Family History of Colon Cancer? Get Screened Early

4.30.2021

 

Does colon cancer run in your family? If so, you could be eligible for a free or low-cost screening colonoscopy before the age of 50.

Adults who are at average risk for colon cancer should get a baseline colonoscopy at 50 years of age, but if you have a family history of colon cancer or polyps, you should be screened earlier.  A family history of colon cancer is defined as having a first degree relative (mother, father, sister or brother) with colon cancer, precancerous polyps or cancerous polyps.

How do I find out if I am eligible for a free or low-cost screening colonoscopy?

If you meet these criteria, there are specific steps that you should take so that you can be eligible for a free or low-cost screening colonoscopy before the age of 50.  

  1. Find out what age your first-degree relative was diagnosed with colon cancer or polyps.
  2. Talk to your primary care physician and say, “My __________ (mother, father, sister or brother) was diagnosed with colon cancer/polyps at the age of ___.  I need to have ‘family history of colon cancer and/or polyps’ added into my medical records.” The records should include the family member(s) and the age(s).
  3. Call your insurance provider and convey the same information. Ask the representative to notate this information in your records.
  4. Ask your insurance provider if you have colonoscopy screening benefits in your policy. This benefit may vary among policies even within the same provider. Not all private insurance has colonoscopy screening benefits, and it is up to you to find out before you schedule your colonoscopy.
  5. Ask your insurance provider, “At what age am I eligible for screening benefits?” Some policies may allow you a screening colonoscopy at the same age as your first-degree relative was diagnosed with colon cancer or polyps, and some policies may allow you to have a screening performed earlier. 
  6. Ask your insurance provider, “How much it will cost if the gastroenterologist finds a polyp in during my colonoscopy?” Polyp removal and biopsy often do not fall under “screening” so they may be filed under “medical.”  This would affect your financial responsibility, althought pathology (tests on the polyp(s) removed) is usually not exceptaionally expensive and is a small price to pay for preventing cancer!  Also important, ask whether the colonoscopy would change from a screening colonoscopy to a diagnostic colonoscopy if a polyp is discovered and how that may affect your payment.  

When your doctor and insurance provider are aware of your family history and you are aware of your benefits, you can now safely schedule your colonoscopy.

How much will my colonoscopy cost me?

When there is a family history of colon cancer or polyps, some insurance providers pay 100 percent of colonoscopy screenings. Others may pay 80 percent or 90 percent, so be aware of your portion of the cost-share. Remember that all coverage and cost-sharing questions are policy-specific and only your health care provider can answer these questions for you. As tempting as it is to ask a friend, “How much was your colonoscopy?” remember that your benefits are specific to your plan.

Having a family history of colon cancer may be enough to qualify you for a free or low-cost colonoscopy under your health plan. It is essential that you initiate the process by asking the right questions and having proper documentation in your medical records and health plan records. Talk to your doctor and insurance provider so you can have a colonoscopy screening when the time is right for you. Most colon cancer is very treatable when found in the early stages, and early screening means prevention, early detection and early treatment!