Patients reveal ‘horror stories’ of cancer screenings as cases surge among young people

Doctors are raising fears that patients may be avoiding preventative colon cancer care because of hidden costs – even as the disease is surging among young adults.

A colonoscopy – the golden standard of colon cancer screening – is recommended for every 10 years starting at the age of 45.

On most insurance plans, the procedure should cost on average $79 out-of-pocket, with health insurers footing the rest of the about $2,125 bill.

But recently, patients have come forward to say they’ve been charged upward of $5,000, $7,000 and even $20,000 for the procedure, despite having health insurance.

In some cases, patients were just trying to ‘do the right thing’ and often didn’t have symptoms suggesting they had cancer.

Doctors slammed these bills, warning surprise – and unaffordable –  costs could put people off getting screened, meaning cancers may not be detected until it’s too late.

Dr Glenn Littenberg, a physician who recently chaired the reimbursement committee of the American Society of Gastrointestinal Endoscopy, told DailyMail.com: ‘The majority of people who do preventative screening should have very little out-of-pocket cost, regardless of where they go.

‘But there are horror stories, with the exception being when someone goes out of network for their physical or hospital.’

He added: ‘Screening reveals benign polyps that aren’t cancer, but by removing them we are reducing the risk of cancer developing.

‘If patients are putting off colonoscopies worrying about costs, then this means these aren’t removed.’

He warned: ‘If you put off screening and don’t do anything, there’s certainly a much higher probability that when you go in, you have symptoms,’ which may raise the risk of being diagnosed with cancer.

Colon cancer often causes no symptoms until it has spread to other areas of the body, where it becomes harder to treat. 

But warning signs can include trouble using the bathroom, blood in feces and persistent diarrhea or constipation.

Doctors fear that, faced with the risk of high prices, patients may put off any screenings — which can find pre-cancerous growths and eliminate them, slashing the risk of developing the cancer.

They may also put off screenings even when they have symptoms, risking the cancer reaching an advanced stage — making it harder to treat and deadlier. 

About 67 percent of adults adhere to current screening requirements, below the US government target of at least 70 percent.

In one case, a small business owner from Illinois was hit with a bill for $7,000 after getting a colonoscopy.

Tim Winard, 57, had no symptoms of the disease, but opted to get screened to ‘do the right thing’ and be on the safe side.

He had six-month short-term health insurance, which he took out while he worked on his business. He said his insurer told him he could get the cancer screening ‘anywhere’.

He went to Endeavor Health Elmhurst Hospital outside Chicago and was in and out of the center the same day. Later, he was told his results were normal.

But then his bill came. He was charged $7,000 after his insurance paid only $814.47 towards the cost.

Confused, he contacted the insurance company and said a representative told him the insurance would not pay more because his procedure was ‘out of network’.

Mr Winard then contacted the media, with his story first reported by KFF Health News. 

After they contacted the health insurer, he was issued a new bill for only $770 — with no explanation given for the shift in the price.

In another case, Mike Meier from Georgia, who had health insurance through Alliant, went to get a colonoscopy after it was recommended by his doctor.

The screening found a benign polyp on his colon and it was successfully removed.

But then he received the bill, totaling $10,745, prompting him to immediately contact his insurer and hospital — Aurora Health Care — to ask about the cost.

Through numerous complaints and appeals, it eventually emerged that his insurance company had misprinted his insurance card to suggest he had out-of-network coverage for more than just emergency care – when he actually did not. 

Despite the error, however, his insurer was still unwilling to pay because he had taken out an insurance plan with a $20,000 deductible. (Most plans have a deductible around $1,790).

Under the Affordable Care Act, healthcare plans are required to cover certain preventive services, including screenings for colon cancer in asymptomatic adults, for those who are 45 to 75 years old.

But Mr Meier was short of that when he had the procedure, just a few months from his 45th birthday.

In a third case, a patient on Reddit came forward two months ago to say they had a colonoscopy with an in-network doctor and was charged $20,000.

The patient, who was not named, said beforehand they had contacted their doctor and the billing office who said the procedure was covered by insurance.

But after receiving two denial letters, the patient had been billed, with the insurance saying the surgery center and anesthesiologist were out-of-network.

Colonoscopies are complex procedures, that often require a doctor to undertake them as well as an anesthesiologist to ensure a patient’s comfort when deep sedation and general anesthesia are used. 

A breakdown of the costs was not revealed, but people commenting said the patient was likely being billed for their doctor, the surgery center and the anesthesiologist.

The post was flooded with 236 comments from others who also said they had been charged outrageous amounts for colonoscopies or similar procedures.

Doctors said that to get a colonoscopy at a lower price patients should always contact their insurer first to ensure the colonoscopy is in network.

They also recommended going to a freestanding endoscopy center or ambulatory surgery center not associated with a hospital, which tends to be cheaper.

A 2021 study that examined healthcare claims among 333,000 adults with average risk of colon cancer between 2014 and 2019 found that they paid, on average, $79 out-of-pocket for a colonoscopy.

Misleading and confusing payment and coverage information has doctors worried because of the rapid surge in colon cancer cases, particularly among young adults.

About 12 cases per 100,000 people under the age of 45 years were reported in 2021, data suggests, compared to less than six per 100,000 in 2021.