Consumer Charged Hundreds by Hospital for a Routine Preventive Colonoscopy 

By Consumers for Quality Care, on April 9, 2024

Consumer Charged Hundreds by Hospital for a Routine Preventive Colonoscopy 

An Indiana hospital charged a woman hundreds of dollars for a routine preventive-care colonoscopy that she believed would be covered by her insurance, according to WVPE, an NPR affiliate in northern Indiana.  

Karen Campbell, 46, a local news reporter, followed her doctor’s recommendation to get a colonoscopy screening, which she elected to have done at a nearby hospital. Campbell was given anesthesia, and no issues were found during the procedure. But later, Campbell was hit with an unexpected bill. She had believed that the preventive screening would be fully covered by the Affordable Care Act (ACA) and was stunned when she received a bill for $765.  

The ACA aims to improve health care outcomes by including preventive services free of charge, so that consumers don’t skip or delay medical care for fear of incurring bills, according to Anna Schwamlein Howard, Policy Principal at the American Cancer Society’s Cancer Action Network. “We want to encourage people to take advantage of evidence-based preventive services to keep people healthy for as long as possible [and] to detect diseases like cancer early,” Howard said. “One way that you want to encourage people… is you want to remove as many barriers as possible.” 

Campbell would later learn that her insurer did pay in full for the colonoscopy itself, but it did not fully cover a “recovery room” charge. The hospital tacked on this extra charge of $2,888 for a medical team to monitor Campbell as she awoke from anesthesia. This equates to a hospital facility fee charge, since according to John Hargraves, Director of Data Strategy at the Health Care Cost Institute, a doctor’s office would not categorize a recovery room as a billable service. 

For Campbell, she found herself caught in the middle of a billing dispute, since it’s up to the insurance company, not the provider, to ensure that preventive services are covered free of charge. For their part, providers often exploit this loophole by adding extra charges to their bills, and often insurers attempt to pass these costs on to consumers.  

Campbell refused to pay the bill, going back and forth with both her insurer and the hospital for a year and a half. Her bill was even sent to collections, after which debt collectors harassed her daily. “They leave texts and call as many as five times a day every day,” Campbell said. Eventually, Campbell was able to have her bill resolved, but consumer advocates like Howard worry these fees could cause more consumers to delay preventive care.  

CQC applauds Campbell for sharing her story and for her willingness to challenge these unfair charges. Consumers must be made aware that preventive procedures, such as colonoscopy screenings, are covered under the ACA. CQC urges lawmakers and regulators to hold insurers and providers accountable for not ensuring that preventive procedures are fully covered.