Angry Patients Stuck With Big Medical Bills After “Bait And Switch”

By Joe Shortsleeve, WBZ-TV

BOSTON (CBS) – The national health care reform law requires insurance companies to cover 100% of the cost of screening tests for dozens of potentially deadly diseases. But thousands of patients are finding out the hard way that free doesn’t always mean free.

When Jim Dungee had his first colonoscopy, doctors found several polyps, which are a precursor to colon cancer. “Therefore, I had to come back in three years,” he said. The three year mark was back in December. Knowing the test could save his life, Jim did not hesitate to make an appointment. He even called his insurance company to make sure it was covered. “I was told as long as it was put in as a preventive procedure, it was covered 100%,” he recalled.

WBZ-TV’s Joe Shortsleeve reports

Jim had the test and never gave it another thought until the bills started rolling in for his free screening. “Clearly a bait and switch, I was told one thing and they did the opposite,” he said.

Here is what happened. Doctors found more polyps during Jim’s second colonoscopy and removed them during the procedure. That, according to gastroenterologist Giancarlo Mercogliano, changed everything. “When we do the procedure and we find something, it’s no longer considered preventative. It becomes diagnostic,” he said.

That distinction left Jim on the hook for all kinds of co-payments and deductibles. He got one bill for $388 dollars and another for $64. “While you’re under anesthesia, they are actually changing the way you are going to be billed,” he said.

These surprise bills are not isolated to colonoscopies according to breast surgeon, Dr. Jennifer Sabol. She sees it happening to patients who are called back when their screening mammogram turns up something suspicious. “You have to come back on a separate day for that. That procedure is then called a diagnostic test,” she said.

Some insurance plans will cover the entire cost, but many of the more affordable plans with high deductibles, will not. “It’s been a big problem because patients are going to the less expensive insurance plans,” Dr. Sabol explained.

“It’s sort of an unintended consequence,” explained MIT professor John Gruber, who advised President Obama on health care reform. According to Gruber, the plan is not perfect but it does provide free access to screening tests that many patients might not get if they had to pay for them. “It used to be it cost money no matter what. Now, it might be free and it might cost money,” he said.

Jim Dungee believes doctors need to be upfront about all the potential fees, particularly when it comes to test patients assume will be free. “I just feel so, you know, ripped off,” he said.

When a CBS producer contacted Jim’s insurance company they agreed to waive his fees, but under the rules, they didn’t have to. If you are having a screening test, talk with your doctor to make sure you understand all the potential costs involved.

  • Ellen Sing

    I just saw this clip on channel 4 boston. I was horrified by the term “free.” Paying premiums to health insurance companies do not make preventative procedures “free.” In Massachusetts, we pay dearly for our health insurance premiums and nothing is “free.” We pay into the insurance companies and can spend months and years not going to physicians or using our insurance health care benefits. When we use one benefit that is a covered service, all of a sudden you consider it free? No, no this thinking is very wrong. We could spent years not utilizing benefits while still paying hefty monthly premiums.
    If you have car insurance for 5 years and all of a sudden you get into one accident, is the insurance company giving us a free service by fixing our car.
    No they are not. That is what insurance is for and that is why we pay premiums and this is what insurance is for.

    • Uncle Omar

      Auntie Zeituni says you are wrong, that healthcare is free.

      • Batman

        It’s free for most of 0bama’s supporters. The taxpayers foot the bill

    • Pilot.Dave

      The takeaway from the story should have been that Healthcare Reform as written was never intended to change the COST of healthcare, but spread the PRICE around to many healthy people who were not buying insurance in the first place. So, the cost will continue to rise after the initial equilibrium is reached. Just look at MA’s system….

      Root causes of the high cost range from malpractice litigation, settlement, and insurance, “defensive medicine”, the customer never see’s the price of what they are buying before they purchase (us patients), and the structural fact that we are the only country in the world where MOST people receive their healthcare coverage from our employer (with most of them NOT buying actual Insurance but rather paying an “Insurance company” to pay the bills, and pass them on to the employer to pay with a small administrative fee.

