TULSA, Okla. — Family, most folks will tell you, means everything.
The very reason Jason VanHoose decided to take care of his health, even if it means doing what he dreads.
“As we turn 50, you’re supposed to get your colonoscopy done, right?”
Absolutely, medical experts say.
And with most insurance plans, it’s considered preventative, which requires it to be covered at no cost to the patient, like Jason.
“I go in pretty blind to what the process is, but I read my insurance information, and it’s covered 100%,” Jason tells us.
So imagine Jason’s surprise then, shock really, he says, when bills for more than two thousand dollars show up that he’s told he needs to pay immediately.
“I thought it was a mistake. This is 100% covered, I was a little confounded by this.”
Jason says they did find some polyps during the procedure, and the doctor removed them right away.
Jason tells us that’s why he believes he was now responsible for paying for the entire procedure.
But now, even as he disputes those bills, they’ve gone to collections.
“It said it was 100% covered, there were no asterisks on it that said if they found something, then you’d have to pay.”
Jason says he talked with the doctor's billing office and Blue Cross Blue Shield, trying to find out what’s going on, but feels he’s getting nowhere, fast.
To make things worse, Jason says he’s been out of work for a few months now, making a two-thousand-dollar medical bill, an even bigger pill to swallow.
“So that makes it even more top of mind and critical that I get this taken care of.”
Jason contacted the problem solvers, wondering if others were going through the same situation.
We got in touch with an insurance company representative, who said they’d look into Jason’s experience.
He’s been paired up with a customer advocate to help figure everything out.
Since then, insurance has paid all but $500, and they’re still looking into his bill, including working with the medical providers involved making sure procedures and services are coded correctly so they’re covered as preventative.
In general, Blue Cross Blue Shield says they process claims based on information from the health care provider.
If mistaken claims are corrected by the provider, they’ll adjust the benefits paid.
Preventative services are covered at 100%.
If issues are detected, additional tests and treatments may be subject to deductibles and cost-sharing.
But when we asked for clarification, such as when issues are taken care of during the actual preventative procedure, Blue Cross Blue Shield would only point us back to their previous statement.
After his 10-month ordeal, from setting up his colonoscopy to finally getting some of his claims paid, Jason has this advice about preventative care.
“You should really investigate it, you should ask questions.”
After it all, Jason says he’s grateful that proactive, preventative procedure accomplished the medical mission for which it’s designed — to find problems that can be resolved before they lead to more severe, serious, and complicated health issues later.
Jason hopes it means he can be there every step of the way for his family.
This is Blue Cross Blue Shield’s complete statement to 2News Oklahoma:
“We process claims based on information sent from the health care provider. If the initial claim was billed incorrectly, benefits will be adjusted once we receive the corrected claim from the provider. Preventive services are covered at 100% when claims are submitted correctly. When an issue is detected, additional diagnostic tests and treatments may be required outside of the preventive screening. These may be subject to applicable deductibles and other cost-sharing. Members should review their plan benefits for coverage details. “
We checked with the Oklahoma Insurance Department.
They tell us they don’t run into many complaints about covered preventative services.
But they encourage anyone who does to file a complaint with them here.
Contact the Problem Solvers:
- 918-748-1502
- problemsolvers@kjrh.com
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