Colonoscopy
There are two types
of colonoscopies:
1.
Diagnostic (also known as medical)
2.
Screening (also known as preventative or
routine) (Screenings are also classified as average or high risk)
Diagnostic
A
diagnostic colonoscopy is performed for a patient with symptoms. (Examples:
constipation, diarrhea, weight loss, abdominal pain, rectal bleeding, anemia,
history of colon polyps or cancer)
Screenings
Average
risk screening – A patient that is at least 50 years old and has no past or
current bowel symptoms and no risk factors.
High
risk or surveillance screening – A patient with risk factors or personal
history of colon polyps and/or colon cancer, a family history of colon polyps
and/or colon cancer and certain inflammatory bowel diseases. The age of the
patient would not apply. Due to your risk factor, your physician will recommend
you have these more frequently.
How does my insurance cover my colonoscopy?
A diagnostic or medical colonoscopy is generally subject to
one’s major medical benefits, deductibles, co-insurance and/or co-pays). These
are performed as an outpatient procedure so checking your benefits for
“outpatient surgery” will give you a better idea of what type of out-of-pocket
expenses you may incur.
An average risk screening is generally covered by one’s
wellness benefits. Most (not all) insurance companies will cover this at 100%,
once every ten years and the patient must be over the age of 50. However, if
during your screening colonoscopy a diagnosis is made, an additional procedure
is performed and/or biopsy or specimen is collected, you may be responsible for
out of-pocket costs as a “diagnostic/medical colonoscopy”.
A high risk or surveillance screening coverage is specific
to your insurance company. Some insurance companies will cover these under
wellness benefits and some will cover these under major medical benefits.
Insurance companies DO NOT have to cover these at 100%.
**This is only a general guideline of insurance coverage for
your colonoscopy benefits. Each insurance company will vary their coverage and
costs.