Obamacare Promises “Free” Colonoscopies – Yeah Right!


Official photographic portrait of US President...
Official photographic portrait of US President Barack Obama (born 4 August 1961; assumed office 20 January 2009) (Photo credit: Wikipedia)

Let me start out by saying that I am neither Republican or Democrat.  I lean-to the right of center but have no desire to be included with the extremist in the “Tea Party.”

I am not ashamed to say that my vote for president was not for B. Obama.  It was not because I believed anything that came out of M. Romney’s mouth.  It was because I do not like Obama’s cabinet choices.  Fortunately, much of his cabinet will be replaced during his second term.

It is too bad that the one that I dislike the most, Secretary of Health and Human Services, is not.  In addition to other decisions, she will decide what is and is not included in the “Essential Benefits” health insurance plan that every American must buy or pay a penalty tax.

Now, that I have vented, let me share the real reason for this post.  On March 23, 2010 President Obama signed The Patient’s Protection and Affordable Care Act into law.  The purpose of the PPACA was to reform the entire health care industry of the United States.

Section 2713 of the new law reads,

‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for—

‘‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;

Since the law known as “Obamacare” became the law of the land, much has been said about the new “FREE” benefits.  Being the skeptic that I am, I decided to see how “free” the new “free” benefits actually were.  My wife recently celebrated her 50th birthday.  She wanted one of the “free” colonoscopies that were promised by Obamacare.  Here is my accounting.

MUST HAVE INSURANCE

The PPACA does not make colonoscopies free to every American over the age of 50.  One of the pre-requisites is that you must pay for health insurance.

States differ on what individual policies are required to pay.  In the state in which we live, individual policies are only required to pay for complications of pregnancy.  They are not required to pay for routine maternity and delivery of babies.  Since routine maternity is not required for individual health insurance, individual plans tend to be 40-60% of the cost of group insurance in our state.

Since Obamacare removes the deductible requirement for preventive services, regardless of what deductible the plan has, the plan she elected had a higher than normal deductible at $2500.

By doing a little shopping, I was able to get health insurance for her for just $203 a month.  I am perfectly aware that is a great deal of money each month.  However, I am painfully aware that many people are paying significantly more than $203 each month.

When the Essential Benefit policies are fully implemented in January, 2014, individual plans, as we know them today, will disappear.  All of us will pay group health insurance rates.  If you are looking for a way to keep your health insurance premiums lower, you can only use this strategy for another year.  Click the banner below to do some shopping.

I would have health insurance on her regardless of any federal mandate.  I love my wife.  When health care is 1/6 of the national economy and health care providers continue to raise their fees, I want to know that if my wife gets seriously ill, there will be money available to pay for her to get treatment.

The colonoscopy she had done was nothing more than a preventive test.  It is designed to see if she has any cancerous cells in her colon.  It is much less expensive to treat cancer if it is caught early.

The mandate that insurance companies are supposed to waive the deductible for a colonoscopy is a nice improvement but calling them “free” is a bit of political spin.

Before my wife could have her “free” colonoscopy, I had to pay $203 a month for health insurance.  That is $2436 a year, so that my wife could have a “free” colonoscopy.

MUST PAY FOR PREP

Part of the process of the colonoscopy is a thorough cleaning of your bowels.  That requires you to take some “industrial strength laxative” the night before your procedure.

I know there is a more scientific term than “industrial strength laxative” to describe the medicine she had to take the night before but that is the best description I could think of.

My poor wife got very little sleep the night before her procedure.  She drank that awful medicine and stayed up most of the night sitting on the toilet as her bowels drained.

The good news is that she lost some weight that night.  The bad news is that it is a terrible way to lose weight.

For the privilege of non-stop diarrhea, she had to pay for her prepatory medication.  It cost her $97 at the pharmacy for her “free” colonoscopy.

MUST PAY FOR ANESTHETIST IF THEY ARE OUT OF NETWORK

Insurance companies are only required to pay for your colonoscopy if you use one of their network facilities.  If you use a physician who is not in their network, you have to pay them directly.

We confirmed that the facility that did my wife’s procedure was in the insurance company’s network before she did anything.  As a result, the procedure itself did not cost us one dime.  The insurance company paid for 100% of the actual procedure.

So far Obama’s “free” colonoscopy only cost me $2533 for 2012.  However, there were more bills to come.

The facility failed to tell us, and we failed to ask, that the anesthetists that they used were not in our insurance company’s network of physicians.  They also failed to tell us that the anesthetists would bill separately from the health care facility she used.

About 4 months after her colonoscopy we got a bill from the anesthetist of over $800.

LOST WORK

I know that some Americans are paid a salary.  Others have “sick days” that they can use.  My wife is self-employed.  If she does not work, she does not get paid.

Michele is the owner of QB DATA.  She charges her clients $35 an hour for her services.  In an 8 hour day she earns, $280.

The facility her doctor sent her to is not open on the week-end.  She had no choice but to have her procedure done on a work-day.   Although there was nothing wrong with her, the medicine that the anesthetist gave her made her groggy for the entire day.  She was unable to do any work on that day.

SUM TOTAL

The way I figure it, the “free” colonoscopy cost us $3613.  It is nice to know that my wife’s colon is free of cancer.  I probably would have paid for that test anyway if that is what she wanted.  However, I am a bit offended that politicians are talking like all preventive services are now “free.”

My experience is that the “free” benefits are costly.   Here is what my wife’s “free” colonoscopy cost us.

  1. Health Insurance       $2436
  2. Prep Medication        $97
  3. Anesthetist                  $800
  4. Lost Work                    $280

TOTAL                       $3613

LESSONS LEARNED

From this experienced I had a few lessons that I have learned in the past reinforced.

  1. DONT TRUST POLITICIANS – They will say what you want to hear long enough to secure your vote.  They do not care what the truth is as long as they get to stay in power.
  2. ASK SPECIFIC QUESTIONS –  We could have saved ourselves much aggravation and money if we had only asked the facility if the entire cost of the procedure was billed by the medical facility or if they sub-contracted any part of the procedure out.  If the entire bill was presented by the network facility, they would have paid the anesthetist.  By using a sub-contractor, we were responsible for their bill.  Since they were “out-of-network” we got stuck with their entire bill.
  3. SHOP AROUND – The only reason that we used this particular facility was that they have an office in the same building that houses my wife’s primary care doctor.  They were convenient to her doctor.  Houston is a big city.  There are other facilities that do the same procedure.  There is a good chance that if we had thought about asking specific questions, we would have found a facility that would have given her the same level of care but used anesthetists that were in the insurance company’s network.  If we had done our shopping rather than try to be convenient to her doctor, we would have saved that $800 anesthetist bill.

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