Health Services to Cut Colonoscopy Costs

Focused on Health - March 2011

by Robin Davidson and Laura Nathan-Garner

couple smiling If you’re age 50 or older, high colonoscopy costs may be preventing you from scheduling this important exam.

Well, health care reform hopes to change all that.

Some of these cost-saving changes are already in place. Others will slowly be rolled out over the next few years.

Here’s some advice on taking advantage of what’s available now.

Colonoscopy coverage for the insured

So you have insurance but your colonoscopy co-pay is higher than the cost of a new flat screen TV? How can health care reform help you?

The answer depends on what kind of health insurance you have.

Have an individual or work insurance plan that started on or after
September 23, 2010?
Your plan must cover a long list of preventive services, including colorectal cancer screening.

But, you may need to see an in-network doctor to get these services with no out-of-pocket costs. And, coverage for some services may depend on your age, risk factors and screening guidelines.

Have an individual or work insurance plan that started before
September 23, 2010?
If your policy hasn't changed much, it may be “grandfathered.” So, it may or may not cover prevention services, like the colonoscopy.

But, it also can’t get rid of any prevention services covered on March 23, 2010 or raise your rates too much. If it does, it becomes a “new” plan, complete with free prevention services.

Ask your insurance provider if your policy is grandfathered. They’re required to tell you.

Virtual colonoscopies aren’t included in the health care reform coverage changes. So, if you’d rather schedule this exam instead of a traditional colonoscopy, check with your insurance provider to find out exactly what your policy covers. Not all providers cover the costs of a virtual colonoscopy.

Have Medicare?
As of January 1, 2011, Medicare co-pays for many prevention services — including colonoscopies — have been eliminated.

Resources for the under-insured and uninsured

What if you don’t have insurance? Or what if the insurance you do have won’t cover most of your screening costs?

Well, state and local resources may help.

First, visit the federal government’s website, HealthCare.gov, to find out if you qualify for assistance. Benefits vary from state to state. You also can contact your state Medicaid office for information about more affordable insurance options.

customer service agent talking to client

Then, try contacting non-profit organizations. Many have programs that cover colonoscopy costs for those who qualify. Some of these programs also may help cover additional costs if an abnormality is found, and you need other tests or treatment.

Contact the organizations below to find out what resources are available in your area:

Colorectal Cancer Program (CDC)
National Cancer Institute’s Cancer Information Service
Texas Cancer Information for Texas residents

Future of prevention looks more affordable

Keep in mind that many details of health care reform are still being hammered out. But it looks like law changes will make it less costly for you to get a colonoscopy.

“Colon cancer screening saves lives but sadly most people aren’t going in for regular colorectal screening exams,” says Lewis Foxhall, M.D., vice president of health policy at MD Anderson. “Hopefully, health care reform will change this by making prevention more affordable.”