Under the Patient Protection and Affordable Care Act (ACA, or Obamacare), health insurance plans must provide colonoscopie screening without incurring an out-of-pocket cost for people between 50-75. Guidelines from the United States Preventative Services Task Force will govern their coverage.
However, variations between insurers’ billing code practices and how doctors conduct colonoscopies may lead to cost sharing arrangements for this necessary preventive procedure.
What is a colonoscopy?
Colonoscopy is a health care procedure that allows healthcare providers to see inside of your large intestine (colon) and rectum, where doctors can detect abnormal growths (polyps) or biopsy tissue for testing purposes. For optimal results, patients must follow all necessary bowel prep instructions carefully prior to having their procedure.
Patients may receive medication to help them relax prior to an exam. The form of this sedation medication could range from oral pills or an intravenous infusion. Some individuals opt for no sedation at all while others choose light or moderate levels depending on age, health status and individual preference.
At this stage of the procedure, a gastroenterologist will use a colonoscope – a long, thin flexible tube equipped with light and camera at one end – to inflate the colon for better viewing. Polyps that may have formed during testing are typically noncancerous but the doctor can also remove cancerous ones during a colonoscopy and thus greatly reducing your chances of colorectal cancer in future years.
How often should I get a colonoscopy?
Physicians typically advise having a screening colonoscopy every ten years for those aged 50 or over; those at greater risk for colorectal cancer should receive screening more frequently.
The Affordable Care Act mandates that health insurance plans waive patients’ cost share (deductible and copay) for preventive services recommended by the U.S. Preventive Services Task Force. According to this task force, everyone over age 50 should receive a colonoscopy screening in order to detect polyps and abnormalities that can lead to colon cancer.
Insurance companies do not abide by a single interpretation when it comes to the USPSTF guidelines for colonoscopie screening services, however. Some have misinterpreted them and taken them to mean that an colonoscopy performed following a positive FOBT is diagnostic rather than screening; thus requiring patients to pay both their deductible and copay; this interpretation falls outside of what was intended by USPSTF’s recommendations.
What happens if I don’t get a colonoscopy?
Colonoscopie can pose significant health risks, including colon cancer – the third-leading cause of cancer death in the US. With regular screenings, this issue can be avoided entirely and your doctor can treat symptoms like rectal bleeding early to avoid more serious problems down the line.
But the Affordable Care Act (ACA) mandates insurance policies waive patient cost-sharing obligations for certain preventive services – like colonoscopies – without incurring cost-sharing obligations, creating an intricate coverage minefield. Coding for the procedure has proven particularly challenging. Coding of diagnostic colonoscopies may not qualify for free coverage under ACA; billing experts add. For example, removing polyps during screening colonoscopies would qualify as diagnostic procedures that may not qualify as free coverage under this program even when correctly coded using diagnostic codes correctly coded by doctors correctly using diagnosis codes accepted by insurers who do not accept them due to billing systems not accepting them properly coding methods used by billing specialists when billing experts are involved with billing experts’ involvement with billing experts when billing them separately from health insurers accepting them when billing them to insurers who then may refuse.
What happens if I have a colonoscopy?
Colonoscopy allows your doctor to view the inside of your colon, rectum and anus using a thin flexible tube equipped with a camera called a colonoscope. Your physician can remove polyps and send them for lab analysis to see whether they’re cancerous; also detect inflamed tissue or open sores in your colon; follow any preoperative instructions related to food or beverage intake prior to your procedure; etc.
As with most procedures, anesthesia and sedatives will take effect slowly over the course of your stay at either a hospital or outpatient center. Therefore, it’s recommended that a friend or relative accompany you until this point; otherwise you won’t be able to drive yourself home afterwards. After your procedure you might feel gassy or bloated but this should pass shortly thereafter; blood in your first stool after surgery is also normal, however if bleeding persists please inform your physician.
