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Dr. Roach: Insurance, location can influence cost of medical procedures

Keith Roach
To Your Health

Dear Dr. Roach: Is there a way to determine the average cost for certain medical procedures in a specific location? For instance, a colonoscopy? I know some health insurance policies cover it, but when your policy doesn't, what is the best way to see what the costs would be? Is it something someone should shop around for?

— K.

Dear K.: If health care were like anything else, there would be an understanding, before performing a procedure, what the out-of-pocket costs to the patient would be. Unfortunately, in the United States, it's not that simple.

While geography does have a significant role to play in what a clinic or hospital will charge for a screening colonoscopy, the charges from one facility to another in the same city can vary tenfold. I spent some time looking at what people have said about their out-of-pocket costs, and many were unable to get a confirmed price before the procedure. Insurance coverage can be dramatically different from one plan to another. While the Affordable Care Act (Obamacare) mandates that all ACA-compliant policies cover screening colonoscopies, people may still be charged for anesthesia, pathology and facility fees, among other costs. Many, but not all, private insurances will cover a screening colonoscopy.

A diagnostic colonoscopy, such as one performed to find the cause of a symptom, does not have this protection and can be much more expensive.

Dear Dr. Roach: When I was younger, I was diagnosed as obese and subjected to all kinds of treatments, including being on a two-week fast. I was bullied on the playground and badly damaged psychologically by my family. At the age of 75, I was diagnosed with lipedema. Finally, I now have a name for what I am.

When I mention this to people in the medical profession, I often get blank stares. Can you comment on this condition? I came to find out about it because someone who knew about it looked at me and saw it. My cardiologist then sent me for an evaluation. I've looked this up on the internet, and found blogs from people suffering from this.

— J.R.

Dear J.R.: Lipedema is a rare disorder that is often misdiagnosed as obesity or the much more common lymphedema. Despite their similar-sounding names, they are very different. While lymphedema is caused by damage to the lymphatics — delicate vessels that carry fluid, not blood, back to the heart, and which can be damaged by cancer, surgery or trauma — lipedema is caused by deposition of fat in the limbs, sparing the trunk, feet and hands. The fat deposition is painful and can cause fatigue and joint abnormalities. The psychological distress you discuss can be profound. Lipedema is almost never found in men. It most commonly arises at puberty, but can also begin during pregnancy or menopause. Diagnosis at a young age is less common.

There are other ways lipedema can be distinguished from lymphedema. Lymphedema generally affects one extremity, not multiple. Lymphedema gets better with elevating the extremity, where lipedema does not. In the lower extremity, lymphedema usually affects the foot; lipedema does not.

Lipedema sometimes runs in families. The exact cause is unknown. Lipedema is not obesity; diets are ineffective at treating the condition. Interestingly, people with lipedema have a surprisingly low risk for diabetes, high blood pressure and high cholesterol.

Liposuction is emerging as a promising treatment for lipedema. I found much more information at curelipedema.org.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.