Aurora Advanced Health Care review: Colonoscopy Bait & Switch

Fall of 2020, my doctor ordered what I thought was a preventative colonoscopy procedure. Days later I get a call from Aurora saying my payment would be approx. $3K because it was ordered as a "diagnostic". I immediately emailed my doctor who ordered it and asked why this was being ordered as a "diagnostic" as I've had no problems or issues, ever. I stated (in writing) I would not have this procedure if it was not covered by my insurance. Shortly thereafter, my doctor's office emailed back that my procedure was ordered as a "screening" and gave me the code so I could double-check the coverage with my insurance. I then called Aetna Insurance and gave them the code my doctor gave me for the screening procedure. Aetna said the procedure would be covered at 100%. Relieved, I went a head and had the procedure 2 weeks later. Three weeks after that I received a whooping bill for $3681.81 as it was billed as a "diagnostic" procedure and Aetna would not cover it.

In my fight against this issue, three Aurora department officials told me that since I had a colonoscopy in 2013 in which a polyp was removed, all subsequent colonoscopies for me in the future are ordered as "diagnostic". This is Aurora's policy. Why then, would my doctor order this as a "screening" and worse yet, TELL ME it was a screening? Why wouldn't patients be given this information?... My doctor is a long-time doctor within Aurora, an internist, and even married to an GI doctor who works within the same Aurora system. I just don't understand how she could make a mistake like this and I hate to think this is a common deception that is being used to procure hefty colonoscopy charges by Aurora, but my doctor has not replied to my inquiries on this issue and no one else at Aurora is addressing this. You would think an established Aurora doctor would know the correct coding guidelines to order procedures at her own clinic.?

One official did acknowledge that I received "inconsistent messaging" and sent my case to Aurora's Quality & Risk Management department [protected]) but they reviewed my case and saw absolutely nothing had been done wrong and shifted the narrative by addressing EVERY issue BUT the issue of my doctor ordering this procedure incorrectly. Bottom line is that I RELIED on what my doctor told me in order to decide if I would have this procedure. I have lost trust not only in my long-term health care clinic but also in my doctor as well. I feel bamboozled.