      • bumpkin

        Not only that, but a patient asking a doc what charges they can expect to incur is like asking a fish what bait s/he will be offered! Look; the docs never, EVER know what the insurance companies will cover and not cover- they are too busy doctoring.- being docs. Ask the receptionist- the outer office is the responsible party for billing insurances, et al. You can expect doc to refer you to the front desk, then the person that tends to coding/billing part of his/her practice. It’s MUCH easier to call the insurance office, BEFORE the test, and BE sure to ask for the rep’s name and employee number, if they use one, when you ask for the information, then write it down, verbatim, while they wait-so you have a ‘leg’ to stand on when you complain that you were misled. Then you can ask “is this correct?”, when you finish writing. THEN, and only then, will they have to consider making their information stand after you were told something.

    • Peter

      What’s the point of “screening” people for “free”, if they can’t afford the treatment? If they’re fit, the screening accomplished nothing. If they’re sick and can’t afford the cure it also accomplished nothing.

      • snewsom2997

        Free is like fly to honey for people, you could give free anything and they will be happy to take it, without caring what is involved, I venture not 1% of average people have read the legislation regarding Masscare or ACA much less their actual Insurance or Medicare Documentation, chances are most wouldn’t understand it either.

    • John

      This commwnt is right on!!! Whoever screens the “news” as it is finally aired should hold his/her head in SHAME. The whole piece is disingenuous, and obviously intended to scare the public, not report the news (of course, we know that these are not news programs, but rather entertainment, for ratings. Aren’t world events in the public domain? If so, how can reporters accept payment for their “work” yet chastise medical facilities and doctors for charging for their services? (and consider the relative salaries of all involved) Finally, if this “news” piece were truly news (which, considering the inaccuracies and the clear editorializing, as well as the intentional scare tactic, it is not), how, then, can WBZTV advertise for this piece for several days in advance? It is disgraceful!!!!!

      • mike Smith

        I don’t quite understand your comments. The article was about a sort os shell game that patients aren’t aware of. This patient was not given the correct information, or not enough. It’s not a scare tactic, it is simply scary. I’m assuming, you are a supporter of Obamacare, but if I’m wrong, please forgive me. Many of us are having ar difficult time understanding Obamathink and Liberalthink. With apologies, it is without logic, all emotional and without any rational conclusions.

      • Ignorant Cons

        O’Romneycare starts in 2014

        We only have Romneycare today, and that has nothing to do with this article.


        Another 5 letter word for Fraud…

  • Harriet

    A very weak,misleading story. Was the physician to leave the polyps in place? Either way, patient incurs the deductibles at some point. Does patient prefer to have a 3rd procedure at a later time to remove the polyps–maybe when it’s too late for a cure?

    Shame on you for headline “Bait and switch”!

    • JMac

      I agree completely. For $452 this man is blaiming the doctors for his obese life style and the doctor may have saved his life. Pretty cheap to extend his life for a few more years of sloth.

      • Linda

        What planet are you on? I am a 50 year old woman, who regularly passes for 35. I am 5’6″ tall and weigh 120 lbs I am fit, healthy – no meds, exercise, eat well and guess what?! My Dr found 2 polyps during my exam. So, whatever….

    • Ryan

      The point is this: They almost ALWAYS find polyps, and they don’t TELL you what it will really cost. It just happened to me. Mr. Doctor said I’d turned 50 and time for a routine screen. I called insurance and they said “it’s covered”. I had two Polyps, and now have a total bill of $3148! which I do not have. If they had told me the truth and given me the facts, I could have made a better decision. It IS bait and switch. It’s a total scam.

    • Floater

      +1 @Harriet. That $452 could possibly have saved him $1000’s if those polyps turned into tumors and possibly saved his life. Had they not found anything that would not have been charge (not free).

      Our society has become so short-sighted. Instead of being thankful he healthy, he’s p!ssed because he’s out of pocket a few hundred dollars.

      Whatever happened to the old saying – “at least I have my health”?

      • kiabuk

        Don’t think it’s about out of pocket, but the big lie of Obamacare being more affordable, while getting the best quality care Americans have come to expect. No way this will happen. Obamacare = increased cost and subpar care.

      • maxtor

        not the point!!!

    • JC

      Exactly. Great point. And it’s actually the lousy coverage these people have from their coverage that is to blame, not the preventative tests.

