Why will an insurance company pay a doctor (if your luck, and not an intern,) 1200-1500.00 and an anestheiologist another 800-1000 to do an optical colonoscopy, but will NOT pay for a VIRTUAL colonoscopy that costs from 400-600 and requires no sedation and is more accurate because it's an MRI/PET scan??? Makes no sense to me at all, but since Brains and Common Sense....what do I know? LOL
2007-10-18 14:12:25 · 4 answers · asked by serialmom12 5 in Business & Finance ➔ Insurance
Well, I'm trying to figure out why they won't pay $3800 to a licensed midwife for all prenatal care and testing and a homebirth, but they'll pay $12,000 for a hospital birth and prenatal care with an ob?
Health insurance is a bit different from other kinds of insurance. I haven't quite figured out the logic for it.
2007-10-18 14:55:56 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
The answer has to do with lawyers, an optical colonoscopy is established medical procedure. Insurance companies are not going to pay for procedures that are not accepted as standard practice because then they could be sued for any cancer that the procedure failed to detect. Believe me, on lawsuit can be much more costly that a thousand colonoscopies.
2007-10-18 14:28:35 · answer #2 · answered by milton b 7 · 0⤊ 0⤋
My guess is that the virtual colonoscopy is not an "approved" procedure. Either an industry group or a government organization has to approve these things before the insurance companies will cover it.
2007-10-18 14:25:24 · answer #3 · answered by hottotrot1_usa 7 · 0⤊ 0⤋
It takes awhile for those newer types of procedures to get on the approved lists for payment - there needs to be enough verifiable information out there about them.
Often once Medicare starts paying for a procedure, other insurers will start to follow suit.
2007-10-18 16:22:27 · answer #4 · answered by sarah314 6 · 0⤊ 0⤋