Colorectal Cancer News

Colonoscopy Coverage & Confusion

The new federal health care law requires that vital preventive services, including colonoscopies, be covered by insurance companies at no out-of-pocket cost. Insurance providers, doctors, and everyone else agrees on this when a patient goes in for a routine colonoscopy during which no polyps are found. However, if a polyp is found and removed during the colonoscopy procedure, some private companies and Medicare are charging the patient with fees upwards of several hundred dollars.

These extra expenses can include deductibles, co-payments, and co-insurance, and patients are often unprepared for these costs before going into the colonoscopy. These hidden fees are causing confusion among doctors, patients, and insurance providers and raising concern from patient advocacy groups. The problem becomes is that once doctors remove a polyp, the visit is then considered a treatment procedure rather than a preventive test, which federal law does not require insurance companies to cover.

Colonoscopies aren’t the only procedure that is raising issues – it still remains unclear how to handle other preventive checkups that turn into therapeutic visits, such as when a skin lump or breast lesion needs a biopsy or excision during that visit. Officials, insurance providers, doctors, and other patient groups are working together to help patients better understand what is covered and to help clarify terminology and procedures.

References:
Meyer, Harris. Confusion alert: When prevention and treatment mix, who pays? Los Angeles Times. 2011 April 23.

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