    • picklewalker

      You are right. It wasn’t the doctors fault that the insurance company did not cover the procedure.

  • Stuart Steller

    I just saw this clip on channel 4 boston this evening and it seemed like Dejavu. I recently went through the exact same procedure and was billed similarly upon completion of the Colonoscopy. I have spent countless hours on the phone with the Insurance provider as well as the GastroIntestinal Group, the Hospital where the procedure was done and the Lab to re-submit their billing as a Preventative measure. My Primary Physician’s office would not even make a call to anyone of the parties to try and help with a resolution. Last I was told, it was under 2nd level review and may get some type of resolution within a few months but that the resolution may not change the outcome. Can you make any suggestions or can the Investigative Team at the station assist me in getting a resolution?? Thank you, Stuart Steller

  • TG

    It really gets me steamed that Dr’s are being characterized as con artists in reports like this. As a medical biller you see insurance policies with these insane regulations of what is covered. We have to bill what the Dr does and I’m shocked that after the Dr removes TWICE polyps from this colon that anybody thinks it’s cosidered “preventive” . The adverage Dr’s office cannot tell prior to a testing like this if it will be 100% covered not knowing if polyps developed again. The sad thing is if the government makes this Medicare cut quality care as we know it will get worse because the other insurance companies will follow with cuts. Patients need to question their coverage and be educated of benefits. If gov is looking at Dr ‘s they also need to look at the insurance companies too because their greed makes Dr’s jump thru hoops to get paid.

    • EF

      exactly TG I work for a health insurance company and what is and is not covered in in the member’s evidence of coverage handbook, but I doubt very many people read that.

      • Geroge Bush

        That book is about 100 pages of double-speak and I get a new one every year. I bet you never read yours cover to cover either EF.

        That is like the credit card terms, I read them to a class of MBA candidates and they could not agree with what was being said. I bet it is the same if you read that coverage handbook to a bunch of Doctors.

      • tray117

        And most Americans can read this handbook in its entirety and completely understand the legal mumbo-jumbo and double-speak. Right.

  • RS

    Company I work for- coworker goes to New England Baptsist Hospital, colonoscoy, no charge, covered by our BC/BS plan. I go to a Colonoscopy Center, They accept BC/BS- who has informed me that this is exam covered under the plan. They are not happy with the payment from BC/BS- bill me for whatever they feel they would like to. How about we do not execpt BC/BS as payment before procedure– Bail & Switch, YES!

  • Jim

    I have the insurance that screws you if they find a polyp. I have money, so I get the test done regardless of any extra expenses that may be incurred. Now think about someone who is troubled financially, they are going to think twice before having a procedure that could end up costing them money. As a result, these people may put off or not have this very important test. Now, some of those people may develope full blow cancer. That ends up costing the insurance company hundreds of thousands of dollars for long term care and everything else.
    Instead of nickle and diming people that are found to have polyps, the insurance companies should send thank you cards to everyone that has had this test and has very curable polyps removed, instead of punishing them with bills.
    The current system that is in place sounds stupid because it is stupid.

    • Terrance

      Many of you are missing the big picture. There is no such thing as “free.” When Obamacare mandated that screening procedures be covered 100% with no co-pay, what did you think would happen? That the cost wouldn’t shiff? That the insurance companies would just absorb this? Sorry to break it to you but they aren’t in business to give their services away. And it’s also about time that we as consumers take some responsiblitiy. Imagine what your car insurance would cost if you demanded that your insurance company cover every expense related to owning an automobile: all your oil changes, tires, batteries, gas — your premium would be ridiculous. Yet we expect health insurance to pay for every last aspirin – and then we act all shocked and surprised when health insurance premiums go up. It’s only going to get worse – the more stuff that Obama and his minions decide has to be given away, the more it’s going to cost you in the end (so to speak).

      • Resist Now

        If you think medical insurance is expensive now, wait until Obamacare makes it free!

      • Geepa

        Well said and exactly right.

        I’ve been in healthcare for almost 40 years. The only time I’ve ever seen medical costs go down was with out-dated/out-moded treatments/medicines.

