Get Gephardt | Stories - Costly colonoscopy following a man's belly ache
Thursday, July 3 2014, 11:00 PM MDT
Costly colonoscopy following a man's belly ache
MANILA, UT (KUTV) There has been a big healthcare push - everyone should get a colonoscopy by the time they are 50 years old. In ads, broadcaster Doug Miller's daughter says a colonoscopy could have saved her father's life.

"My dad was 58 years old," she says in the ad. "He had not had a colonoscopy."

Floyd Briggs, who once fished with his friend Doug Miller in Manilla, Utah took those appeals to heart.

"I just heard enough about getting a colonoscopy that I decided I better do it," Floyd says.

And why not? Besides the health benefits, the procedure is 100% covered by his insurance company as a preventative screening.

Last April, Floyd went Uintah Basin Healthcare's The Clinic in Roosevelt. He had the procedure and he says was given a clean bill of health. But he got a surprise weeks later in the mail when $2500 in bills showed up.

Floyd says that when he called his insurance company he was told that is a result of the way the clinic coded the colonoscopy. Only a 'screening' colonoscopy would be free. The Clinic had billed Floyd's as 'diagnostic' colonoscopy. But the insurance company seemed amenable to paying; The Clinic would simply need to resubmit the bill as a 'screening.'

"[The Insurance Company] didn't see it as a problem being coded as a screening," Floyd said.

But when Floyd called The Clinic, they refused, saying it was not a screening. Before the colonoscopy, The Clinic asked Floyd if he'd had any pain in his abdomen. He told them, yes. Even thought he felt fine now, about a week prior he had what he thought might be a touch of the flu.

"I was having some bloating and diarrhea," Floyd said.

That did it. Because Floyd told the doctor about his recent tummy ache, they will not bill it as a preventative screening and Floyd has to pay.

"All I want is it coded from a [diagnostic] procedure to a screening," Floyd said. "My intentions all along were to have a colonoscopy done."

Not wanting to pay thousands for something he thought was free, Floyd decided to Get Gephardt.

We contacted the Uintah Basin Medical Center to ask why they won't resubmit the bill as a screening when both the insurance company and the patient want it billed that way. Marketing Director Maigen Zobell said that doing so would be insurance fraud.

The medical records are a "binding legal document that cannot be changed to facilitate better insurance coverage," Zobell said. "Altering a chart or bill for the sole purpose of coverage determination ... is considered insurance fraud and is punishable by law."

According to the American Gastroenterological Association website, a screening test is, "a test provided to a patient in the absence of signs or symptoms."  A diagnostic colonoscopy is, "a test performed as a result of an abnormal finding, sign or symptom, such as abdominal pain, bleeding [or] diarrhea."

As for Floyd, he swears that he had intended to get the colonoscopy even before he had that mild flu. But he can't prove it and is thus stuck paying a $2500 bill for a diagnostic colonoscopy.

He says his story should arm anyone else considering a colonoscopy to be aware of the magic words: screening and diagnostic.

"I think everybody has stomach problems," he said.

By Matt Gephardt
Produced by Michelle Poe
Photography by Mike Fessler

(Copyright 2014 Sinclair Broadcasting Group.)

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