She had a colonoscopy without anesthesia - but it was on her bill anyway

Judy Politzer was positive she did not need anesthesia for her colonoscopy.

She had done the procedure – in which a tube is snaked up through the colon so it can be examined for polyps — sans sedation before. What's more, she birthed three babies – without pain killers — at home.

She has high tolerance for pain. And low tolerance for malarkey.

So when Politzer, a retired midwife from Swarthmore, saw the $5,000 bill for her colonoscopy with anesthesia, she snapped into action.

"It's just ridiculous," said Politzer, who has an individual health insurance plan through Aetna. "And there's no one to fight for consumers on this except ourselves.

"I'm not going to let them get away with it," she said.

The procedure went off without a hitch – and, she said, without anesthesia —  last October at Crozer-Keystone Health System's Havertown Surgery Center.

Doctors recommend that people over age 50 have a colonoscopy to screen for cancer at least once every 10 years.

Politzer, 64, has one every five years because doctors have found polyps in the past.

Politzer specifically asked to be spared the sedation because she wanted to see what was happening and be able to talk to her doctor whenever possible during the medical procedure.

"I want to know what's going on with my body," she said.

A colonoscopy without anesthesia may sound unusual — and it is, said Anthony Infantolino, a gastroenterologist at Jefferson Health.

Infantolino, who did not treat Politzer, estimated that he's performed 10 colonoscopies without anesthesia in his 27-year career. He doesn't recommend it because patients can't change their mind once the procedure has started, and may be turned off from having it done again if they have a painful experience, he said. Anesthesia makes most patients more at ease during what can otherwise be an uncomfortable procedure.

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But there's nothing wrong with forgoing anesthesia, he said.

"An average person with a perfectly organized colon of average length, no funny angles — you can probably get away with it," he said. "For other people it's going to be torture."

Politzer's doctor and nurse both approved her decision, she said. When the anesthesiologist came in the room, she waved him off from the gurney, figuring that having a conversation would land her with a consultation fee.

Politzer's medical record, which she shared with the Inquirer, showed she was in the operating room for 16 minutes, during which time the doctor removed a polyp. She spent 10 more minutes in the recovery room, where she got dressed, ate a few crackers, and gulped some juice before heading on her way.

"It was no big deal. There was nothing complicated about it," Politzer said. "Until I got the bill."

Politzer was surprised by the complex list of services and charges — totaling $5,339 — that followed what she had considered a straightforward visit.

The explanation of benefits statement from Aetna included:

According to the explanation of benefits, Aetna negotiated lower rates for the colonoscopy and the doctor's fee — $1,999 and $438.92, respectively. Both charges, a total of $2,437.92, were billed to Politzer because she had not yet met her deductible.

Screening colonoscopies are covered by insurance, but diagnostic colonoscopies to remove a polyp — the kind Politzer had — often require patients to pay out of pocket, if they haven't met their deductible.

The remaining fees for anesthesia, medical services and recovery were covered by Aetna's agreement with Crozer.

Even though she wasn't on the hook to pay for it, Politzer was bothered that Crozer had billed for services she did not receive.

"They took my blood pressure, my pulse and gave me a gown to put on," Politzer said of the surgery prep charge. "How does that cost a thousand dollars?"

Politzer said she made several calls to Crozer and Aetna before finally calling the office of Crozer's president.

"We always strive to bill appropriately for the care delivered and to work with patients throughout the billing process," said Sean M. Fitzpatrick, Crozer's chief financial officer, in a statement. "If a patient has a question about their bill or suspects a billing error, they should contact the location of service."

Crozer has financial counselors at all its sites to work with patients to investigate billing issues and make sure corrections are submitted to their insurance carrier, he said.

In February, the health system sent her a new bill, removing the anesthesia fee.

But Politzer wasn't satisfied.

The bill still included the prep and recovery charges. She isn't being asked to pay those charges, but wants them off her record regardless.

"It matters to me," she said. "It matters that they're billing for things that never happened, that's what really bothers me."

She contacted the Inquirer after reading about Philly Health Costs, the newspaper's new project aimed at making medical billing more transparent. At philly.com/healthcosts, consumers can do as Politzer did, and add their own experiences to our crowdsourced database of costs, or search cash prices for many common procedures compiled by journalists at ClearHealthCosts.

Medical bill errors are very common, with some studies estimating that up to 80 percent of bills have a mistake, said Kevin Flynn, president of HealthCare Advocates, a Philadelphia-based patient advocate firm.

"It's becoming more of an issue now that everyone has high-deductible plans," he said. "These errors are becoming much more costly."

But the true number of errors is impossible to know. Some patients automatically pay whatever they are billed either because they don't scrutinize bills, or give up in frustration.

How many patients take the time, as Politzer has, to protest errors that don't hit their own checkbook?

Patients need to get in the habit of scanning medical bills for errors, the way they check credit card bills for unauthorized charges or utility bills for erroneous fees, Flynn said.

Patients who suspect a mistake should go first to the provider, which is often more accessible than an insurance company with millions of members, he said.

Not sure what a charge is for? Call and ask, Flynn advises.

"Now that we are having to pay out of our own pocket, now is the time to change the mindset of checking these routinely," he said.

That's why Politzer keeps such a close eye on her medical bills and why she piped up when she saw a mistake.

"This stuff happens all the time," she said. "It's just that people don't bother fighting it when it happens."