Any idea what an endoscopy costs in Brooklyn?
September 20, 2022 8:50 AM   Subscribe

I've been having acid reflux and my GI scheduled an endoscopy. I'd like to have the test to put my mind at ease. But apparently there's no way to tell what the cost will be. I have a really high deductible and so basically the first $5000 is on me. If it's 2K, that's fine, but I don't want to pay much more than for a test that may not be essential. I'm in NYC. Any idea what it might cost at an NYU outpatient center?
posted by swheatie to Health & Fitness (18 answers total)
 
I came across this site * a while ago, which claims to compare prices for different medical procedures across the US. According to the info here, the average cost for an endoscopy in NYC is $1961, taken from an average of 317 providers. Top cost looks to be $3900.

*I am not in the US, and have never used any of these services, so can't vouch for the info provided, but it might be a good place to start.
posted by rpfields at 9:15 AM on September 20


While I believe the underlying data is incomplete, I have used the information at FairHealthConsumer.org to negotiate with providers who I believed were overcharging. I'd put your ZIP code and procedure information in there and see what comes up.
posted by gauche at 9:22 AM on September 20 [1 favorite]


It's late in the game now, but if/since you have a high deductible health plan you should open and contribute to a Health Savings Account (HSA). You would be paying into the account with pre-tax dollars and saving up money in reserve to meet your annual deductible.

The first year can be tough, since you must have funds in the HSA to cover any medical expenses, but once you have a year's annual deductible amount saved up in the account, you can pay for expenses against the deductible for this year while you are contributing for next year's deductible.

I know this doesnt answer your question, but HSAs eliminate my concerns about out of pocket expenses before the deductible.
posted by Billiken at 9:45 AM on September 20 [1 favorite]


I know this doesnt answer your question, but HSAs eliminate my concerns about out of pocket expenses before the deductible.

It's still your money and you're still paying for it, even if it's at a tax exempt rate.

OP you can call your insurance provider and they should be able to give you a billing rate for the service, or at least a range. Even with a HDHP, the cost you pay is a negotiated rate. Your out of pocket cost isn't covered by insurance, but you're also not paying the sticker price. Exactly what that dollar amount will be is a secret sauce that only your insurer can provide. But they can provide it, and should be able to when asked.
posted by phunniemee at 10:13 AM on September 20 [2 favorites]


This was in Boston, not NYC, but the endoscopy I got about a year ago was $1800.
posted by litera scripta manet at 10:27 AM on September 20


I had a similar problem recently for a colonoscopy. HDHP, previous suspect colonoscopy, moved to a 5-year schedule. When my time came, they said if they don't find anything, then it's a preventative procedure and covered at 100%. If they find something, then it's a diagnostic procedure and covered at 0%. And they couldn't give a price for the procedure at all: I would have been on the hook for a random amount between $0 and probably $10k, to be determined after I'd incurred the bill.

I ended up finding an independent medical practice that does colonoscopies on a cash basis for $1800. Easy, no dealing with insurance (and the colonoscopy came up clean).

This is, of course, the best possible outcome for my insurer, because the $1800 didn't even count against my deductible.
posted by spacewrench at 10:39 AM on September 20


Response by poster: $1800? I need to move to Boston! Medical tourism!

I was able to get someone at NYU to give me an estimate, which turned out to be the wrong facility, so I'm still waiting for the final quote, but it's looking like somewhere around $3500. I still have to decide, but it's really unconscionable that they don't make it easy to find out the cost in advance. The healthcare system is so broken, and for a self-employed person like me who buys insurance on the exchange, that's especially true.

But Billiken, thank you for the HSA suggestion. I've never quite known what that was, but I'm going to do that.
posted by swheatie at 10:40 AM on September 20 [1 favorite]


I didn't want to chime in with non-directly-helpful info before, but wanted to confirm that the HSA is a very good idea. There are some semi-advanced tricks you can do with it to use it as a savings vehicle but even just using it to cover the deductible will give you significant savings.
posted by praemunire at 10:48 AM on September 20


It is a real real pain to figure out how much things will cost on a HDHP. The hospital & provider likely do not know what their agreed on rate with insurance will be. You pay the agreed on rate.

The way I have done it in the past is to get the procedure code and diagnosis code from the doctors office. Then I call my insurance company and ask what the rate is given those codes. But some doctors offices don't know the codes if they use a third party biller and some insurance companies don't want to tell the cost because they suck.
posted by muddgirl at 12:00 PM on September 20


Hospitals are legally required to provide this information. However, many hospitals are out of compliance.
posted by oceano at 12:24 PM on September 20 [3 favorites]


If you are using your insurance but have to pay 100% of the cost since you haven't met your deductible than you should get the benefit of the negotiated insurance rate. This is usually significantly less than the full price, private pay rate. Your insurance website may have a cost estimated that you can use. You may need to get the procedure code or billing code (called CPT codes) from the doctor's office to make sure you are looking at the right thing.

If you are not using insurance, the hospital is legally required to give you a Good Faith Estimate (see oceano's links) but I don't think that law applies if you are using your insurance.
posted by metahawk at 1:29 PM on September 20 [1 favorite]


Response by poster: Hey just chiming in here one last time to say that my criminal, high-deductible plan with Emblem Health does not ALLOW HSAs! WTF?

Also, when I called them and gave them the CPT code, they still could tell me nothing. I hate them.
posted by swheatie at 2:06 PM on September 20


Going slightly off-topic here, but maybe you should ask your doctor if a transnasal esophagoscopy is a possible option.

It is like an endoscope, but more slender, and usually does not have as much capability to do minor procedures like biopsies. But, they are passed transnasally, and going that route avoids the gag reflex, so no sedation is required. They can visualize the esophagus and stomach.

You don't need someone to drive you to your appointment, and since there is no sedation (which makes the procedure on-paper far less complicated) it is billed much less- in fact so much less that some theorize this is why it is not more widely known and practiced in the US. I've heard it can cost on average around $600 (and I've heard the quoted $1800 or so for EGD (sedation required)).

I seem to remember seeing a youtube video of a doctor performing this procedure on himself on live tv-- can't find it now, but there are many other videos of unsedated TNE.
posted by Maxwell_Smart at 2:56 PM on September 20


Hey what exact plan do you have with Emblem? I can do a little research for you on the HSA. I do benefit admin as part of my job and know just enough to maybe be helpful. Feel free to memail me.
posted by phunniemee at 4:07 PM on September 20


I don't think the insurance company decides whether you can have an HSA...it's just a question of whether the plan qualifies under IRS rules. Since you're self-employed, you don't need your employer to be involved either. But, obviously, don't just rely on my lay understanding...!
posted by praemunire at 4:44 PM on September 20


Is there a specific need to have it done at NYU? I would assume that the city hospital system is where you'll get the most bang for your buck. Coney Island Hospital seems to be the only one that has a dedicated endoscopy unit but I would assume the other hospitals offer it as well.
posted by fox problems at 4:55 PM on September 20


I just listened to this podcast where they interviewed the CEO of turquoise health which is supposed to help to you answer this exact question based on some newly available datasets.

Put in your insurance and comparison shop.
posted by jourman2 at 12:27 PM on September 21


Here is a fun* fact that I'm going to drop here for anyone who finds this thread on a google search and needs it later:

It is possible for your deductible to be TOO HIGH for the IRS to qualify it as a High Deductible plan, which therefore makes it INeligible for you to contribute to an HSA while enrolled. (Out of pocket max limit to qualify in 2022 is $14,100.)

*isn't it fun that American healthcare is a dystopian hellscape of only bad or worse choices
posted by phunniemee at 2:57 PM on September 22


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