        Obamacare was sold to the American people with the idea, in part, that it would decrease costs. Hear me now and believe me later – costs are NOT going down.

        The best thing you as an individual can do is vote Obama out of office so the new Rebublican president can repeal Obamacare.

      • JMac

        Exactly right. If you have ‘real’ insurance, wait to see how expensive it becomes. But, if you have Medicare, or no insurance, it’s all free. More entitlements for people who don’t work, or lie and live off the government. Stop the entitlement run away train, NOW. Vote Oblama out. But since more than 48% of people live off the government, out debt will only doulbe again. Here comes Greece.

  • tsalnew

    It is not clear whether the gentleman called his doctor to find out how he bills the procedure. A call can never stop with an insurance company. It’s bad enough we have to start with one since mostly they are full of double talk. I had four colonoscopies last year and wasn’t charged. I have another this April and my husband has a three-year in a few weeks. You all may not like this article but I think it brings to light what we need to do to advocate for ourselves

  • firemanmark

    Do what Aunt Zoonie and Uncle “I think I shall like to call the White House” would do.Send the bill to Obama,Pelosi,Reid and the rest of the Socialist criminals on Capital Hill. They want socialized medicine? Let them take it out of welfare and medicaid accounts.Stop giving the real”free stuff” to illegals related to Obama!

  • travis

    Nothing is free. We pay threw the nose every week for Medical Insurance that most people use maybe once a year. So we get told it preventive checking and then they do something to cost the ins company less in the long run and we get billed for it. Why should we get checked then. I rather get really sick and make them pay through the nose for all the treatments you will need. If treatment is done in a preventive matter it shold not be looked at as a seperate percedure.

    • Resist Now

      This is like not changing brake pads and ultimately running into a wall and then demanding everything you can from the insurer to get the car fixed.
      You, travis, are a moron.

    • BevfromNYC

      And THAT is what insurance should be for – for when you are really sick. Not when you get a routine coloscopy. We should bare the cost for the preventative procedures and the insurance should pick up the cost of the diagnostic procedures. Not the other way around.

      Car insurance companies don’t pay to have the oil changed and the tires rotated. Homeowners insurance doesn’t pay to change a lightbulb or checking for termites. Why do health ins. companies have to pay for routine preventatvie maintenance?

  • Nick C.

    Joe Shortsleeve was once a respected news man. Now he’s a caricature of a tabloid reporter. Sad.

  • Cindy Lou

    Joe – Thanks for doing this story. Same thing happens with Mammograms…if radiologist wants an additional picture a week later, it is no longer a wellness coverage but a diagnostic…even the folks I spoke with a BCBS think its unfair. They won’t cover the additional call back at $250 but BCBS is fine paying the $100k for breast cancer…makes no sense!

    • Leslie

      Especially since there could be a hundred different REASONS the mammogram comes of suspect. Some of those reasons can because it’s a bad picture or the radiologist sucks at reading them or you moved minutely during the x-ray….who knows, but I think a follow up should be included for any test.


    FIRE OBAMA! 2012!!!! Go SANTORUM!

    • Immolator

      I’d rather set myself on fire than vote for Santorum

  • Tom in NY

    Obama is as Obama does.

    When you mandate “free” someone always still pays for it.

    • Resist Now

      The trouble with Socialism is that eventually you run out of other people’s money.

      • Geroge Bush

        So you don’t like your socialist Romneycare?

        Reagan raised taxes 11 times was he a communist?

  • suzy000

    It happened to me too….my son’s pimples has turned out to be a $1300.00 Bill…NO LIE! In the days BEFORE OBAMA..we paid our co-payment up to $250.00 max and we were done…now after our premiums have gone up 87% in the last 3 years I am paying out of my ying yang for silly stuff. We have stopped getting healthcare because we are tired of not being able to have what we need throughout the month. It is either EAT or have GOOD HEALTH…what a shame we have to pick. No way am I voting for Obama…anybody but Obama!

  • Brian

    Sooo, for less than $500, he prevented a possible horrific death. He obviously has money to spend on food, so why he’s whining about a life saving procedure boggles my mind. Glad they got rid of the polyps, zero pity for him.

    • Elsa

      Exactly my thought. He probably eats 500 bucks a week in junk food.

