Satellite_Beacj
New Member
- 2
I am 39 years old and have Cigna HRA/OPEN ACCESS PLUS insurance through my employer in Florida with an $8500 in-network deductible. If I pay the first $1500 then I have an HRA that can help out with the next $2100, then I'm back on my own until I reach the $8500. When I check my contributions to Cigna for 2018, it looks like I contribute just under $4K for my family and my employer paid Cigna just under $14K. Recently I started experiencing some symptoms. I went to my primary care physician and she referred me to a local gastrointestinal specialist. Both doctors agreed that they think I should move forward with a colonoscopy to find the cause.
Cigna is telling me that if I was 10 years older that this procedure would be covered at100% and coded as Preventative. However, even though I am exhibiting symptoms that something is not right, it will have to be coded as Diagnostic and I will most likely have to pay $1200-2000 out of pocket to receive this routine procedure. (CPT 45378, Diagnostic K62.5) I have been told that even if they perform the procedure and find major issues that I will still need to pay the $1200-2000.
If my wife wasn't pushing me to do this, due to an experience of a family friend, then I probably just wouldn't go through with the procedure. It isn't anything I'm looking forward to, so the price tag isn't helping. I'm paying Cigna about as much as I am paying on my car loan each month. I can go see a doctor anytime I want for $25 a visit to get a Z-pack or whatever the 2-3 times a year when I need it but when I really need insurance, it doesn't really seem to help all that much.
Is there a better way to have this procedure covered by insurance? This doesn't seem right. Do I just have bad/catastrophic insurance? I don't feel like I'm paying bottom of the barrel prices, yet that's the kind of coverage it feels like I have. Any advice would be greatly appreciated.
Thanks,
Nathan
Cigna is telling me that if I was 10 years older that this procedure would be covered at100% and coded as Preventative. However, even though I am exhibiting symptoms that something is not right, it will have to be coded as Diagnostic and I will most likely have to pay $1200-2000 out of pocket to receive this routine procedure. (CPT 45378, Diagnostic K62.5) I have been told that even if they perform the procedure and find major issues that I will still need to pay the $1200-2000.
If my wife wasn't pushing me to do this, due to an experience of a family friend, then I probably just wouldn't go through with the procedure. It isn't anything I'm looking forward to, so the price tag isn't helping. I'm paying Cigna about as much as I am paying on my car loan each month. I can go see a doctor anytime I want for $25 a visit to get a Z-pack or whatever the 2-3 times a year when I need it but when I really need insurance, it doesn't really seem to help all that much.
Is there a better way to have this procedure covered by insurance? This doesn't seem right. Do I just have bad/catastrophic insurance? I don't feel like I'm paying bottom of the barrel prices, yet that's the kind of coverage it feels like I have. Any advice would be greatly appreciated.
Thanks,
Nathan