Can your health insurance bill you for treatment of an uncovered procedure found during a covered procedure?

Bartonville

I had a colonoscopy done because I was feeling nauseous and couldn’t keep my food down. The doctor thought it might be IBS. My insurance company agreed that this was a covered procedure as long as there is no pre-existing condition which there wasn’t. Now they are saying I owe them about $7500 because the doctor found hemorrhoids and that is one of the items not covered within the first 6 months of me being insured. My question is, I didn’t go to the doctor because of hemorrhoids (I’m not bleeding or ever had any symptoms), I went because I was sick and couldn’t keep my food down. So how can they be denying the coverage when I didn’t even know that’s what they would find? Shouldn’t they cover you based on the initial visit diagnosis and the reason why you’re having the procedure in the first place? The doctor found internal hemorrhoids which 98% of us have – they’re benign and not a condition. They do nothing. The doctor says that was the diagnosis and the outcome of the procedure so that’s how they report it. The insurance company says, sorry, we told you hemorrhoids weren’t covered. And I’m wondering how it is that I went in for a supposed covered procedure because I was just sick in my stomach and came out owing almost 8K. Anyone ever heard of this?!?! I’m very concerned…



Maryland City

I think you mean that the colonoscopy is not being considered as 'covered' by the insurance co. coz doctor found hemorroids.The insurance ppl are wrong. The provisional diagnosis should have been some other disease rather than internal hemorrhoids as nausea is not usually associated with the hemorrhoids. You should stress that the provisional diagnosis was something else, that needed to be ruled out and hence the procedure was performed. This way the insurance will have to pay for the procedure.Hope you will win the argument.All the best !



Poughkeepsie

The insurance company is wrong. Stand your ground with this one. You had a covered colonoscopy to look for possible IBS. Hemorrhoids don't cause IBS or nausea and are irrelevant. It's like the dentist looking for a cavity and finding that you have tonsils while he's in your mouth. Make your insurance company look like idiots !!!