| > I believe that in the US, there is a certain age, after which, they're covered. There is a lot of confusion over this point, even among support agents for health insurance companies. i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0. ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure. In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA" It's common for people to confuse these things. In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars. [i] https://www.healthcare.gov/preventive-care-adults/ |
At least with my ACA insurance plan, you have to appeal it first because they pretend like it's actually diagnostic even though it was billed as screening.
It's fraud prevention! You see, people love to shit in a bucket multiple times a year to have their shit tested all to defraud insurance companies.