Insurance, location can influence cost of medical procedures

DEAR DR. ROACH>> Is there a way to determine the average cost for certain medical procedures in a specific location? For instance, a colonoscopy? I know some health insurance policies cover it, but when your policy doesn’t, what is the best way to see what the costs would be? Is it something someone should shop around for?

— K.

ANSWER>> If health care were like anything else, there would be an understanding, before performing a procedure, what the out-of-pocket costs to the patient would be. Unfortunately, in the United States, it’s not that simple.

While geography does have a significant role to play in what a clinic or hospital will charge for a screening colonoscopy, the charges from one facility to another in the same city can vary tenfold. I spent some time looking at what people have said about their out-of-pocket costs, and many were unable to get a confirmed price before the procedure. Insurance coverage can be dramatically different from one plan to another. While the Affordable Care Act (Obamacare) mandates that all ACA-compliant policies cover screening colonoscopies, people may still be charged for anesthesia, pathology and facility fees, among other costs. Many, but not all, private insurances will cover a screening colonoscopy.

A diagnostic colonoscopy, such as one performed to find the cause of a symptom, does not have this protection and can be much more expensive.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.