Upper Endoscopy on an HDHP

A High Deductible Health Plan (HDHP) can be a wise way to save money on health insurance and take a proactive role in your healthcare. A lower monthly premium gives you the power to choose how you want to spend your reserved healthcare funds. Instead of contributing your hard-earned dollars toward a healthcare network account which pays for thousands of people of varying degrees of health, you can invest that same money, tax-free, into your HSA for your own medical costs and even earn interest.

What is an upper endoscopy?

Monthly contributions to your HSA can help pay for necessary tests and procedures like an upper endoscopy. Also known as esophagogastroduodenoscopy (EGD), this procedure is used to determine the cause of gastrointestinal disorders and symptoms including:

  • Acid reflux
  • Gastroesophageal reflux disease (GERD)
  • Heartburn
  • Swallowing difficulties
  • Upper abdominal pain

Why might you need an endoscopy?

An upper endoscopy is used to diagnose or treat conditions of the upper digestive tract. This procedure is performed by a gastroenterologist – a doctor who specializes in digestive conditions. Gastroenterologists perform upper endoscopies to:

  • Investigate the cause of symptoms – Upper endoscopy can help determine the cause of nausea, vomiting, upper gastrointestinal bleeding, upper abdominal pain or difficulty swallowing.
  • Diagnose conditions – Upper endoscopy can be used to confirm or rule out conditions of the upper digestive tract. Tissue samples may be sent to a lab for biopsy.
  • Treat symptoms – Your gastroenterologist can use tools to perform procedures during upper endoscopy. This may include esophageal dilation, removal of polyps, removal of foreign objects or cauterization of blood vessels.

How much does an upper endoscopy cost?

There are many factors that can influence the cost of an upper endoscopy, so it is imperative that you do your homework beforehand. These factors include:

  • Medical code — The cost of an upper endoscopy will be influenced by how the procedure is coded. Medical codes are used to describe diagnoses and treatments and help determine costs and reimbursements. Request the Current Procedural Terminology (CPT) code from the doctor who is ordering the test. You will need it later.
  • Your doctor and facility of choice — Choosing an in-network gastroenterologist and an in-network facility will save you money. Also, consider having your procedure done at an ambulatory surgery center (ASC) because it is often less expensive than a hospital.
  • Timing of your procedure — If you have not met your deductible, you will be responsible for the charges for the upper endoscopy. If you have already met your annual deductible, your insurance may cover the procedure, but you may still be responsible for some cost-sharing.

Questions to ask your insurance company before you schedule an upper endoscopy

Before scheduling an upper endoscopy, you should make a list of questions to ask your insurance provider to determine your financial responsibility. These questions include, but are not limited to:

  • My doctor has ordered an upper endoscopy for me. The CPT code is _______. Would you please tell me how close I am to reaching my annual deductible?
  • My doctor suggests that I have Dr. __________ perform my procedure. Is Dr. ___________ in-network and covered under my policy? What other gastroenterologists in my local area are part of my network? I would like to call them and price compare using the CPT code.
  • Is ______________ [your preferred hospital or ambulatory surgery center] in-network and covered under my policy?
  • I know that if a biopsy is needed, this will be an additional cost to me. What cost should I anticipate if this is needed? What other out-of-pocket costs should I inquire about when calling these gastroenterologists?

Shop around for the best price for your upper endoscopy

Now that you have this information, you can begin comparing costs among gastroenterologists and facilities in your area. Cost for an upper endoscopy can vary widely, even within a small radius, so take your time and call several providers. Make sure to look at physician ratings and reviews and make them an equally important component in your decision-making process. You may have to call your insurance company back and ask them additional questions before making your final choice.

Use your HSA funds

Before you call your doctor of choice to schedule the upper endoscopy, look carefully at your HSA and verify that you have enough funds in your account to pay for the procedure. If you do not, you can speak to the billing office about a payment plan.

With some careful budgeting and planning, you can schedule your endoscopy knowing that you are getting quality care at the most reasonable price. HDHPs with HSA gives you flexibility and choice so you can make informed decisions about your healthcare.

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