You have made one of the most important decisions you will ever make: you are getting a colonoscopy! Your doctor has recommended this important procedure, and now it’s time for you to take some action. The next step is for you to call your insurance company to see if you have any cost-sharing responsibilities. A screening colonoscopy can be fully or mostly covered under the Affordable Care Act depending on your insurance plan. Coverage is not always clear, and it is certainly not the same across the board. Before you have your colonoscopy, it is your responsibility to find out how much the procedure will cost.
Call Your Insurance Provider Before Your Colonoscopy
How should you approach this phone call? What are the correct questions to ask? Here is a sample dialogue to use as a guideline as you speak to your insurance provider to estimate your out-of pocket cost for your upcoming colonoscopy:
Patient: "I am ____ years old and my doctor wants me to get a colonoscopy." (The recommended age for a colonoscopy is age 50 unless you are at high risk)
Patient: "Am I subject to a deductible for this procedure? What percentage of the procedure is my responsibility?"
Patient: "If I have come in for a screening colonoscopy and my doctor finds a polyp, how might this affect my cost-sharing responsibility?"
Patient: "If I add up these charges, will that give me the exact amount I am paying?"
Patient: "Can you direct me to the place on your website that will go over these details we just spoke about so I can refer to my benefits later?" (You always want to be able to access this information again. Having a representative explain your benefits is very important so you understand the charges, but you need to be able to find a copy of your colonoscopy benefits and even print them off for your reference).
Final Cost is Determined by Your Doctor
Remember that the type of colonoscopy you have (diagnostic or screening) and how your procedure is coded is up to your doctor and not your insurance company. Your insurance company is somewhat limited in its ability to tell you what your out-of-pocket cost will be because it is the doctor’s office that applies specific codes to the procedures. Therefore, it is best to view this call as a rough estimate of your cost-sharing responsibility. It is a very good idea to call your doctor's office or facility to confirm costs and how they will code your procedure based on your patient information.
A colonoscopy is one of the best steps that you can take for your health. Because colonoscopies are the most effective test for preventing and diagnosing colon cancer, they carry the highest price tag. However, screening colonoscopies may be free or prove to be very reasonable when you ask the right questions. Call your insurance provider before you schedule your colonoscopy so you can verify that: