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Questions to Ask Your Insurance Provider to Determine Your Colonoscopy Cost

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You have made one of the most important decisions you will ever make: you are getting a colonoscopy! Your doctor has recommended this important procedure, and now it’s time for you to take some action. The next step is for you to call your insurance company to see if you have any cost-sharing responsibilities. A screening colonoscopy can be fully or mostly covered under the Affordable Care Act depending on your insurance plan. Coverage is not always clear, and it is certainly not the same across the board. Before you have your colonoscopy, it is your responsibility to find out how much the procedure will cost.

Call Your Insurance Provider Before Your Colonoscopy

How should you approach this phone call? What are the correct questions to ask? Here is a sample dialogue to use as a guideline as you speak to your insurance provider to estimate your out-of pocket cost for your upcoming colonoscopy:

Patient: “I am ____ years old and my doctor wants me to get a colonoscopy.” (The recommended age for a colonoscopy is age 50 unless you are at high risk)

  • Provider: “Who is the surgeon or gastroenterologist who will be performing the procedure? What is the name of the hospital or ambulatory surgery center where you will have the procedure? I would like to check to see if your doctor and facility are in-network.” (This information will help your provider tell you how much your procedure will cost for an in-network doctor and facility vs. an out-of-network doctor and facility. Your provider can also direct you to a list of in-network doctors and facilities to save you money.)

Patient: “Am I subject to a deductible for this procedure? What percentage of the procedure is my responsibility?”

  • Provider: “To answer those questions, I need to ask you a few questions: Is this your first colonoscopy? Are you having problems? Did your doctor refer to this procedure as a screening colonoscopy or a diagnostic colonoscopy?” (A screening colonoscopy is when there are no symptoms or perceived problems. A diagnostic colonoscopy is associated with symptoms).

Patient: “If I have come in for a screening colonoscopy and my doctor finds a polyp, how might this affect my cost-sharing responsibility?”

  • Provider: “That is a great question. Let me look at your plan so I can give you details on your surgery benefits. If a polyp is found and removed during a screening colonoscopy, you may responsible for the cost of the removal and pathology.”

Patient: “If I add up these charges, will that give me the exact amount I am paying?”

  • Provider: “This is just an estimate of the charges for your colonoscopy. The final cost is determined by how the procedure is billed and whether the colonoscopy is coded as a screening or a diagnostic colonoscopy.”

Patient: “Can you direct me to the place on your website that will go over these details we just spoke about so I can refer to my benefits later?” (You always want to be able to access this information again. Having a representative explain your benefits is very important so you understand the charges, but you need to be able to find a copy of your colonoscopy benefits and even print them off for your reference).

Final Cost is Determined by Your Doctor

Remember that the type of colonoscopy you have (diagnostic or screening) and how your procedure is coded is up to your doctor and not your insurance company. Your insurance company is somewhat limited in its ability to tell you what your out-of-pocket cost will be because it is the doctor’s office that applies specific codes to the procedures. Therefore, it is best to view this call as a rough estimate of your cost-sharing responsibility.  It is a very good idea to call your doctor’s office or facility to confirm costs and how they will code your procedure based on your patient information.

A colonoscopy is one of the best steps that you can take for your health. Because colonoscopies are the most effective test for preventing and diagnosing colon cancer, they carry the highest price tag. However, screening colonoscopies may be free or prove to be very reasonable when you ask the right questions. Call your insurance provider before you schedule your colonoscopy so you can verify that:

  • Your doctor is in-network
  • Your facility is in-network
  • You have colonoscopy screening benefits
  • You understand how various outcomes of your colonoscopy will affect your cost-sharing responsibilities.

Family History Could Cover Your Colonoscopy

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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!

How Do I Choose the Best Doctor for My Colonoscopy?

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Let’s say it’s time for your very first screening colonoscopy. How do you choose your gastroenterologist for your procedure? You may look online for gastroenterologists in your area. You may ask your friends for a recommendation. But which doctor is the right one for you? The short answer is: the doctor who finds the most polpys!

Study Links Polyp Detection Rate to Colon Cancer Rate

According to a study published by the New England Journal of Medicine, the likelihood of developing colon cancer is significantly reduced among individuals whose doctors removed a greater number of adenomas, or premalignant polyps. The study examined 300,000 screening colonoscopies performed by 136 physicians who had performed at least 300 colonoscopies. Among the physicians, the polyp detection rate ranged from 7.4 and 52.5 percent. They physicians were divided into five groups according to their polyp detection rate. The research team then assessed the number of colon cancers that resulted between six months and 10 years after screening.

