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When I read the headline, I thought it was going to be about the rare cases where they punch a hole through your colon with the scope and have to open you up to repair the damage. Instead, it's about people getting screwed by big bills from anesthesiologists that aren't covered by insurance.

Just one more thing to worry about as you get older.

http://well.blogs.nytimes.com/2012/05/28/waking-up-to-major-...

Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. But in both cases, the gastroenterologists chose full anesthesia with Propofol, a powerful drug that must be administered by an anesthesiologist, instead of moderate, or “conscious,” sedation that often gastroenterologists can administer themselves.

And in both cases, the gastroenterologists were assisted in the procedure by anesthesiologists who were not covered by the couple’s insurance. They billed the couple’s insurance at rates far higher than any plan would reimburse — two to four times as high, experts say.

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intercst
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I cannot think of any bigger waste of money than hiring an anesthesiologist to put you under for this. Mild sedation gets rid of virtually all of the pain. In my case, the normal dose of sedation also gives me after-effects (like a lack of coordination) that last into the next day. This is not good - I do not like running into walls. So last time I had the doctor give me less than the usual amount of sedation. There was a little bit of pain, but nothing worth mentioning, and I felt normal by the afternoon.

The only part where there is any bit of pain is where the scope goes from the transverse colon around down to the appendix. Turning that corner hurts a bit. If they snip off a polyp (which I got to watch once), there is no pain.

I really think that many people want to be put under anesthesia because they are freaked out about the idea of having a scope pushed up their intestines. So the anesthesia is more for psychological reasons than anything else.

Also, it is not just for a colonoscopy that there may be an anesthesiologist who bills separately. I have run into that for other procedures at the emergency room as well, although the details have escaped me.
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I note the article said the percent of complete sedation colonscopies to all colnoscopies done had doubled from 14% to 30%. It has been suggested that with an extra pair of hands in the room that the number of colonoscopies per day that a doc complete is increased.

Well someone has to pay fer that Caribbean vacation.
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I cannot think of any bigger waste of money than hiring an anesthesiologist to put you under for this.


for a toothache?
for a pedicure?
just for grins?


I really think that many people want to be put under anesthesia because they are freaked out about the idea of having a scope pushed up their intestines. So the anesthesia is more for psychological reasons than anything else.


probably is largely nervousness, but there might also be legal or medical reasons
regardless .in my experience

• Doctors of ALL sorts 'bill' 2 to 10x what the Ins. will pay
• anesthesiologist IS a bit more tricky because one's surgeon (or whatever) might chose anesthesiologist who's not In-Plan --

so two things to consider for ANY procedure(not just 'scopies') -- whether and what sort of anesthesia is appropriate? whether anesthesiologist is "in-plan' for you.

(never been an issue for me ...and i've had many many procedures
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A few comments from an insider, in no particular order.....

--Propofol is a very nice drug and safe drug. Unless you are a dumba$$ like Micheal Jackson or his pretend physician. Its effects are almost like a light switch, off and on, with very little after effects. Has almost no nausea/vomiting. Unlike the drugs used for moderate sedation. I have had one too many friends spend the rest of the afternoon puking their guts up and holding their head over the toilet because the GI doc doesn't know better.

--having an anesthesiologist is a safety factor. With a sicker and aging population, even giving moderate sedation is not without risk. Think of driving while texting, not a good idea. Having the GI doc doing the procedure and directing the nurse on how much sedation to give and monitoring the patients respiratory status, blood pressure, etc., etc. is an equally divided attention situation. You might get by for awhile, but sooner or later you're asking for trouble.

--I'm sure malpractice insurance plays a role in this. One too many filings against GI docs for complications/deaths while they weren't paying attention. "Do you swear to tell the truth, the whole truth, so help you personal deity?", "Yes", "Are you board certified or have received any extensive training in anesthesia/sedation?", "No", "Plantiff rests its case your honor". Bam, insurance rates go up. Same thing happened with OB/Gyn's that used to do their own labor epidurals. Too many things went wrong and insurance companies quit covering.

--knowing you're having general anesthesia and NOT finding out if the anesthesiologist participates in your insurance plan is YOUR fault.

--many insurance companies have started denying reimbursement of general anesthesia in adults for GI procedures. Unless extenuating circumstances are documented by the GI doc/internist. Multiple medical problems, dementia/uncooperative, etc., etc. They still reimburse without question for pediatric GI procedures (under 18). It might change after one too many insurance CEOs/families have one too many FUBARs.

