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.

Comments (158)
  1. Steve says:

    What are you all crying about. This is exactly what you wanted. You were warned over and over and over again that if you voted Obama in to the White House this is what you would get. A do nothing Socialist President, And with that comes, Higher health care costs, Higher gas prices, Higher unemployment, Higher forclosures, Higher taxes, No pipelines, No drilling, Failed Energy Companies, Billions of our tax dollars for bailouts, More food stamps, More welfare, Failed foreign policies and on the verge of WW3. He wooed you sheeples with his speech and promises for change. Hows that going for ya. Stupid Americans!

  2. JC says:

    Don’t blame the law covering the preventative tests for free. Blame the crappy insurance coverage these people discover they actually have under our current “employer-based” when a problem is discovered.

  3. shawn says:

    i wouldn’t pay i wouldn’t even think about it. send it to collections sue me whatever i wont pay, hell id quit my job and work under the table before accepting getting RAPED by my health care provider, seems like a nice lawsuit to me.

  4. Gary says:

    This almost happened to me before I had my “Preventive Colonoscopy”. I went in for the Pre-consultation, and the doctor asked me questions about my family history. Based on the answer that a few of my relatives have had colon cancer, he determined that the procedure was “Diagnostic” instead of “Preventative”. When I called to confirm that the procedure was covered, I was informed that I would have to pay my deductable and Co-pay. I went back to the doctor and argued that by answering questions honestly, I was costing myself money out of pocket. He changed the billing submission, but I still took the chance that they would find something.
    No cost to me if I don’t need it, but steep cost if I do. Seems backward, I should pay if I “Just want it done”, but I have insurance to cover what “Needs to be done”.

    1. ALAN says:

      So to say money you would like to your doctor? God way to accidentally die.

    2. doc says:

      and now your doctor is potentially liable for fraud if medicare takes the time to audit his charts.

      doesn’t matter if you have medicare or not. if medicare finds your doctor is billing its patients differently than other insurance types, that is fraud.

    3. snewsom2997 says:

      Fiddling with billing codes is the number 1 way medicare and medicaid fraud are committed, your doctor just signed himself up for a giant fine and possibly criminal charges for fraud if and when the government decides to check. Once again thanks for making my care cost more so you could pay less, kudos on working the system.

  5. ALAN says:

    I am a physician in NYC and this idiot wants me to tell him what his insurance will and will not cover? Is he out of his mind? I treat patients, and have no idea whats in his contract with the insurance. We help the patient fill out the forms but he is responsible for the bill being paid, not me. Lets hear it for idiots who want others to pay for his service and do all the ground work.

    Note to you liberal idiots expecting to get free coverage. Let me explain to you what many of my friends are doing. They are establishing boutiqe practices in which patients pay upfront, 10K a year. For this money they get free healthcare from the office which includes general maintence and exams. What is not included is any additional costs like medication and such. We are going to let the patients deal 100% with their own insurance and we will not accept any insurance. In other words, we will demand payment up front or no treatment. Many of us already do not accept medicaid and medicare. Good luck in finding a quality physician who will accept the obamacare garbage. ,You get what you pay for.

    1. snewsom2997 says:

      Concierge Medicine has been popping up in St Louis and many other markets as well, and even PCP’s are starting to offer cash prices, just so they don’t have to deal with Ins Co’s. People with money pay their bills, they pay with cash and they pay promptly, and you do not need an army of office people to deal with the government and the insurance companies. This will be the start of a truly two tier system, those with money will get whatever they want and can afford, those without will get the county hospital wards of old.

    2. george says:

      Will this type of practice still be legal when Obamacare kicks in fully? In the U.K. it is apparently legal, but I seem to remember that under Hillary’s universal-care plan it was specifically forbidden. Oh well. The bill has passed, and I guess we’ll still be finding out what was in it until, as they say, the cows come home.

  6. Ron says:

    The last line of the article says to talk to your doctor so that you can understand the costs. I am a surgeon and I can tell you that we doctors have no idea about what is and is not covered by any patient’s individual insurance plan. They really need to call their insurance company themselves.

    1. doc says:

      Can’t agree more. I’m a doctor also. I treat medical problems. I don’t know jack about how a patients insurance works. If I did, you don’t want me to be your doctors.

  7. Lipstick says:

    The guy should have gotten the colonoscopy for free and had to pay for pylop removal.