For patients whose doctors had the highest percentage of polyp detection, their colon cancer rate was about 50 percent of the rate whose doctors fell into the lowest group for polyp detection. Patients with fatal colon tumors also had much higher rate of survival with physicians who had high detection rates. Researchers also documented that physician skill affects the stage at which colon and rectal cancers are discovered.

Therefore, it would seem that there is an inverse relationship between a gastroenterologist’s frequency in removing benign polyps and their patients developing colon cancer. In the New England Journal of Medicines’ blog, it reads, “each 1 percent increase in adenoma detection rate brought with it a 3 percent decrease in interval cancer risk and a 5 percent decrease in risk of fatal colon cancer.”

What Affects a GI’s Polyp Detection Rate?

This study actually prompts new questions such as, “Why is there such a wide range of polyp detection rates among physicians?” There are many factors that affect detection rates such as:

  • Demographics— physician who serve older populations may detect more polyps
  • Colon prep— how well the gut has been cleansed affects detection rates
  • Patient insurance and reimbursement— how much the doctor is being reimbursed for the procedure may affect the thoroughness of the procedure

Spending More Time “Down There” Matters

Probably the most significant factor in polyp detection rates is how long and hard the physician actively looks for polyps. Sometimes, it just comes down to how much time your doctor spends in your colon. If a doctor passes the colonoscope through the entire colon and diligently scopes for polyps until the scope nears the appendix at the end of the right colon, the chances of polyp detection are higher.

Take Time to Ask Questions

So if it’s time for your first colonoscopy, don’t be afraid to ask your doctor questions such as:

  1. What is your experience in performing colonoscopies?
  2. How long does the procedure normally take you to perform?
  3. What is your polyp detection rate for patients my age?

Never be hesitant to ask questions. Your colonoscopy can be a window into your health. Do your part by preparing for the procedure thoroughly and by asking good qualifying questions to your doctor. The proof is in numbers, so find a doctor with high detection rates (Source: Forbes).

Frequency of Repeat Colonoscopy in Average Risk Patients

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All adults that are at average risk should have a baseline colonoscopy at the age of 50. Certain risk factors may lower the age for a recommended baseline colonoscopy. If you have a clear colonoscopy and no polyps or abnormalities are discovered, you most likely will not have to have another colonoscopy for 10 years.

If your gastroenterologist finds polyps during your colonoscopy, how soon will you have to schedule another procedure? The general guidelines state that a repeat colonoscopy should be performed in five years if one or two small adenomas (precancerous polyps) are found and 10 years if hyperplastic (noncancerous) polyps are found.

The Study

A study in the April issue of Gastrointestinal Endoscopy analyzed the frequency of repeat colonoscopies in Michigan. The lead author of the journal article was Stacy Menees, M.D., of the University of Michigan Health System. She stated, “The aim of our study was to quantify the frequency of appropriate follow-up colonoscopy recommendations after one or two polyps were found during the screening colonoscopy in average risk patients. In addition, we aimed to identify factors associated with adherence to guideline recommendations including bowel preparation quality, demographic factor and procedural factors.”

The study was conducted between January 1, 2009, and December 31, 2009, among average risk individuals aged 50 or over who were undergoing colonoscopy screening and had one to two small polyps. All results were taken from a retrospective endoscopic database from the University of Michigan in-hospital medical procedure unit, two outpatient ambulatory surgery centers and the Ann Arbor Veterans Affairs Health Care System in-hospital endoscopy suite.

The endoscopists (physicians who perform endoscopic procedures like colonoscopies) may sometimes vary from the guidelines. More specifically, the guidelines state that average risk patients with one or two small (less than one centimeter) adenomas (precancerous polyps) at screening colonoscopy should be directed to get a surveillance colonoscopy in 5 to 10 years. If 1 to 2 small hyperplastic (noncancerous) polyps are found, a colonoscopy should be performed in 10 years. Because of the Affordable Care Act, recommending repeat colonoscopies sooner than the guidelines are more scrutinized today, so this study comes at a very appropriate time.

