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Myth vs. Fact: The Cost of a Colonoscopy

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Myth vs. Fact: The Cost of a Colonoscopy

There are a multitude of myths surrounding the colonoscopy procedure. But one of the most damaging isn’t about the procedure itself—it’s about the cost. While some people know the facts—that most private insurance now covers screening colonoscopies and that some people can even qualify for low cost or free procedures—many still believe the myth that having a colonoscopy will cost a significant amount out of their own pocket.

When it was first announced in 2010 that a routine colonoscopy would be covered for free under the Affordable Care Act (ACA), the news got a lot of attention. Specifically, it required all insurance plans such as Aetna, Blue Cross Blue Shield, Cigna and United Health Care to cover screening colonoscopies at no cost to the patient. Additionally, if a patient is on Medicare and considered low risk, Medicare will pay for one screening colonoscopy every 10 years.

But then something happened.

Many insurers started charging if a doctor discovered polyps during the screening colonoscopy and removed them. The insurers did this by reclassifying the colonoscopy from a “preventive screening” to a “diagnostic procedure”—and in certain instances, the cost the patient was responsible for was significant.

In early 2013, the Department of Health and Human Services (HHS) put an end to this, and announced that this would no longer be allowed. Specifically they stated: “…polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure.” Including polyp removal as part of a routine colonoscopy also has the backing of several medical associations, the agency noted.

However, if you didn’t hear the announcement or you knew of people who had had a bad experience and ended up paying large amounts out of pocket before the HHS intervened, you may still believe the myth that a colonoscopy could cost you thousands of dollars.

So, if you’ve hesitated scheduling a colonoscopy because you were worried about the cost—even though you’ve been told you should have one—you now know the facts and can move forward.

The first step is to contact your insurance provider to make sure you are following their rules and meet their requirements—for instance, most insurance requires that you be at least 50 years old in order to cover your screening colonoscopy.

But before you make that call, make a list of questions to ask so you fully understand your financial responsibility. Examples of things to ask include:

  • How old do I need to be to qualify?
  • If I use my preferred physician, will I be covered?
  • If I have anesthesia, will I have to pay for any of those costs out of pocket?
  • If my doctor finds a polyp and removes it, do I have to pay for any lab work performed on the tissue to determine if it is cancerous?

And remember: the best way to dispel harmful myths and help the people you care about is to share accurate, helpful information with them. So, if you know someone who may be due for a screening colonoscopy, invite them to visit Stop Colon Cancer Now and encourage them to contact their insurance provider and schedule a screening colonoscopy today.

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