  8. Ellen Sing says:

    From the various comments I get the feeling that people thought that our health care for all meant that people would actually be covered for services at the hospital and doctors. No it meant that everyone must buy insurance and if they can’t afford the high premiums for a very good plan than they still must pay for insurance premiums because they will be penalized but have to pay for most things out of pocket that way health insurances have gotten their premiums and won’t have to pay very much in benefits.

    Why do you think the insurances in Massachusetts agreed to Roomneycare to begin with?

    Now the hospitals and doctors are agreeing to accountable care organizations because they will be paid not to treat. It will be a whole new way to ration health care and the subscriber or patient will really get screwed because they are paying for something they will never receive. Good healthcare. Why pay insurance premiums at all if the hospitals are getting paid before you use their service at all.

    1. snewsom2997 says:

      They will also be penalized for 30 day re admits for particular DRG’s, no matter the cause of re admission, and bundled payments while now voluntary will destroy any ability to operate a hospital and still accept medicare and medicaid, which hospitals can choose to or not to accept, if they choose not to accept they don’t have to allow everyone into the ER either.

  9. Ed Ward II says:

    I can’t believe these idiots are complaining. You pay a few hundred dollars or you die. Which would you prefer?

  10. bobby quinn says:

    So this guy thinks you don’t pay anything? Ever? 452$. Are you kidding me?
    It is truly scary how stupid people in this country are becoming.

  11. stoptouchingthatmabel says:

    Obama hasn’t a clue and the people appointed to carry out his mission are even more obtuse.

  12. Pilot.Dave says:

    The story should have been about the fact 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.

  13. austin says:

    sounds like shortsleeve is more like shortonbrains

  14. samuel madison says:

    It just feels good to say I told you so…

  15. pyeatte says:

    I recently had mitral valve repair heart surgery. I won’t say what the cost was but my share was $750. I gladly paid with no complaints.

  16. Free is never without cost when the government is involved. When you have and use your own money, you call the shots. When the government is the one that details what the insurance company and hospital are to do to you and for how much, you are their slave and you are no longer in control.

    Pay us what we EARN (at least 16.5% more than we get to take home now just because of the employee and employer FICA withholding, plus more for the costs of insurance our employers pay, retirement benefits, unemployment insurance, etc.) …and let us control our own life!

    I want the FREEDOM to be RESPONSIBLE!

    It is important to have laws that require insurance companies to bid across state lines, not cherry pick by location, health, etc. But when the regulations get between me and my doctor and become a very non-productive shell game, government has gone TOO FAR!

    It keeps getting worse and worse… now they tell us what to eat, what our children can eat, what we can believe is moral and not, who is rich and who is not, and now they are even changing the meaning of the word “marriage”!

    Give us equal RIGHTS, then protect our RIGHTS, but quit micromanaging every little thing with the result of “helping” us be irresponsible!

    Re gay marriage: rather than redefining marriage, simply remove all mention of man, woman and marriage from the laws! We’re not suppose to discriminate in the laws based on male/female anyway! The whole thing was a violation of the church/state separation ages ago when the state started regulating a natural law or religious law sacrament!

  17. statesrule says:

    He should feel fortunate it’s less than $500 for $20,000 worth of medical attention plus his life..how pathetic he is to complain..get a grip

  18. Priscilla says:

    Wow, rather then be tolerant and practice what they believe by simply not saying the words “under God,” these atheists intolerantly want to dominate the rest of society. When I went through my “I may be an atheist” phase in high school, I said the pledge with a pause so those who wanted to believe our country was “under God” could say it and I rejoined at the next word. It is a very simple procedure and secures the rights of everyone rather then intolerantly discriminating against the majority of the folks. Tolerance allows both ways not my way or the highway.

  19. Vincenzo says:

    Rather than remove the polyps, Mr. Dungee should have immediately been awakened from his anasthesia and allowed the 2-4 hours of recovery with the hose still up his butt until he could be asked whether or not he wished to have the polyps removed. If he agreed then he could have been charged the full cost of the re-administering of the anasthesia, the surgery and the post-op recovery process………This is a classic case of “damn the cost, help me now” but don’t send me the bill.