The Results

Of the 922 colonoscopies with 1 or 2 small polyps discovered, 90.2 percent of patients received correct recommendations for appropriate timing for repeat colonoscopies. Eighty-four percent of patients with 1 to 2 small adenomas and 94 percent of patients with 1 or 2 hyperplastic polyps received recommendations consistent with guidelines.

What would make endoscopists vary from the recommended timing for repeat procedures? A colonoscopy could be recommended sooner if:

  • Bowel prep was fair or poor because polyps or adenomas could be missed
  • Patient is at higher risk for colorectal cancer
  • Patient is older than age 70
  • The endoscopist is concerned about limitations of the colonoscopy in preventing colorectal cancer on the right side
  • Endoscopist distrusts research that supports the guideline recommendations

Four Common Misconceptions about Colonoscopy Prep

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Many of us can remember having test anxiety in school. Sometimes test anxiety included sweaty palms, a raised heart rate and a queasy feeling in our stomachs. Some medical tests and exams can bring on those old familiar feelings of test anxiety. Feeling unprepared or nervous is common, but good studying and preparation can bring confidence on test day.

A colonoscopy can cause a great deal of “test anxiety” because it requires a good amount of preparation to cleanse the colon. Listening to other peoples’ stories about colon cleansing can increase anxiety, especially if this is your first colonoscopy. It is important to be able to find sources of good, sound information and not rely on someone else’s story. Here are a few misconceptions about colonoscopy preparation:

  1. The colon cleanse is a horrible experience—Emptying your colon is necessary for thorough and accurate results. However, the most common complaint from people is the volume of fluid you are required to drink and not the time in the bathroom.
  2. There is only one type of colon preparation—Actually, there are several types of colon preps, and you can talk to your doctor about which one is best for you. Now, there is even a lower-volume option if you have a hard time drinking a large volume of fluid at one time.
  3. You have to go an entire day without eating—Yes, this is partially true. You can only have clear liquids that will pass through your system easily and not interfere with the colonoscopy. However, there are a few items on the approved list that feel more like real food. Along with clear broths and juices, you can also have Jell-o, popsicles and Italian ice (as long as they do not contain red or blue dye). Bring on the treats!
  4. Spending an entire day in the bathroom will be boring—You need to stay close to the bathroom, but try to give yourself something to look forward to on prep day. Subscribe to Netflix and try a new show you have been wanting to see! You could get through a season in one day! Purchase a new book and see how much of it you can read on prep day. You might actually enjoy that time to yourself.

If you still find yourself feeling nervous about your colonoscopy prep and procedure, talk to your doctor and ask for some literature and information. Searching the internet and asking for other people’s opinions can cause misinformation and more anxiety. Save your questions for your doctor, and this will help you feel more informed and confident for your prep day and your colonoscopy.

To find out more tips about prep day and how you can avoid the need to retest, read our comprehensive information about colonoscopy prep.

What are the Different Types of Polyps?

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You have most likely heard of colon polyps. Polyps are the precursor of colon cancer. Did you know that there are different types of polyps? Polyps can be knobby or flat, and some polyps tend to be benign while some polyps are at higher risk for cancer. Let’s go over the basic categories of polyps:

Hyperplastic polyps

> These polyps are small and circular, measuring less than ¼ -inch wide. Usually, hyperplastic polyps are benign. However, if hyperplastic polyps are discovered on the right side of the colon, they should be completely removed because they carry risk for cancer.

 

Adenomas

> Adenomas tend to be circular in shape as well. They account for about 75 percent of all colon polyps, so they are certainly the most common. These polyps are considered precancerous and should be removed. If adenomas are left to grow, they can turn into cancer. There are three types of adeonomas:

 

  • Villous—tend to be the largest and are most likely to become cancerous
  • Tubular—tend to be the least likely to become cancerous
  • Tubulovillous—considered to have a higher risk of malignant transformation than tubular adenoma

Flat Polyps

> Many polyps are easy to detect because they appear like a mushroom. Some polyps are flat, and these can be easily missed during a colonoscopy. Sometimes called lesions, flat polyps can be just as deadly as circular polyps. More studies are revealing the dangers of flat polyps, and gastroenterologists are taking special measures to look for flat polyps during colonoscopies. Flat polyps can be removed just like other types of polyps, but viewing them can be difficult because they appear level or like a small indentation.