      • Linda

        What planet are you on? I am a 50 year old woman, who regularly passes for 35. I am 5’6″ tall and weigh 120 lbs I am fit, healthy – no meds, exercise, eat well and guess what?! My Dr found 2 polyps during my exam. So, whatever….

        Oh, and just to be clear – I hate Obamacare

  • Richard Williams

    “$388 dollars and another for $64.” And that’s all he’s got to complain about?! What a cry baby. From the looks of him, he’s not missing any meals. Good grief. Insurance companies are not benevolent societies. They HAVE to make a profit to survive. This entitlement attitude is going to be our downfall.

    • george

      And empty promises of “free” medical care play right into that very same entitlement attitude. The more something is “free,” the more it ends up costing in the long run. Somebody has to pay for everything.

  • mike

    Why is this guy complaining about bills totalling less than $450?? I pay $130 a month for my health insurance, and the last time I had an MRI it cost me $900 out of pocket. So this guy should stop whining and be happy that the docs removed the polyps, good grief.

  • ClearyJ

    the problem is very simple: The Messiah is trying to order some people, whoever he can bully, to work for free. If it’s not the doctors, then it’s gotta be those working at insurance companies. If it’s not them, then there has to be some other villain – perhaps wascally Wepuwicans. But no one works – willingly works – for free. And being forced to work, whether paid for or not, is slavery. Essentially, The Messiah wants to find some slaves somewhere that other people will accept. And given the ancestry of half of him, he should know better. That he doesn’t is an atrocity.

  • Radiologist

    People have no problem spending several hundred bucks on the latest iphone yet for some reason expect the skill and knowledge of physicians who spend 10+ years in post-graduate education to be free. It’s sickening.

    • Herzen

      Yeah. And did you notice you work in the ONLY two segments of modern commerce that are largely EXEMPT from racketeering and the most basic consumer protection laws? Can’t remember who the segment entities are?

      1) Hospitals

      2) Universities

      Even the major political parties don’t have the brass to overtly practice and actively commercialize racial phrenology and eugenic racial hygiene under the guise of postmodern euphemisms like social justice or ‘medical ethics”. Which human life is worth more? What credentials are necessary to function as a gatekeeper in denying any citizen access to technology capital? Who else but postmodern medical academics could rationalize a national policy of mass murder by exclusive neglect. And here they so pridefully voted for the first Black President who was also half-white by application of the same delusional scientism on which the neo-Hegelian academy is precariously based.

      Medically-speaking, and with the highest academic integrity, perhaps someone can empirically demonstrate in double-blind tests how many drops of what blood made our President the first Black President who was half-white?

      Perhaps they might the Pantone chart of blackness and whiteness these great minds have used to craft the modern hegemony of discredited europhilia that animates the childish institutionalism that neuters candor and forbids its members bold action as intervening, responsible adults.

      No wonder Obamacare is a disaster. It came from an academy awash in intellectual sepsis, molested identity and malignancies of narcissism.

      Perhaps this is why university physician-product of today is largely stillborne.

      Those who escape the conditioning will have to learn anew, and with an authenticity that cannot be found in academic medicine.

      “Free” care is the big lie that universities have championed where the academics within plot to impose upon those who actually see patients for a living. As all have been dehumanized, it doesn’t feel like telling self-enriching lies that provoke predatory entitlement in others to expect a human right to steal from others.

      Mark my words. Millions will be killed before their time under Obamacare. For their own good, of course. We’re just too unsophisticated to understand our betters. There are so many clever ways to orchestrate ‘murder by neglect.’

      And thousands of typed pages of unproven regulations, policies and procedures to help cover the tracks.

      Welcome to the Age of Academic Experimentalism.

      Hegelian Supremacists without a Clue.

      • Geepa


    • AMY


    • Trey

      Get me my free medical care while I finish this Big Mac and Fries.

    • rodlou9

      No one expects “free” healthcare, but considering how many people those wonderful and skillful “physicians” kill every year due to misdiagnosis and malpractice, you might want to back off a little on the praise.

      • snewsom2997

        People go to doctors when the are sick and dying sometimes the doc cannot do anything about it. Doctors are people not gods, want perfection in your healthcare pray to god, want man’s best efforts go to the doctor.

