Most colonoscopies should be covered 100% by your insurance

The Affordable Care Act (ACA) requires that insurance companies cover 100 percent of the cost of preventive colonoscopies for adults older than age 50. Of course you’ll need to see a provider who is part of your plan’s provider network.

However, despite this new reform, we do hear consumers who’ve had a routine preventive colonoscopy only to have their insurer process their claim as “cost-shared diagnostic care,” which is subject to their annual deductible and coinsurance.

We also sometimes hear from consumers who receive a substantial surgical bill when a polyp is discovered and removed during a preventive colonoscopy. The Affordable Care Act and other federal guidelines protect consumers from extra charges for polyp removal during a preventive colonoscopy. If you receive a bill for polyp removal, you should file a complaint with us and we’ll help you get those charges reversed.

If you are diagnosed with colon cancer, any previous related symptoms may result in your provider processing the cancer screening as diagnostic and not preventive. In that case, your treatment would not be covered as preventive care and you’ll likely have additional costs. If you have any questions, check with your doctor.

Be aware that if a procedure or treatment is not a recommended preventive service, it may be subject to your plan’s deductible and cost-sharing. Also, if a medical recommendation or guideline regarding a preventive service does not specify the frequency, method, treatment, or setting for that service, your insurer may limit your coverage.
Here are some important tips to remember:

• If you have any questions, first talk to your doctor or medical provider and your insurance company. 
• Read more about which health benefits are required under the ACA.
• If you receive a bill from your insurance company that you disagree with, request an appeal.
• In addition, file a complaint with us.

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