Trumpcare? Obamacare? Who cares? This is about a colonoscopy – Ironic, no?

With all the controversy and blatant partisanship, it’s difficult to know what’s in the new healthcare bill.  Obamacare has been pretty much a disaster, so much so, that United Health Care was expected to lose almost a billion dollars in 2016 and therefore dropped out of many of the exchanges (SOURCE).  Trumpcare will hopefully not be the same mess but my guess it will be filled with stuff people just don’t like–same as Obamacare.

One of the major issues with ACA (Affordable Care Act or the uACA- – unaffordable care act…) is the premiums and high deductibles.  This short article isn’t about Trumpcare or Obamacare exactly, it’s about a failing healthcare system.

You see, my sister was very recently diagnosed with stage IV colon Cancer and is currently undergoing chemotherapy.  All the medical experts agree that a screening colonoscopy should be for individuals 50 years or older.  They also agree that a screening colonoscopy should be for anyone with a first-degree relative (mom, dad, brother, sister) with a diagnosis of colon cancer 10 years before their relative’s diagnosis.  Meaning, since my sister’s diagnosis was made at 46 years old, her sibling (me) should have a screening colonoscopy at 36 years old. Well, I’m 42, so I should have one, obviously.  I meet all criteria, right?  ONE WOULD THINK.  I was told that my colonoscopy will cost upwards of $2,000 when all is said and done (my deductible is about that much, so it’s all out of pocket!  If it goes over my deductible, I will have to pay 30% on top of that).  I called BLUE SHIELD and they told me,

“I’m sorry, but we only cover colonoscopies for people 50 and over, period.”

 I said, “but wait,  my sister has colon cancer and all the experts agree that I should have one…this is standard of care.”  “Sorry,” they said, “it will be billed as a diagnostic colonoscopy”  (aka: not covered).   A screening colonoscopy is covered 100%.  A diagnostic colonoscopy is billed against your deductible and co-insurance.   I hung up the phone furious because that’s a lot of money to come up with out of pocket.  I also forgot to mention they want the fees for the facility before the procedure!  That begs the question – “If one can’t afford to pay, do they simply run the risk of missing a cancer diagnosis?

Logic 101 (Thanks, Jenn): One would think that if someone has a greater than average risk of cancer (1st degree relative with cancer), that the insurance companies would want to find, diagnose and treat quickly instead of waiting until a cancer is present,  correct?  Why?  Because the cost of treating a patient with cancer is much more than the cost of treating a potentially cancerous polyp.

Image result for understanding coinsurance deductible

So, knowing that my colonoscopy wouldn’t be covered,  I did what any “concierge doctor” would do, I asked, “How much would it be if I just payed cash?  I was told the facility fee with anesthesia would cost $750, which doesn’t include the doctor’s professional fee.  Still, even with a “professional discount,” my cost will likely be 50% less than using my health insurance.  It’s atrocious.   We spend so much money on monthly dues for basically a useless plan.  Granted, if you are hospitalized, the deductible is minute compared to the billed fees from the hospital.  Insurance is supposed to be for catastrophic events, just like car insurance.  Huh?  Let’s break it down:

Car insurance is paid (in whatever interval you pay).  Car insurance doesn’t pay for tire changes or rotation, oil changes, windshield wipers or fluid adjustments.  Car insurance (health insurance) is supposed to pay for your car (self) once it goes in the shop (hospital). Got it?  Preventive maintenance doesn’t need to use insurance because it’s typically inexpensive to provide these services (whether automotive or healthcare).  This is why concierge medicine (cash based practices with incredible access to your doctor) is on the rise.  

If Trumpcare introduces catastrophic care (high deductible/low premium) as they should, concierge medicine (direct primary care) will flourish even more than it is now.  Why?  Because who doesn’t want same day access, wholesale medications, long/unhurried appointments, 24/7 access to their doctor and a doctor who really knows you?  That’s why I offer my services – because I want to provide what you want, and I don’t want to work for the insurance companies anymore.  

I digress.

The moral of the story: In an environment where our healthcare field is failing, one must look outside of the proverbial box to find alternative ways to have care delivered.  Maybe that’s concierge medicine.  Maybe that’s asking for cash pricing wherever you go.  I don’t know what your answer is, but when a healthcare system that was supposedly going to make our lives better has their hands in our pockets, it’s time to call them what they are…thieves.



Postscript:  I want to acknowledge that there have been people that have benefited from Obamacare/AHA – It’s not an all good or all bad situation.  I hope that in the future we will see improvements which benefit not only our health but our pocketbooks as well.



A Frustrated Dr. Mike

About the author

I am a Board Certified Family Practice Physician (MD) that has a passion for the proper treatment of patients. We are more than just our physical beings. We are complex and the current medical climate is failing both patients and physicians. As a new author, I feel passionately about letting everyone know how the system is failing us, moreover, how to overcome these barriers!

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Michael Lewis, MD
I am board certified in family medicine and passionate about caring for the whole patient: mind, body, spirit. I am married to a wonderful woman Jenniffer, who is a clinical psychologist and works right here in Willow Medical Center. I have a 7-year-old daughter, Bailey who is the light of my life. I am a soul searcher for myself and others. I also love to help men reach their potential as a conscious male. I am also a musician/guitarist. I have found that nurturing this part of my brain helps me think out of the proverbial box and provide better medicine.