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Diagnosing Ulcers and Cancer - The Cost of Endoscopy

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Last updated: 07/07/2009

 

Endoscopy, as in upper endoscopy, is a procedure that uses a thin, flexible tube to visualize the throat, esophagus, stomach and first part of the small intestine. Endoscopy can provide invaluable information about the health of the gastrointestinal structures and diagnose things such as ulcers and cancer. Unlike colonoscopy (endoscopy of the lower GI system), upper endoscopy is not used as a screening for cancer. Endoscopy is used to diagnose diseases of the upper GI tract based on a patient’s symptoms and the doctor’s clinical suspicion of such disease. Patients with health insurance will have most or all of their endoscopy cost covered; however, patients that are uninsured or underinsured may bear all of the cost of the procedure themselves.
 
 
The average endoscopy cost in United States can vary widely based on type of endoscopy that is being performed and if any samples or biopsies are sent to pathology for analysis. For this procedure, the fees charged by the facility can exceed the fees charged by the physician. In New York for example, the hospital may charge $2,000 for an endoscopy but the physician may only charge $700. If a tissue sample is taken and sent to pathology, the overall endoscopy cost can increase from $200 to $800 depending on the tests being done on the tissue.
 
Unfortunately it is not possible to determine what will happen during the endoscopy therefore it can be quite difficult to estimate cost. If the physician suspects a GI cancer, almost certainly a tissue sample will be taken, but if the endoscopy is being done to diagnose a source of bleeding, a sample may not be needed. Many endoscopic procedures are done as part of a hospitalization and their cost often gets including in one of the various bills that come after the hospital stay. Also, the need for endoscopy can be urgent or emergent, making a cost comparison impossible.
 
If you are without insurance and endoscopy cost is a concern, it is important to talk to your surgeon about all of the possible fees associated with the endoscopy. Regardless of your presumed diagnosis, ask for an estimate of the following things:
  • Physician fees
  •  Anesthesia fees
    • Local
      • With sedation
      • Without sedation
    • General
  • Facility fees
  • Pathology fees
With these endoscopy costs in hand, you can properly compare different physicians and venues under a variety of circumstances.
 
If you do have health insurance, call your insurer and ask about your co-pay and related fees, if any. Some insurance plans require a deductible to be paid for any major procedure. Sadly it is sometimes challenging to obtain this information from your insurance company, but it is available. It may require a bit of time on the phone in order to get it. However, the alternative is to have the endoscopy and wait to see what portion you are billed. This approach is ill-advised. Insurance companies are more apt to pay for procedures that are identified ahead of time and usually approve the release of funds in a timely manner if notified in advance. Otherwise, payment of the endoscopy costs may be disputed and delayed.

 


Last Updated: 07/07/2009

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