  20. Nancy says:

    It is not up to the doctor to know what your coverage is with your insurance company. Take responsibility for calling your insurance company and clearly knowing what your benefits are. Be prepared. A doctor sees many patients with not only different insurance companies but also various plans from the same insurance company. If a doctor had to figure out each patients’ insurance before they saw the patient, or stop while doing a procedure, to see if it is covered by the insurance, that would be ridiculous and you would be complaining the doctor would not provide you with adequate medical care based on your insurance. I do not see a bait and switch here. I see someone who did not take the time to fully understand their own medical coverage.

    1. RS says:

      Nancy Called BC/BS – understood my coverage included at not cost Colonoscopy screenings – made appointment with doctor- they should inform patients that they do not perform the procedure for the fee BC/BS provides. I spcifically asked. Why would a ptatient go there when there are providers that will provide this procedure under the terms that BC/BS provides? When a patient calls thier office today- do you think that they will inform patient that they will not except BC/BS as full payment. No they will just book the appointment and bill latter- Bait & Switch!

      1. snewsom2997 says:

        It is up to you to know if your insurance company will pay, the doctor only provides the service, doctors are not your Insurance Reps, and the Insurance Contracts are 100 pages long for a reason, it is Insurance they do not make money paying out more money than they take in.

  21. Luke says:

    Think this is bad. Wait till we get the so called national health plan!

  22. Wendy says:

    I worked for a major health insurance company for years! This is not fall out from Obama’s healthcare reform, this has always been happening. If the doctor finds something and bills it as anything but a preventative screening it will be processed under your benefits for a diagnostic test. That’s the way it has ALWAYS been.

    1. Wendy says:

      The real difference is prior to Obama’s healthcare reform, many people with high deductible plans were going WITHOUT these screening tests because even preventative screening tests were covered the same as any other diagnostic test, either subject to deductible and coinsurance or with a co-payment.

  23. Beefo says:

    I got screwed by the insurance company twice. Once for the colonoscopy and another time for a mamogram. Both times they changed it from preventive to diagnostic. Then the Dr. had the nerve to ask me to come back for a repeat in 3 months. NOT

  24. Susan says:

    I read most of the comments and the only one that makes any sense is from Wendy who worked for a health care insurance company. Why is everyone blaming Obama for this? BTW, what is the definition of “Obama Care”? Most of what President Obama wants to put into place is not even in place yet and if you read what his plan is it is to help middle class Americans who are getting screwed by insurance companies all the time. I can not believe you idiots are defending the insurance companies who are laughing all the way to the bank and wall street by you paying your premiums and being denied what should be a covered benefit. Look at the stock market and see how well insurance companies are doing. If you want the truth about how we’re all getting screwed by the insurance companues read Deadly Spin by Wendall Potter.

  25. Susan says:

    To Alan the physician I just went over the comments again. Are you kidding me? You’re a physician and you won’t take medicaid or medicare. Didn’t you take an oath to do no harm? Not taking patients based on their insurance coverage is a disgrace. Why did you bother spending all those years in medical school, internship, residency and maybe a fellowship to come out as a greedy sob. I feel sorry for you and your other physician “buddies” who seem to care more about money than a patient. Wait until the day you’re the patient!

  26. Geroge Bush says:

    ATTENTION IGORANT CONS:

    O’BamaRomenycare starts in 2014.

    We have just pure Romneycare in Mass. now, blaming Obama just makes you look stupid.

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    California long term proper care fees * how you can reduced the price of long lasting proper care insurance policy throughout florida ; locating the optimal along with least expensive term life insurance ; cheapest british isles existence Insuranceubezpieczenia anglia

  28. alfred brunell says:

    we only pay inssurance execs we do not get coverage for our illnesses i now pay for four insurances medicade medicare. a donut hole dental care and also perrscription drug coverage cocaine gives me the same relief i feel good after taking it then get down and take somemore i get no results from either drug deale astreet coner person or in the drug store plus i pay about the same for each and get the same results

  29. brianH says:

    Have had insurance with the samecompany for 20 years. Switched to “new” style policy in november,2011, to get screening colonoscopy as i am 57 and never had one. Even advised by thier phone agent to update my policy for these benefits.One polyp removed and you know the rest of the story-now is coded as preventative. My bill for full cost.4500$. I dont borrow money and have my house paid for so think i will just let my credit rating take a hit and not pay the bill-have never not paid a bill in my life–time to take a stand

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