Aurora Advanced Health Care Anne Feltmeyer - Quality and Risk Management Department Colonoscopy Bait & Switch Milwaukee Wisconsin
My doctor ordered what I thought was, a preventative colonoscopy procedure. Days later I get a call from Aurora saying my payment would be approx. $3K (!) because it was ordered as a "diagnostic". I immediately emailed my doctor who ordered it and asked why this was being ordered as a "diagnostic"; I've had no problems or issues ever. I stated (in writing) I would not have this procedure if it was not covered by my insurance.
Shortly thereafter, my doctor's office emailed back that my procedure WAS ORDERED AS A "SCREENING" and gave me the code so I could double check the coverage with my insurance. I then called Aetna Insurance and gave them the code my doctor gave me for the screening procedure. Aetna said the procedure would be covered at 100%. Relieved, I went a head and had the procedure 2 weeks later. Three weeks after that I received a WHOOPING BILL for $3681.81 as it was billed as a "diagnostic" procedure and Aetna would not cover it.
In my fight against this, three Aurora department officials stated to me that since I had a colonoscopy in 2013 which a polyp was removed, all subsequent colonoscopies for me in the future are ordered as "diagnostic". This is Aurora's policy. Why then, would my doctor order this as a "screening" and worse yet, TELL ME it was a screening? She's a long-time doctor within Aurora, an internist, and even married to an GI doctor who works within the same Aurora system. I just don't understand this and I hate to think this is a common deception that is being used, but my doctor has not replied back to my inquiries on this issue and no one else at Aurora is addressing this.
You would think an established Aurora internist doctor would know the correct coding guidelines to order procedures at her clinic. One official did acknowledge that I received "inconsistant messaging" and sent my case to Aurora's Quality & Risk Management department but they reviewed my case and saw nothing had been done wrong and addressed EVERY issue BUT the issue of my doctor ordering this procedure incorrectly. Bottom line is that I RELIED on what my doctor told me in order to decide if I would have this procedure. I feel bamboozled.
Anyone have a similar story?