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Cost Of A Biopsy...

Willow5

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Willow5 Rookie
Willow5
Posted

Found out that my Insurance will not cover any of this testing, Can anyone let me know aproximately what to expect for the cost of a biopsy if we choose to do this?

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Lisa Mentor
Lisa
Posted

I had an endoscopy and colonosopy and the total bill for both was around $3,000. Which is totally outragious as I saw the doctor once for five minutes and was too dopy to understand what he said.

Our insurance paid for most of it.

Why won't your insurance pay?

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Willow5 Rookie
Willow5
  • Author
Posted
I had an endoscopy and colonosopy and the total bill for both was around $3,000. Which is totally outragious as I saw the doctor once for five minutes and was too dopy to understand what he said.

Our insurance paid for most of it.

Why won't your insurance pay?

They are saying it is a pre-existing and/or genetic condition and not elegible for coverage. Does not matter that we knew nothing of this.

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Lisa Mentor
Lisa
Posted
They are saying it is a pre-existing and/or genetic condition and not elegible for coverage. Does not matter that we knew nothing of this.

I personally think that is a bunch of crap. You are getting a biopsy to confirm a diognosis. Be persistant and get a letter from your doctor. There is NO reason why they should not pay. <_<

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clhsc Apprentice
clhsc
Posted
They are saying it is a pre-existing and/or genetic condition and not elegible for coverage. Does not matter that we knew nothing of this.

I work with insurance in a surgical office. From my experience, pre-existing has to be something that was previously treated under a previous insurance company and you have to have a 90 day lapse in coverage. If you didn't lapse in coverage for more than 90 days you will need proof of credible coverage from your previous insurance carrier.

My insurance carrier tried to pull that on me too with my asthma, but when I threatened to just show up at the ER every time I had an attack they quickly decided to pay for my inhaler. Sometimes with insurance companies it's all about who you talk to. Maybe you should ask to speak to the insurance company's nurse or some one who is higher up who might have a clue!

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jayhawkmom Enthusiast
jayhawkmom
Posted

Mine was close to $2000.00, but my insurance paid all but $30.00 of that. (Well, they wrote off most of it!)

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kbtoyssni Contributor
kbtoyssni
Posted

I agree that your insurance should pay for this. But if they won't pay, you do have the option of not getting a biopsy. Your signature says that you have positive blood work and dietary response so a scope wouldn't confirm anything.

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Willow5 Rookie
Willow5
  • Author
Posted

Insurance stuff really blows my mind! Even though I am an RN and earn a living by the health care system here in US, I am Canadian and really miss the hassel free and yes almost free health care system of Canada. My Mom got her testing done without cost and for us we are looking at almost a thousand just for blood work in our family!

I am going to do some more research into our insurance coverage and appeals etc. They had no problem paying for my thyroid and heart troubles (I've since discovered that my heart beats irregularily when I eat gluten!) They might be interested in assisting in diagnosing the true cause as opposed to all the symptoms!

My blood work was not altogether conclusive - I updated specifics on my blood work under my signature because it was just enough positive in only one area to create questions but not give answers.

Thanks for the input!

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babygirl1234 Rookie
babygirl1234
Posted

i had to have a waver done so my insurecence would pay for it and it was over a 1,000 for the scope and biosy alone

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Anise Rookie
Anise
Posted
i had to have a waver done so my insurecence would pay for it and it was over a 1,000 for the scope and biosy alone

An endoscopy would be $2300, I was just informed, and my insurance wouldn't cover a cent because I haven't met any of the deductible this year yet. (What good does it do to have them say they'll cover it if it doesn't reach the deductible... mutter, mutter, mutter....) Honestly, is it worth it under these circumstances???

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elye Community Regular
elye
Posted

Wow...the things we take for granted. I'm also Canadian, and all endoscopic proceedures are fully covered here by the health care system. Don't need to worry about insurance...incredible, I had no idea what you guys in the States without insurance are having to pay for this. :(

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jayhawkmom Enthusiast
jayhawkmom
Posted

Nan - my IgG AB's were WAY high. But, everything else was high normal. I've had positive response to a gluten-free diet.... but DID have the endoscopy because my GI wasn't positive that the gluten issues were the ONLY issues I was dealing with. Had he said that villi damage was all he was looking for, I would never have had the scope/biopsy done.

Turns out, it was a good thing I did have it.... I have a hiatal hernia that I was unaware of, and scarring in my esophagus due to gastritis. (I also had trouble swallowing and a constant need to clear my throat) I'm glad that was found, but again... if he was ONLY looking for Celiac damage, I would not have done it, regardless as to whether my insurance would have covered it or not.

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Willow5 Rookie
Willow5
  • Author
Posted
Nan - my IgG AB's were WAY high. But, everything else was high normal. I've had positive response to a gluten-free diet.... but DID have the endoscopy because my GI wasn't positive that the gluten issues were the ONLY issues I was dealing with. Had he said that villi damage was all he was looking for, I would never have had the scope/biopsy done.

Turns out, it was a good thing I did have it.... I have a hiatal hernia that I was unaware of, and scarring in my esophagus due to gastritis. (I also had trouble swallowing and a constant need to clear my throat) I'm glad that was found, but again... if he was ONLY looking for Celiac damage, I would not have done it, regardless as to whether my insurance would have covered it or not.

Do you remember what the "Way High" results were and the normal values? Also, did the Endoscopy actually show that you had villi damage?

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happygirl Collaborator
happygirl
Posted

What insurance do you have? Have you recently switched insurance? Something is not adding up here---they are giving you the run-around. Do you have your explanation of benefits?

I have gone through H$ll and back with a previous insurance (it was a student insurance) so I understand.

Good luck

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super-sally888 Contributor
super-sally888
Posted

Hi,

Come to Philippines! I am having endoscopy and colonoscopy tomorrow and the whole thing, including biopsies is going to cost about $500. Mind you, I have to pay for all of that myself. My insurance only covers accident or hospitalisation.

The money you save on the tests, you could have a holiday. Gluten free eating is probably easier here because people's diet is rice rather than wheat based (at least I hope so.... I will be starting gluten free diet tomorrow after all the testing)...

And I love my Doctor. Met him for the first time last Saturday and we are doing all the tests tomorrow (within one week). He is very experienced (also has practice at one of the best hospitals here). The clinic I go appears not to have many gastro patients so there is no waiting to see him, though he is only there once a week. He gave me his cell no. and told me to contact him if I had any questions or concerns. I texted him today about the tests and he responded straight away...

So there are some benefits to living in a developing country. :) I am Australian living in Philippines for the last 9 years.

Sally

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Willow5 Rookie
Willow5
  • Author
Posted

I would LOVE to go back to my home in Canada where the medical is free... Oh well! Sometimes one has to think about these things a while to figure them out. In the mean time I feel so much better on gluten-free and my 2 kids are able to have BM's without the aid of Laxatives which is a blessing.

I would like to have the "Gold Standard" diagnosis of the endoscopy and biopsy, but even now, I don't actually know if our family could handle going back on Gluten for the sake of that undeniable diagnosis. I actually tried about two weeks ago giving my 2yr old daughter Gluten in the form of pasta and breads for a few days - she got so constipated that she started throwing up - she is just starting to get over that bout.

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