 

Rely on the Expertise of Your Doctor

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While round or circular polyps are much more common, a significant percentage of cancers are found in flat, depressed growths. In fact, researchers found that flat growths are nearly 10 times more likely to be cancerous than polyps. Because flat polyps can be so dangerous, it is important to have a thorough colonoscopy. A skilled gastroenterologist can identify and remove suspicious polyps during the procedure, and a trained pathologist can review specimens to examine for cancerous cells. Now that doctors know more about flat polyps, they know what to look for during the exam (Source: NBC News).

The patient has a responsibility as well. Your preparation for the procedure will make it easier or more difficult for the gastroenterologist to see. A complete colon cleanse is essential for maximum viewing, especially for flat polyps. If you have questions about how to effectively prepare for your colonoscopy, talk to your doctor or read “Your Guide to an Easy Prep.”

Does a Colon Polyp Always Mean Colon Cancer?

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Most colon polyps are noncancerous tissue that can sometimes develop into colon cancer. Colon cancer usually begins as a polyp, or a growth on the inner surface of the colon. Polyps are made of clumps of cells that grow slowly over time. If left to grow, larger polyps can bleed or even block the colon. In the most severe cases, polyps can lead to abdominal pain, nausea, vomiting and constipation.

Do polyps always mean colon cancer? Not at all. Having colon polyps increases the likelihood to have more polyps in the future, but it does not necessarily mean that you have colon cancer. Having polyps will make you a candidate for more routine colonoscopies. A colonoscopy is the most effective type of screening method for colon cancer. Your doctor can examine the entire colon for precancerous polyps and remove any suspicious polyps during the procedure. For larger polyps, a biopsy can be taken during the colonoscopy to test for cancerous cells.

Regular colon screenings are important because polyps can move progressively from noncancerous to cancerous. There are two main types of polyps in the colon and rectum:

Hyperplastic and inflammatory polyps
These polyps are not at high risk for becoming cancerous, except for large hyperplastic polyps on the right side of the colon. These polyps are more concerning and should be removed entirely.

Adenomas and adenomatous polyps
These are considered pre-cancerous and should be removed. Often, if left alone, these polyps can turn into cancer. One specific type of condition is called familial adenomatous polyposis is an inherited disorder in which patients develop multiple noncancerous polyps in their teenage years, and polyps progressively become malignant.

Colon cancer and cancerous polyps often have no symptoms, so the most important thing to remember is to talk to your doctor about how often you should be screened. Regular screening significantly lowers your risk for colon cancer, and the disease is highly treatable when found in the early stages. Not all polyps are cancerous, but don’t take a chance. Schedule your colonoscopy today by contacting one of our treatment centers.

Five Red and Purple Foods To Avoid Before Your Colonoscopy

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Preparing for a colonoscopy is not necessarily a cup of tea. However, it is a necessary process that needs to be taken seriously and completed thoroughly. On the day before your colonoscopy, you have a very detailed regimen of laxatives that you must take to completely cleanse the colon. Along with the laxatives, you may have clear liquids such as coffee, tea, clear soup or broth, soda, juice and water.

In addition to clear liquids, there are actually a few treats that dissolve into clear liquids which are on the safe list. These foods can “fool” your brain into thinking that you are eating. However, you must remember that anything RED or PURPLE is off limits when it comes to colonoscopy preparation. Red dye or purple dye masks the lining of the colon and can interfere with getting accurate results.

Find a Gastroenterologist

Here is a Top Five list of red and purple foods and drinks to avoid before your colonoscopy:

  • Jell-O—Avoid strawberry, raspberry, cherry or black cherry and grape
  • Popsicles—Avoid any red or purple in a variety pack. Try the natural frozen fruit bars made with real fruit juice. There are some delicious lemon or tangerine pops that are made with 100 percent fruit juice. Just make sure that there are no bits of fruit in the popsicle, and it is juice only.
  • Kool-Aid—It’s been a while since you have had Kool-Aid, hasn’t it? Unfortunately, most Kool-Aid flavors have red or purple dye. Lemon, lime or orange Kool-Aid is acceptable but no grape, cherry, fruit punch or strawberry.
  • Italian ice—This delicious treat is tasty enough to make you forget you are prepping for a colonoscopy! Just remember to avoid strawberry. Choose lemon.
  • Juice—No grape, pomegranate, cherry, cranberry or cranberry cocktail juices are permitted. Stick with apple juice or white grape.

