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Medical Maze

A letter from the editor of our August 2016 issue.

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Perhaps it was serendipitous that I had a medical procedure as we were wrapping up this issue. My primary care doctor wanted me to have a colonoscopy, given my family history of colon cancer; however, I am 42, and most people don’t get the screening until they’re 50. So before I scheduled anything, I decided it would be wise to consult with deputy editor Lindsey B. Koehler, who had been working for months on “Savvy Shoppers”, a companion to 5280’s Top Doctors list that explores how to better understand our labyrinthine health care system. Then I did something I’d never bothered to do before: I investigated the potential costs.

5280’s benefits liaison informed me that because I wasn’t 50, the colonoscopy would not be covered as a preventive procedure (which would be fully paid for by insurance). Instead, I’d be responsible for whatever amount was left on my deductible and my portion of the coinsurance. This sort of one-size-fits-all care is, of course, patently absurd, and so I fought the decision. My gastroenterologist wrote a letter on my behalf, which stated that because of my family history, the early colonoscopy was considered a preventive procedure under the “current standard of care.” After months of back-and-forth, my insurance provider agreed to cover the procedure—which, fortunately, didn’t reveal any adverse findings—as a preventive screening. But winning that battle was only possible because I had Koehler’s research to help me navigate things. And now, thanks to her feature, you do too.

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