7Investigates: Price for Prevention

BOSTON (WHDH) - Catching cancer early could help save lives. But some patients are paying a high price for prevention.

Many are getting big bills for a crucial procedure. It turns out, it’s supposed to be free.

7News’ Steve Tellier investigates.

It’s a procedure that could save your life. Millions of Americans get colonoscopies every year. But many of them are getting hit with bills they shouldn’t have to pay.

“I thought I was covered,” Michael Ross said.

Ross lost his father to colon cancer, and he’s an oncologist himself.

“I see what happens if it isn’t diagnosed early,” Ross said.

But after his routine colonoscopy several years ago, his insurer wanted several hundred dollars from him. Ross was positive he wasn’t supposed to pay a penny.

“I wrote a letter to the insurance carrier and said, ‘What gives,'” Ross said.

Then, last year, another colonoscopy, and another big bill, for nearly $800.

“It bothered me first of all because it happened twice in a row, which said, this may not be a mistake,” Ross said.

Under the Affordable Care Act, many preventive procedures are supposed to be free for patients. That includes *screening* colonoscopies, those that older men and women are supposed to get periodically, to catch colon cancer early on. But experts tell 7News many of those patients are getting billed anyway.

“It happens over and over and over again,” added healthcare cost expert Jeanne Pinder.

Experts say the medical coding for colonoscopies can be incredibly complex. So, some of the bills are just mistakes. But they say others are intentional.

“It’s the insurers,” Mark said. “They would like to pass along some of the costs and not pay 100 percent of the cost if they don’t have to.”

Steve Tellier: “You think someone’s doing this intentionally?” Ross: “I wonder about it.”

To make sure you don’t get billed for your colonoscopy, ask whether it’s a preventative screening beforehand and how much is should cost. And if you still get billed for a screening colonoscopy, fight it.

That’s what Ross did, and the insurer backed down twice. Still, he’s worried the bills will discourage other people from getting colonoscopies until it’s too late for treatment.

“And that’s not acceptable,” Ross said.

If you’re already having symptoms before your colonoscopy, it’s not fully covered. And other factors like your medical history could mean you have to pay a portion as well.

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