It’s a common misconception that the procedures you need to protect your health are a drain on your personal finances. The truth is that many patients can get a screening colonoscopy for free. Yes, you read that right — free. Under the Affordable Care Act, all screening colonoscopies (including anesthesia) are covered for healthy, insured patients.
What if you’re not insured? Don’t worry. You can get a colonoscopy with an expert gastroenterologist and a top-quality facility without breaking the bank.
Your colonoscopy cost depends on the type of colonoscopy you are scheduling. Your colonoscopy doctor, called a gastroenterologist, performs two types of colonoscopies: screening and diagnostic.
Screening Colonoscopy – This preventive procedure scans for precancerous colon polyps in individuals who have no symptoms of colon cancer and no personal or family history of colon cancer, colon polyps, gastrointestinal (GI) disease or cancer.
Diagnostic Colonoscopy – This procedure is for individuals who have a history of colon polyps, colon cancer, GI disease or colon cancer symptoms. A colonoscopy is diagnostic if an individual schedules the procedure because of symptoms such as abdominal pain, rectal bleeding or bowel obstruction. Insurance typically does not cover diagnostic colon cancer screenings. If you need a diagnostic colonoscopy, you will likely have to pay your insurance deductible and copay.
Under the Affordable Care Act (ACA), a screening colonoscopy should not have a copay, even for anesthesia costs and polyp removal. The ACA requires private healthcare insurers and Medicare to cover colon cancer screenings, including colonoscopies, with no copay or deductible because the U.S. Preventive Services Task Force (USPSTF) recommends it. Insurance will usually cover the cost of a screening exam once every ten years beginning at age 50.
With an open Access Colonoscopy, or Direct Access colonoscopy, healthy, insured patients with no history of polyps or colon cancer may be eligible for a screening colonoscopy without an initial office visit or copay to a gastroenterologist. To determine if you are eligible for a screening colonoscopy without an advanced consultation from a gastroenterologist, visit our physician locator page, Find a Gastroenterologist Near Me (not available at all locations).
To avoid surprise charges, call your insurance company with the CPT medical code and ask how much, if anything, you should expect to pay for the procedure. You could still be responsible for charges if you schedule your procedure with an out-of-network doctor or facility.
Screening colonoscopies are fully covered under Medicare, but beneficiaries may be subject to a copayment if doctors remove a polyp during the procedure. Medicare patients can estimate their colonoscopy costs using the new Procedure Price Lookup Tool. This tool provides quick access to compare payments and copayments for colonoscopies and other medical procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs).
Regardless of the referral recommendations made by your primary care doctor, you have the right to choose where you have your procedure. Sites like Healthcare Bluebook can help you find the best value facility to suit your personal preferences.
A colonoscopy is a lifesaving procedure and an essential component of digestive wellness, even if insurance does not cover it.
There are many situations in which you may need to cover all or most of the costs of your colonoscopy:
If you are uninsured or your insurance will not cover your colonoscopy, there are ways to keep your colonoscopy more affordable: