Colorectal cancer rates in people under 55 are rising according to a new report from the American Cancer Society. Twenty percent of diagnoses in 2019 were in people younger than 55. That’s double the rate in 1995. Yet, the recommended age for a colonoscopy, the exam done inside of the colon to look for abnormalities including polyps and cancer, is 45 years old.
My name is Andryanna Sheppard. I’m WINK News’ Consumer Reporter and I got a colonoscopy at 28 due to family history. My great-grandmother had colon cancer, so did my grandma. My uncle was diagnosed in his 40s and my mother started getting colonoscopies in her 30s. Each one of them discovered a polyp, a bundle of cells that forms in the colon lining and can be cancerous.
I originally set out to do this story breaking down all my struggles navigating health insurance to help others get a lifesaving colonoscopy. I didn’t run into a single problem with my insurance. My issues came with the hospital system that performed the procedure, Lee Health.
I wasn’t looking forward to the procedure but after numerous conversations with my family throughout my 20s, I decided I couldn’t wait until my 45th birthday. The prep was the worst part. The day before the procedure, I was on a liquid diet. Later that evening at around 6:30pm I did the first round of the colon cleansing prep then again at 4:30am. Two hours after that, I was cut off from liquids. My colonoscopy was scheduled for 9:30am.
Getting to the preparation point with Lee Health also proved to be a struggle. My doctor’s office and I spoke in May 2022. They sent me home with a referral order for gastroenterology. It reads “You will receive a call from our referral specialist or from the doctor’s office in 3-5 business days to schedule your appointment.” I got that call more than 200 days later in January 2023.
I reached out to Lee Health to ask why it took so long to call me. A spokesperson wrote:
“We are not sure why you may have been told 3-5 days. Lee Health referrals are typically done electronically for the patient and can sometimes take more than 5 days, if they aren’t urgent. We encourage our patients to call their provider’s office if they haven’t heard from someone in the referral department within 7-10 business days. We also encourage our patients to always advocate for themselves and please call us if they have any questions. We are here to help.”
When I scheduled the appointment, I was told I’d get a call before to break down cost. So, I went on a search to figure out how much I’d have to pay. I called the estimate line on Lee Health’s website multiple times and left a voicemail. I eventually emailed the estimate email address on the website and got a response pretty quickly. Weeks later, I got a response to my voicemail. The person on the other end told me the number listed on the website doesn’t go anywhere specific and when someone has the time, they go through and answer those voicemails.
Lee Health’s spokesperson told me:
“We have team members at each hospital campus who are trained in creating estimates. The phone number you referenced above that is on website is set up to ring at all hospital campuses so that our team members who are trained in estimates can help the callers. This number gets very few calls because most patients who are scheduled for procedures receive their estimates once we’ve scheduled and verified their insurance. Immediately after that is done, we reach out to them without them having to call us.”
Multiple people with Lee Health told me I’d have to pay thousands. I even started making arrangements to make payments. Lee Health later told me:
“Because the procedure had not yet been scheduled, we needed to know from you exactly what procedure you were having so we could get you an accurate estimate. Typically, the patient is scheduled for the procedure first, and the code is included in the scheduled appointment. Then we reach out to the patient to let them know what the cost will be.”
There were multiple times I considered canceling this potentially lifesaving procedure because of the price tag. After multiple conversations with my family, some filled with tears, I decided to go forward. I didn’t want my life to be potentially lost over something that cost a couple thousand dollars and could be prevented.
Dr. Abbie Leibowitz is the Chief Medical Officer for Health Advocate based in Pennsylvania. Employers can add the business as part of their benefits to help their employees navigate the healthcare system. He and I spoke to figure out how to make this process easier for others. He told me preventative procedures like colonoscopies are completely covered by insurance and it’s the law.
“The Affordable Care Act changes a lot about healthcare in America,” Dr. Leibowitz said. “And specifically, it required that health plans provide preventive services to members without a copay applying or deductible applying, in other words, full coverage of things that were preventive”
And my age shouldn’t be a factor.
“Preventive care can happen at any age,” added Dr. Leibowitz. “It’s an individualized thing”
So, I called my insurance company. They told me to call Lee Health back because they should not be asking me to pay. The billing department told me I wouldn’t have to pay anything when I showed up but if they sent the bill to the insurer and they don’t cover the whole thing, I’d have to deal with my insurance directly.
I reached out to Lee Health about why they were going to charge me even though the Affordable Care Act says I don’t owe a dime, a spokesperson said:
“If patients have questions about what is going to be covered with their insurance, they should always be comfortable to contact their insurance company – that is who ultimately decides what will be paid. We are acting on behalf of our patients to find this information out for them, but even when an insurance company verifies benefits, they remind us that it is not a guarantee of payment for the service. We always do our best to try and help our patients navigate this process, but our estimate of liability is based on what the insurance company tells us when we contact them to verify benefits.”
“The amount we asked you to pay is what your insurance company told us you would owe. Once you told us that your insurer said you had 100% coverage, we took your word and did not require payment prior to having the procedure, so that you could get it done.”
Dr. Leibowitz thinks someone during the process must have been confused on if my colonoscopy was considered preventative.
“I don’t know if it was the physician themselves, or the billing company or whatever. Confusion on their part about the definition of preventive care,” said Dr. Leibowitz.
In the end, I got the procedure mid-February. All of the doctors, nurses and other staff around me before, during and after the procedure were incredibly kind. They knew I was scared, worried and stressed. One of them even offered to hold my hand as I started to fade away from the anesthesia. I woke up shortly after to the doctor telling me they didn’t find any polyps or any signs of cancer.
Doctors say most people should get a colonoscopy every 10 years as long as there aren’t any signs of cancer. But because I have extensive family history of the disease, I get to come back in 5 years.
A couple weeks later, I got an email from my insurer letting me know the claim for the procedure was processed. I didn’t have to pay a cent.
Dr. Leibowitz said he helps people deal with the exact problems I ran into a lot. Every year your employer sends out your healthcare benefits letting you know what’s covered and how much you’ll have to pay for your doctor’s visits or trips to the emergency room. Dr. Leibowitz added they’re long and boring, but read them.