Yes Calmom they want to work for Kaiser. It relates to dstarks article which claims there are 7 applicants for each position Kaiser posts, and other clinics are having difficulty hiring enough quality staff. If available, I’d be at Kaiser in a heartbeat.
Oops. I read that as 2014. 
Look. I hear great things. I just thought I would provide a 10 year link to verify what I hear.
My daughter did see a nurse practioner who did her pap smear.
@dietz199 I can beat that Sutter facility charge! I had a screening colonoscopy last Monday at the Tresanti Center in San Ramon. I just checked my on line Blue Shield account. The claim is still pending but Tresanti billed $5,000!!! My doctor billed $3050 of which my responsibility is $488. The EOB is not viewable so I don’t know the details but BS is paying 0 of the $3050 billed. (Unfortunately I did have two small polyps that he wasn’t too concerned with so maybe that’s what I"m paying for.) There was also a letter in my discharge papers from the anesthesiologist company saying that the “large balance indicating that you owe money” on your EOB is not a billing statement from us. Oh I just can’t wait to see how this turns out!
By the way I had Kaiser for several years but because I have kids attending college out of their area I went with a PPO. I also have had about five fecal blood tests that were all negative. Do you know if Kaiser ever does colonoscopies?
They do. My husband did one there a few years ago. He was loopy from the drugs for the rest of the day.
@marie1234 Was there a reason he had one? Is he over 60? My husband and I are in our late 50s and we just had the fecal blood tests at Kaiser.
3younguns: Wow…just …wow…sounds like you may have a long battle on your hands. Ugh.
I had a screening colonoscopy at Kaiser at age 50.
His was a screening and I’m pretty sure 50 was the age but he had just joined Kaiser when it was recommended.
@3younguns – if you are age 50 or over and have an ACA compliant plan, then the screening colonoscopy falls under “preventive” and should be covered 100% by the insurance.
I had an issue last summer with a mammogram – the EOB online showed that Blue Shield wasn’t paying and it went on my deductible, but I called Blue Shield and as soon as I got a claims person on the line they acknowledged that it was an error and they recoded it – they said it was a data entry error. As I recall I probably had to wait about 45 minutes on hold to get through, but no hassle other than that – they were very polite and apologetic about the whole thing.
Good to know @calmom. I did call to confirm that with Blue Shield and they assured me it was covered as I am over 50 and I have a covered ca plan. But I hear people saying that if you have polyps then you may have to pay as it changes from screening to diagnostic.
I wonder about that “error”, calmom. You knew that your mammogram should have been covered, but how many others would have just shrugged and paid?
If anything is found during a preventative screening colonoscopy it will be billed as diagnostic. That portion is the patients responsibility. Years ago H went for a preventative visit but they found polyps. It took me the better part or 6 months to get the doc to recode the procedure so that one part was preventative and the other was diagnostic. His recent procedure also found polyps but this time the billing was done correctly. I did however have to get the providers office to recode the initial pre-procedure visit as preventative since the initial coding resulted in the full cost being applied to the deductible. However, we still had to pay for the goop he had to drink the day before.
Not any more, @dietz199 – the Obama administration issued guidance on that last year: http://www.dol.gov/ebsa/faqs/faq-aca12.html
“Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?
No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.”
Your doctor should bill this as a screening colonoscopy.
If you need a subsequent colonoscopy to verify that all is good in several years, that one might not be coverd as a preventative service, and instead be diagnostic. (I am not sure on that one.)
The FAQ’s I referenced above are useful to read. I used #7 to appeal a coverage denial on an immunization.
I have had 2 colonoscopies, 7 years apart. Both times polyps were found. Both times only paid the minimal office copay. Second one I had to make sure I had it done at a place that qualified as an “office.” It didn’t look like an office. But had I gone to the other place that was a hospital I would have had to pay up to my $2500 deductible instead of a $25 copay. Big difference! I might need another in a couple years. Will have to check my calendar. I think the doc told me it takes 7 yrs for a polyp to grow into a cancer, hence the 7 yr recommendation. If no polyps they recommend 10 yr intervals. I bet others get different recommendations.
And… just when you think you have it figured out. Our 28 yr old son got a job, low pay and part time, but qualifies him for ACA subsidies, so we were telling him to go ahead and sign up . BUT… wait a sec, what if he loses his job. At that point you really are supposed to tell them your circumstances have changed and they would cut off his subsidy and he would be left with the expensive ACA plan after giving up his current reasonably priced plan… He needs to make $11,700 as a single person in NC to escape the Medicaid hole.
NJres, for your next colonoscopy, you will have to pay nothing. Colonoscopies are now required by law to be provided free of charge to those in the recommended screening group.
That’s old information – under ACA, if polyps are found & removed during the screening colonoscopy, at least under current regulations. See: http://kaiserhealthnews.org/news/041613-michelle-andrews-preventive-colonoscopy-costs/
(So please ignore the post by Dietz – she is mistaken as to current law – note that she wrote “years ago…”).
From the article I cited:
@Cardinal Fang – I wondered too about the error, but I’ve really got no way of knowing – there were two separate bills that came through-- I also caught it online weeks before an EOB was mailed to me, so I honestly don’t know whether or not Blue Shield has any internal checks in place double check before the EOB is mailed out. I’m not going to make an assumption based on a single incident.
If he has a job that qualifies him for ACA, and he later loses that job but doesn’t report loss of income to the exchange - instead keeping his subsidized policy – he is FINE for the remainder of the policy year.
So lets say he has a job now, signs up for ACA, and then in April loses his job and isn’t able to get another until September, when he gets another job. Hypothetically he expected to earn $18K over the year but ends up with only $8K. He is able to enroll for insurance in 2016 based on his anticipated earning from the job he gets in September.
What happens? When he files his 2015 tax return in 2016, he’ll get an additional tax credit (refund), based on the difference between the income for which the subsidy was calculated ($18K) and FPL ($11.7K) – that is, his tax credit will be calculated as if he actually made exaction 100% of FPL.
He does NOT Have to report the loss of the job to the exchange if he hopes or intends to get another. The people who need to be proactive about reporting changes in incomes are those whose incomes increase to a level of 400% of FPL or higher, because they will be hit with the maximum clawback-- that is, they will have to repay their subsidy amount.
For those with incomes between the 100-400% level, an increase in income may be less costly because of statutory limits on the maximum clawback – in some cases they may do better to keep the subsidy because even though they will have to pay something back, it may be short of the full amount they received.
Your son should sign up for ACA – it’s there to protect him, it’s a good deal for him, and he will NOT be penalized in any way if he loses his job.
calmom, any idea on if path lab payment is covered at 100%, when the polyps found in a screening colonoscopy are sent out for review?