He went in for a colonoscopy. The bill was $19,000.
“I told Northwestern, ‘I’m not paying that, and I don’t care if you send me to collections,’” Tom Contos said of his share.December 20, 2024
5 min
In June, at his doctor’s recommendation, Tom Contos of Chicago underwent a colonoscopy. The hospital charged nearly three times what it had estimated. (Taylor Glascock for KFF Health News)
By Harris Meyer
Tom Contos is an avid runner. When he started experiencing rectal bleeding in March, he thought exercise could be the cause and tried to ignore it. But he became worried when the bleeding continued for weeks.
The Chicago health-care consultant contacted his physician at Northwestern Medicine, who referred Contos, 45, for a colonoscopy, citing in part a family history of colon issues. “My primary-care physician said, ‘Given your family history, let’s get you in.’”
Northwestern Memorial Hospital asked him to prepay $1,000, and he underwent the procedure in June.
Then the bill came.
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The medical procedure
Colonoscopies are performed in the United States more than 15 million times a year. Rates of colorectal cancer are on the rise, particularly among younger people.
The procedure, which is also a recommended screening for people 45 or older, involves examining the large intestine using a tube with a video camera that can also collect tissue samples.
It typically takes less than an hour, with another hour spent taking the patient’s history, administering anesthesia and monitoring their recovery, said Glenn Littenberg, a physician who recently chaired the reimbursement committee of the American Society for Gastrointestinal Endoscopy.
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According to Contos’s medical record, his colonoscopy was “not difficult.” The gastroenterologist biopsied and removed small growths called polyps from two spots and identified large internal hemorrhoids, which are swollen veins.
Pathology found that the samples were precancerous. The gastroenterologist reported no evidence of cancer and, after reviewing the pathology report, concluded that hemorrhoids probably caused the bleeding.
The final bill
The hospital charged $19,206 for the procedure, including physician fees. After the insurer negotiated discounts and paid $1,979, Contos was on the hook for $4,047. With the $1,000 he paid upfront, plus $1,381 after the procedure, he still owed $1,666.
The billing problem: Colonoscopies that find polyps cost more
Contos was shocked and angry when he received his itemized bill.
“I said, ‘I don’t understand this,’” he said.
He asked the hospital what it charges for a diagnostic colonoscopy and was pointed to a pre-procedure estimate of $7,203, with an out-of-pocket bill of $2,381.
He asked Northwestern why the charges were nearly three times the estimate and why his out-of-pocket share was nearly twice as high.
One reason was in an explanation of benefits statement from Contos’s insurer, Aetna: Northwestern charged for two colonoscopies, at $5,466 each. Plus there were two fees for the gastroenterologist — $1,535 and $1,291.
The first procedure was listed as “colonoscopy and biopsy,” while the second was “colonoscopy w/lesion removal.” Aetna’s negotiated rate reduced the first $5,466 hospital charge to $3,425, while the charge for the second procedure was lowered to $1,787.
Neither the bill nor the benefits statement explained why there was a second procedure listed at a reduced price.
After examining Contos’s bill, Littenberg said it’s standard for providers to bill for two colonoscopies if they remove two or more polyps in different ways, because of the extra work. As in this case, hospitals typically reduce the amount for the second colonoscopy so they charge only for the extra work, he added.
Even with that reduction, Littenberg said Contos’s total out-of-pocket cost of $4,047 was “a lot, though not rare for large academic centers.”
Contos’s insurance documents show that Aetna’s negotiated rate for his colonoscopy at Northwestern was more than twice the insurer’s median negotiated rate for the same procedure at other Chicago-area hospitals, according to Forrest Xiao, director of quantitative research at Turquoise Health, a company that gathers health-care price data.
Contos asked the hospital and insurer why he was charged for two colonoscopies. A Northwestern representative said he wasn’t actually billed for two procedures, which Contos found bewildering.
“I told Northwestern, ‘I’m not paying that, and I don’t care if you send me to collections,’” he said. He filed appeals with the hospital and Aetna but was ultimately told the billing was correct.
The resolution
A representative for Northwestern told Contos that its pricing is in line with other academic medical centers in Chicago and “nonnegotiable” — and that his account would be turned over to a collections agency.
CVS Health spokesperson Phillip Blando said in a statement to KFF Health News that the claims were “paid accurately” by Aetna, declining further comment. (CVS Health owns Aetna.)
Northwestern did not respond to requests for comment.
Contos wrote to his physician that he was dropping him and leaving Northwestern because of its high pricing.
He said he’s still experiencing periodic symptoms, which he relieves with over-the-counter Preparation H. A one-ounce tube costs $10.99 at CVS.
The takeaway
To get a lower price, Littenberg said, patients should consider going to a facility not associated with a hospital. A 2023 study found that ambulatory surgery centers billed insurers an average of $1,030 for a colonoscopy with biopsy or polyp removal, compared with $1,760 at a hospital.
To get a sense of cost, patients can consult the hospital’s and insurer’s cost websites or look up a good-faith estimate of the cash price, which can be cheaper than using insurance. Or they can check websites that draw from federal price-transparency data or claims data from insurers.
Still, the cost could be higher if the colonoscopy finds one or more polyps that need to be removed and biopsied, which occurs in at least 40 percent of colonoscopies, Littenberg said. Patients should ask whether the price includes those services.
It should be easier, Xiao said: “You shouldn’t have to be a medical billing expert to know what you’re going to pay.”
Bill of the Month is a crowdsourced investigation by KFF Health News that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it