--the over billing you can blame on the government and Medicare/Medicaid. Its not an attempt at making up for low/no reimbursement of M/M. Its to actually maintain a normal bill. M/M reimburse based on local "customary rates". Say I normally charge $100/hr. Insurance companies negotiate a 50% discount. M/M then look at that customary rate and reimburse 20% or $20/hr. So if I get someone in a plan I don't participate in, I charge them $100/hr. If I said $50/hr, M/M would come in and say, OK 20% of your new customary charge is now $10/hr. Insurance companies usually try to negotiate off M/M plus X%, so they would be trying to lower things when contracts are up. So you could soon be in a death spiral of lower reimbursement rates. Yes it sounds like a stupid circle jerk but its called self preservation. I do enough free care as it is.

--if you think things are bad now, wait till healthcare is "free". Your anesthesia could be a choice between a mallet or a stick. Assuming you survive the waiting list.

JLC
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This has happened to me.

It is very frustrating but one learns to be very careful if you have PPO insurance (preferred provider, where in network facilities are covered, but out of network may received less than 50% coverage.)

To find an in network gastroenterologist, usually you go to your insurance company's website. But then to find that the doctor has chosen an out of network facility (where often he is part owner) or anesthesiologist is infuriating. The surprise usually arrives only when you get the bill or notice of coverage from your insurance company.

Even though you may be paying thousands in annual health insurance premiums, this means you are only half covered and can end up paying over $1000 in uncovered charges.

So you learn to get a list of all firms who will be billing you and call your insurance company to be sure each is in network.

And by all means call the doctors office and scream about the out of network charges. Next time, find another doctor.
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After having found the time to read the article/blog, I have to laugh. The one main plaintiff actually works for in a field that covers health care. So why was she surprised about some physicians NOT participating in insurance? I think I see why she needed a colonoscopy, she had her head up her a$$.

The article/blog was a little one sided. Yes the one MD didn't respond to calls. But you think you could've talked to another anesthesiologist and perhaps someone that works in medical insurance claims?

The bills themselves didn't seem too outrageous, IMHO. Probably more than what I'd get but in the general ballpark. Many people need to think of anesthesiologists as insurance. Usually our job is boring and we like it that way. But when the sh*t hits the fan (pun intended in this discussion), you don't want some amateur (the GI doc or nurses) trying to resuscitate/rescue you. You want a pro, and that would be me.

JLC
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"Many people need to think of anesthesiologists as insurance. Usually our job is boring and we like it that way."

I guess so. Some time ago there was an anesthesiologist in the Virginia Beach area who did not bother to monitor the blood pressure of his patients while they were under. He just wrote down some good numbers in his report, but never actually took the blood pressure. Finally somebody noticed (why not earlier?), and he lost his license.

Personally, I think I have heard of machines that do that and and keep the records themselves. That would make the job even more boring.

The first time I went under I was about 10-12, and I had my tonsils out. The doctor used ether (other stuff had not yet been invented). He told me to take a deep breath, and, trusting child that I was, I did. THE STUFF WAS TERRIBLE. Then he had to hold me down. The last thing I remember is him saying to me "Don't worry, it don't hurt much". My last thought before going under was "This guy is operating on me and he does not even know good English!" Well, it was in Texas.
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Some time ago there was an anesthesiologist in the Virginia Beach area who did not bother to monitor the blood pressure of his patients while they were under. He just wrote down some good numbers in his report, but never actually took the blood pressure. Finally somebody noticed (why not earlier?), and he lost his license.

I had a couple of attendings in residency training that made comments about recording vitals, etc., during the case. One said, you're not paid to be a secretary, don't get caught up in writing everything down exactly how it goes. Take care of the patient first and write when you can later. Another said, you make the chart up to make the case look like how you wished it went, not necessarily how it actually went.

My own theory of charting. No one else will see this except the workers in medical records (and they are mostly looking to see if everything is signed in the write spot) and potentially a lawyer. Neither of which I care if they can read what I write. But I fall more in line with taking care of patient first, records later.

Personally, I think I have heard of machines that do that and and keep the records themselves.

Those came out while I was in training, so early 90s. Like trying to build something idiot proof, you just build a bigger idiot. We had one for a test drive. You spent more time typing in corrections to erroneous readings that it hurt you more than it helped you. Too many ways to interfere with BP cuff reading (surgeon leaning on it), electrical interference from other machines and the EKG (don't want to spend all case "correcting" a documentation of V fib every 5 minutes), you name it you could mess it up.

That would make the job even more boring.

That's why you download the Words with Friends and Sudoku apps.

JLC
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