July 29, 2014
Colonoscopy Cost
Ask the Experts

Colonoscopy Cost

by Berkeley Wellness  |  

Q: You said that insurance covers colonoscopy screening. My insurer says I have to pay $2,500 for mine because the test found polyps and that’s my annual deductible. What’s going on?

A: It’s crazy, but that’s how most insurers deal with colonoscopies. Under the 2010 Affordable Care Act, preventive services are covered by insurance with no charge. That includes screening colonoscopy, but there’s a big loophole. If polyps are detected (and removed and biopsied), then it becomes a “diagnostic test,” which, depending on your plan, would require you to pay coinsurance (usually around $200 to $300) or your annual deductible (sometimes $2,000 or more). A proposed bill in Congress will waive the 20 percent coinsurance for people on Medicare if polyps are found.

If you have private insurance, call the company before having the test to find out what the charges would be. But don’t let the potential cost keep you from getting tested. Screening is a lifesaver. As an alternative, you can be screened with a stool test or sigmoidoscopy, as we said in April. But if that turns up suspicious findings, you’ll need a colonoscopy, which will be considered “diagnostic” and thus may entail charges.