Banner Health review: Capsule endoscopy

I had been experiencing lower GI issues off and on for several years when I was directed by my PCP to undergo a colonoscopy. I had an upper and lower GI series on or about September 2022 at Banner Gateway Medical Center in Gilbert AZ. I was told by my Gastroenterologist, Dr. Prathab Devaraj after the upper and lower series that there is a small section in between the upper and lower series not visualized and he recommended a Capsule Endoscopy. I was told by his office staff they would submit a pre-authorization to my insurance company, Banner Aetna. When his office called to schedule the appointment, I assumed the insurance authorization had been approved. On 27 October 2022 I had a Capsule Endoscopy which did not reveal any new information on my condition. Several months later I started receiving e-mail invoices for the procedure in the amount of $3229.00, account # 876027. I waited another month or so to see if the insurance would cover it but continued to receive invoices. I started calling Banner and the Insurance company to find out why the bill was not being covered and discovered that Banner Aetna had recoded the procedure as experimental and would not cover it. I appealed to Banner Aetna to have the coding changed back to as Dr. Devaraj had documented it originally in my medical record and was denied. I then decided to contact Dr. Devaraj’s office directly and they also submitted an appeal to recode the procedure for billing purposes and that too was denied. I contacted the Banner Billing department and was told nothing else could be done. I spoke with an office representative of Dr. Devaraj’s on 29 August 2023 asking to speak directly to the doctor because I wanted him to know what was happening with my bill and how this was impacting me and possibly other patients. Specifically, I requested the bill be partially or wholly waived and have not heard back from anyone to date. I feel that there was miscommunication from Dr. Devaraj and his office staff. I was never informed that the pre-authorization was not received or that the Capsule Endoscopy procedure may be deemed experimental and not covered, something I would think Banner staff at a Banner facility caring for a patient with Banner insurance should have known. Had it been made clear to me during the consent process the procedure may not be covered, I would not have had the procedure. Therefore, due to the miscommunication that occurred here, I am respectfully requesting that the bill be waived by Banner. I have in good faith started a payment plan to remain in good standing with Banner Health and to protect my credit. I appreciate your prompt attention to this matter. Please don’t hesitate to reach out if I can provide any additional detail you may need to resolve this matter.

Respectfully,

Mark Coffman

291 N. Norman Way

Chandler AZ. 85225

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