Talk to your doctor to get more information on colonoscopy prep. A wonderful resource can be found on the Colon Cancer Alliance website called Todd’s 6-Day Colonoscopy Prep Guide. Take the time to write out a menu for the days preceding your colonoscopy and make a special trip to the grocery story with your list in hand. Following the correct steps ensures an accurate colonoscopy!

Find out if you’re eligible for a free or reduced cost screening colonoscopy

5 Tips to Conquer the Colonoscopy Prep

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We all know how getting a colonoscopy can save lives. But the minute we hear the word “colonoscopy,” our minds immediately think about the prep that must be taken to clear out the colon. An article from Men’s Health offers five tips and tricks that can make the prep day more comfortable:

  1. Modify your menu: before taking the bowel prep, you need to spend a day on a clear diet of easily digestible liquids to help clear out the colon. Broth and Jell-O are some of the approved foods, but you can also have Italian ice, coffee and hard candies to shake up your flavor palette.
  2. Diaper rash cream is not just for kids: as unpleasant as this may sound, you might experience something akin to a diaper rash as a result of the bowel prep. Diaper rash cream can help with this irritation.
  3. Stay busy: a good tip for the day when you’re taking bowel prep is to stay home and stay busy. Plan an activity or project that will keep you moving for most of the day. The more you move around, the better your stomach empties.
  4. Keep the liquids coming: need a way to make the prep taste better? Try mixing it with some Crystal Light, and chase it with cranberry juice. Also have plenty of water handy.
  5. Make your bathroom more entertaining: you’ll be spending a lot of time in the bathroom. Why not move your TV in there? Or keep some books handy. Whatever can make that time move faster and maybe offer you some distraction is highly encouraged.

These tips are great ways to make your prep day slightly more enjoyable, and if all goes well with your colonoscopy, you won’t have to do that again for another 10 years!

Are there other ways you have tried that have helped you conquer the prep? Let us know! Share your tips and tricks on our Facebook page or email us at info@stopcoloncancernow.com. We’d love to hear from you and share what you’ve learned with the StopColonCancerNow.com community!

Colonoscopy as the Gold Standard for Colon Screening

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Colon cancer is one of the most common and most treatable cancers. In 2013, it is expected that colon cancer will claim the lives of over 50,000 Americans. Since the risk of developing colon cancer is 1 in 20, it is in your best interest to learn more about prevention and early detection for colon cancer. If you are over 50, you should ask your primary care physician about getting an initial screening. Individuals who are African American or who have a family history of colon cancer or exhibit other risk factors should seek early screening.

There are many different screening methods, but the colonoscopy remains the gold standard for colon cancer screening. A colonoscopy is a procedure in which a gastroenterologist inserts a lighted probe into the rectum to look for lesions, polyps and abnormalities in the lining of the colon. One of the best advantages of a colonoscopy is that cancerous polyps can be removed during the procedure if they are discovered. If your colonoscopy is clear, you will not have to have another procedure for 10 years.

Still, as good as this sounds, there are people who will opt out of testing. Many are scared off by the anticipation of pain during the colonoscopy. Most people choose to be sedated, either conscious sedation or total sedation so you will not feed pain during the procedure. Other people dread the prep for colonoscopy and having to stay close to a bathroom all day. There is really no other way to make it more bearable or pleasant, but take heart that if you the preparation correctly the first time, you won’t have to do it again for another decade. Give your cleansing day your best effort because a thorough cleanse will allow your doctor to see even the flattest lesions on your intestine.

There are other methods of colon cancer screening besides the colonoscopy. A flexible sigmoidoscopy involves a flexible tube being inserted into the rectum, but not as far into the colon as a colonoscopy. This test has to be done every five years instead of every ten years. Another test is the double-contrast barium enema, which also has to be done every five years. A virtual colonoscopy has gotten a lot of attention these days, but recently Medicaid Services has refused to pay for the test. As with other testing, when insurance will not pay for the procedure many people will not choose to be tested.

A colonoscopy is the best screening method because it is the most comprehensive exam and allows for polyp removal during the procedure. It is estimated that between 60 to 90 percent of colon cancer deaths could be prevented if everyone over 50 chose to have a colonoscopy. That is 30,000 to 45,000 lives that could be saved! If you have never had a colonoscopy before, take a few moments to view some FAQs and find a treatment center near you.