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Study: One in eight get surprise bills after colonoscopy

Oct. 12 (UPI) — Nearly one in eight people with private health insurance receive a “surprise” bill for out-of-network expenses after undergoing an elective colonoscopy, an analysis published Monday by Annals of Internal Medicine found.

The average amount of these charges was more than $400, the researchers said.

A colonoscopy is used to screen for colon cancer — a disease that affects 150,000 people per year in the United States — through the insertion of a colonoscope, a 4-foot-long flexible tube outfitted with a camera, into the bowel, according to the American Cancer Society.

Currently, the society recommends that adults undergo their first colonoscopy at around age 45 as part of routine cancer screening.

For this study, researchers at the University of Virginia and the University of Michigan reviewed 1.1 million claims from a large national insurer to estimate the prevalence, amount and source of out-of-network claims for people with private health insurance who underwent elective colonoscopies between 2012 and 2017.

All of the endoscopists — the specialists who performed the procedures — and facilities used by participants included in the analysis were in-network.

Among the evaluated insurance claims, 12% of cases received out-of-network claims, with an average surprise bill of $418, the researchers said.

The bills often came because of the use of out-of-network anesthesiologists and out-of-network pathologists, the researchers said.

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Kamala Harris and the Push to Cut Hosptal Bills in California

As a former state attorney general, Senator Kamala D. Harris, the Democratic nominee for vice president, has received significant scrutiny of her record on law enforcement, facing questions and criticism about uneven prosecutions of killings by police officers.

But she is less known for another role she took on, opposing the consolidation of institutions in the health care industry, which has become a major force driving the cost of medical care higher for consumers. She challenged proposed mergers between industry behemoths and anti-competitive behavior by powerful hospital systems and drug makers.

She oversaw multimillion-dollar settlements with major health care corporations like Quest Diagnostics and McKesson, which were the subjects of whistle-blower lawsuits accusing them of fraud against the state Medicaid program.

And she took the lead among state attorneys general in opposing an anti-competitive merger between a big hospital group and a large physician practice. She joined the Justice Department lawsuit that stopped two of the nation’s largest health insurers, Anthem and Cigna, from joining together.

Ms. Harris and Vice President Pence are scheduled to debate on Wednesday evening, at a time when the coronavirus pandemic has put a spotlight on access to health care, high medical bills and drug prices.

“She will be as she has historically been a very strong advocate for consumer protection,” said W. Kenneth Marlow, a health care lawyer with Waller Lansden Dortch & Davis in Nashville who represents for-profit businesses seeking to buy hospitals. If the Democrats win the White House, he predicted her presence in a Biden administration would lead to close scrutiny of health care deals.

Consolidation among major hospital systems has plateaued in recent years, but has continued at a pace that still alarms health policy experts. Recent studies including the RAND examination of prices for hospital and outpatient treatment have made the case that mergers and acquisitions have led to some mega-networks charging two-and-a-half to three times more than Medicare does for patient care.

As the California attorney general from 2011 to 2017, Ms. Harris used her powers to protect consumers and to prosecute fraud or antitrust violations in pursuit of health care industry players she accused of maximizing profits at the expense of patients.

The daughter of a medical researcher, Shyalama G. Harris, who died of cancer in 2009, Ms. Harris took on those big companies in a state with the some of the most sprawling hospital systems in the country.

The Biden campaign declined to make Ms. Harris available for an interview. A statement from Sabrina Singh, a campaign spokeswoman, said that she “had a strong track record of taking on powerful corporations and special interests on behalf of the people of California.”

As attorney general, “she decided that health care was a big priority for her,” said Richard Scheffler, a professor of health economics at the University of California, Berkeley, whose work on the effect of big health systems on prices has been cited by the attorney general’s office. He helped write an analysis of her tenure