  • AJ

    Same thing happened to me a few months ago with some blood work. I go to the doc one every three years or so. Insurance clearly siad preventative appointment free. Doc did some additional testing, and then put it as diagnostic on paperwork. That’s why I have catastrophic coverage only and that still costs me $400 month. Medical system is terrible.

    • lou skunt

      problen is medical insurance and moronic reimbursement system that is driven by government mandates. Doctors have to jump through hoops and get paid less for a colonoscopy than a plumber would charge you to fix you toilet. CPT code for colonoscopy is 45383 – look this up on a Medicare fee schedule – doc gets paid less than $350. Lets see, 8-10 years of school, $50,000 year in malpractice insurance, $100,000+ in school loans … and you get to look up some old guys hairy azzhole for 350 bucks!

      • snewsom2997

        It would be far less if they actually ran medicare like it is legislated, hence the reason for DOC FIX every year,

  • PCWarn

    Seriously, $388 & $64 is what this guy is carping about. What have we become…

  • snewsom2997

    Sucker’s, nothing is free, no one can promise you anything for free, people reap what they sow. Learn how to read your contract and learn the difference between preventative and diagnostic, all those words actually have meanings, real ones in a dictionary. Go in for a Colonoscopy and they find nothing and it is free, just like they advertised. Once they find something it is no longer preventative.There is a price to be paid for only having an 8th grade vocabulary.

    • Myself

      I went to get a check up and vaccinations under the 100% preventative. The doctor discussed my dry skin – no treatment plan or Rx was advised. Dr. billed insurance for the preventative visit and a visit for a medical condition; and billed for vaccines and for administering each one. To summarize a 15 min preventative visit was billed at $600 to insurance. And, I now have a doctor visit charge to pay for. Had I known, I would not have seen the doctor.
      This is why the AMA supported Obamacare – to increase patient visits to come in for wellness, and then to have the chance to “find” a problem. Now, they can double bill. And, never do they think that they have an obligation to discuss the charges they will be submitting to the insurance company. The day needs to come where doctors are transparent with their pricing so that we as consumers can know beforehand what our financial liability will be.

      The only ones that lose are those of us that pay for our insurance as the insurance companies have just built this additional cost into the premiums we pay.

      • doc

        I’m a doctor. I’ve worked at three places. I’ve never known what we charge. Its dictated by the insurance companies. I could never answer that question if you needed me to and I wanted to.

        All we do is document what is discussed with the patient and exam findings as well as an assessment of what is going on (diagnosis) and then a plan. Billing is done according to documentation. Not billing according to the documentation can be labeled as fraud by the government.

  • Joe

    for $450 Dollars??! Holy Crap.. And it probably saved his life…

  • Peter

    So he had to pay $400 bucks. What is the actual cost of that test without the insurance company chipping in? I’ll tell you, at cost the price ranges from $2000 to $3700 depending in part on the geographic region where it is performed. Nothing in life is free and the rest world owes the individual zippo. If you are destitute, there are federal programs already in place to help financially. If you are too cheap to pay the 10% to 20% of the actual cost to receive the test then don’t get it. Take your chances. Oh I’ve got a great idea “free” government healthcare. That will be great until the government says you aren’t eligible for the procedure because due to your age and other health conditions, the process would not be cost effective in your particular case. Take this pill for the pain and wait to die. Coming soon…..

  • Small Shot

    I had one done several years ago with the same insurance lie. I just finished paying the bill and I am a year and a half late for my 3 year follow-up. It’s a fearful shame when the medical community is not committed to financial honesty.

    When I finished paying, the practice sent me letters saying it was time for another procedure. When they called me to set up an appointment, I told them I had no insurance and they stopped contacting me altogether for the procedure.

    It makes you wonder if their integrity is also hindered when it comes to the medical procedure itself. I wonder why they don’t deduct the original procedure amount and forward the difference to the patient. It’s all or nothing. Maybe that’s why they started selling that type of insurance. It would bait the people to buy the seemingly “win, win insurance’ for the preventative only, when they know full well how much they would save with these “finding something” rejection situations.

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