Tom Contos’ Medical Billing Journey: A Double-Charged Colonoscopy Case

Man surprised while looking at laptop screen.

Tom Contos’ unexpected medical billing saga at Northwestern Memorial Hospital reveals the complexities of healthcare expenses in America.

At a Glance

Tom Contos was charged $19,206 for what he believed was a single colonoscopy.
His insurer negotiated the bill down to $5,816, leaving $4,047 as his out-of-pocket cost.
Medical debt impacts over 100 million Americans, sometimes leading to severe financial consequences.
The Biden administration is considering measures to alleviate medical debt burdens.
Patients are advised to use in-network providers and price transparency tools to avoid surprise bills.

A Shocking Bill for Tom Contos

Tom Contos, a running enthusiast, underwent a colonoscopy due to rectal bleeding and his family’s history of colon issues. Expecting a single procedure, he was shocked to receive a bill for $19,206 from Northwestern Memorial Hospital, justified by the facility as the need for polyp removal, effectively charging for two procedures. Despite his insurer negotiating the amount to $5,816, Contos was still left with a $4,047 out-of-pocket cost, much higher than anticipated.

Medical expense shocks like Contos’ are not uncommon. Nearly 1 in 8 patients with commercial insurance who undergo elective colonoscopies face surprise bills due to out-of-network expenses. Additionally, out-of-network anesthesiologists and pathologists often contribute to unexpected costs. Recommendations include partnering with in-network providers and understanding cost-saving strategies to mitigate these surprises.

He Went in for a Colonoscopy. Northwestern Memorial Hospital Charged $19,000 for Two.
To get a colonoscopy at a lower price, patients should consider going to a freestanding endoscopy center or ambulatory surgery center not associated with a hospital.https://t.co/Li9Qg6RZhR

— Harris Meyer (@Meyer_HM) December 19, 2024

Rising Medical Debt Concerns

Medical debt remains a significant issue in America, affecting over 100 million citizens and leading to severe financial hardships like losing homes and depleting retirement savings. These debts can also negatively impact credit scores, making it difficult for individuals to secure loans, housing, and employment. The Biden administration and some states propose to alleviate these burdens through policies such as removing medical debt from credit reports.

The financial strain exposes the necessity of tools that can accurately predict out-of-pocket responsibilities before undergoing procedures. Dr. James M. Scheiman emphasizes, “In addition to insurance reform, which is essential to resolve this risk of cost sharing, we need tools to accurately predict out-of-pocket responsibilities for patients before the procedure is performed to allow opportunities to limit costs without impact on quality.”

He went in for a colonoscopy. The hospital charged $19,000 for two.
https://t.co/latfBhrsbR

— CBS News (@CBSNews) December 19, 2024

Navigating the Billing Complexity

Contos’ experience also reflects the broader issues within medical billing systems in the U.S. which many patients find difficult to navigate. Patients are advised to consider freestanding endoscopy centers for lower costs and use price transparency tools to estimate expenses. In Contos’ words, “You shouldn’t have to be a medical billing expert to know what you’re going to pay.” Such cases underscore the importance of advocating for transparency and equity in healthcare billing practices.

Tom Contos’ colonoscopy charge highlights a wider issue within the healthcare system. The “Bill of the Month” series by KFF Health News and The Washington Post continues to investigate such cases, aiming to help patients understand and reduce their medical expenses. With growing awareness and proposed policy changes, there’s hope for more transparent and manageable healthcare billing.