THERE ARE 2 KINDS OF COLONOSCOPIES
- Preventative (you don’t show any signs, you’re just being smart and pre-emptive)
- Diagnostic (you show signs and or they find polyps once they’re in there and have to remove them (of course).
THERE ARE 2 AGE GROUPS (as far as our health insurance companies and the gov are concerned)
- You are 50 years or older
- You are 49 years or younger
IF YOU HAVE HEALTH INSURANCE AND HAVE LIVED 50 YEARS OR MORE ON THIS PLANET
IF YOU HAVE HEALTH INSURANCE AND HAVE LIVED 49 YEARS OR LESS ON THIS PLANET
In most cases, your insurance will waive the age thing and cover it at 100% if you are considered high risk by your primary doctor. Make an appointment with your regular doc and find out if you are. Aren’t you due (or overdue) for that yearly physical anyway? hrmmmm?
WHAT TO DO FIRST
- What is the coverage for a preventive colonoscopy?
- What if they find polyps and have to remove them (duh), is it still covered at 100%?
- If it isn’t covered at 100%, what exactly will I have to pay?
- Do I need a referral from my primary doctor?
- Can I go to any GI specialist or do you have specific ones I have to go to?
Insurance company policies vary. I spoke with Chris who works in the billing department at North County Gastro where I got my colonoscopies done, and she gave some great input:
- Regardless of age, if you have an HMO or Medical/Medicaid, you must get a referral from your primary doctor, so call your regular doc.
- If you have Medicare, it is covered at 100%
- If you have private health insurance you can most likely call the GI specialist’s office directly.
BEWARE: Some insurance companies say the screening is free (because they have to under the ACA), but if they find polyps, it becomes diagnostic, which will cost you. This created quite the uproar over the last year or so as you can guess, so more and more insurance companies are adopting a good will policy of their own making that always provides full coverage for a colonoscopy even if there is polyp removal, regardless of how the provider codes it.
IF YOU DON’T HAVE INSURANCE
Get Insurance. Seriously, WTF. The job you have can’t be that great if they don’t care enough about you to offer health insurance. If they really are that great, there are seriously no other job options around or you work for yourself then get on ehealthinsurance.com and get some kind of health insurance. Life is just Russian Roulette without it.
For cash/credit paying customers, colonoscopies cost anywhere between $1,000-$2,000, or more (about the same price of a year’s worth of self-pay health insurance, hint-hint). Chris says that most practices will give you a discount for paying cash, but the total will be due by the date of service.
She also says that going through the hospital option, is now pretty much obsolete. The only way a hospital will cover a colonoscopy is under emergency services and we’re not going to wait that long, are we.
And that, my peeps is how to get an appointment for colorectal cancer screening, now do it~