23 October 2022: You probably should not have to pay anything for your colonoscopy

Earlier this year, I had a routine colonoscopy at Henry Ford Health. The cost was about $4,500 and my HAP insurance paid for all but $900. 

At about the same time, I read an article at NPR.org that indicated that under the Affordable Care Act ("Obamacare"), I should not have to pay anything if I had insurance, based on this law, see https://www.npr.org/sections/health-shots/2022/05/31/1101861735/colonoscopy-cost-cancer-screening .

I wrote to Henry Ford Health Systems, who denied my request, and ultimately threatened to send this claim to a collection agency. I then filed a complaint with the Michigan Insurance Commissioner, DIFSComplaints@michigan.gov, see https://www.michigan.gov/difs/about/contact-info (who only responded a week ago requesting more information). It then occurred to me that I should file an appeal with HAP. They took 60 days to respond, but they did agree with me and now the balance is zero (so everything has been resolved).

This was what I wrote to Henry Ford, HAP and the Michigan Insurance Commissioner:

I think this procedure was coded incorrectly.

My understanding is that under The Affordable Care Act, colonoscopies are provided free of charge to patients without cost sharing. This procedure should be coded as Screening, not Diagnostic, and if done properly, there would be no charge to me.

My understanding is that The Centers for Medicare & Medicaid Services has clarified repeatedly over the years that under the preventive services provisions of the ACA, removal of a polyp during a screening colonoscopy is considered an integral part of the procedure and should not change patients' cost-sharing obligations.

Please review and advise.

I hope this information is helpful to you!