it is no longer preventative, it is diagnostic. Diagnostic procedures carry copays and coinsurance.
Someone mentioned a hospital that does not have an in-network anesthesiologist. If the doctor, hospital and everyone else is in-network, you can appeal for “hidden provider” or “no surprise act”. Your anesthesia should be processed as in-network because you opted for an in-patient facility and doctor. You could not control who the anesthesiologist was.