Just when you thought the colonoscopy was done!

January 6, 2016

What makes insurance good? Broad networks? Customer service? Transparent communications? Do you expect your insurance to communicate directly and precisely with you?

Health Affairs published a study last month that looked at the impact of regulations imposed by the Affordable Care Act. It looked at the effect of waiving the out-of-pocket cost for screening colonoscopies. The study found that, in men, colonoscopy screening rates increased 4 percent; in women they did not change – further deduction on why will require additional research. 

So, back to men. 4 percentage points, that’s great. What’s not great is that there is a good chance that these men will get a financial surprise if the payer is Medicare. Why? Because 25% of screening colonoscopies result in polyp removal - and guess what? Medicare considers colonoscopy and polyp removal a “diagnostic” procedure, for which it does not waive out-of-pocket costs. While they are asleep, men with Medicare and colon polyps become financially responsible.  

You’re probably saying, “okay, fine, I have to pay for it. How much will this cost me?”  The answer to this is anything but simple and dependent upon your deductible, how it’s done, where it’s done and who did it.  Some have been bold enough to venture guesses, but the truth is, you won’t know until you receive the final bill. The best thing to do is ask your doctor’s office before the procedure to determine your out of pocket cost if polyp removal is necessary based on your current benefit status. You’ll want to ensure that you take into account the fee for the facility, anesthesia and pathology to ensure you have a complete picture of what you’re facing. 

If a colonoscopy, a relatively minor procedure, has this many caveats, it certainly raises questions around more complex services like knee replacements and penile implants.  Informing yourself as a consumer of healthcare services is more important than ever, so, make sure you are arming yourself with the necessary numbers before you have this, or any service, so you don’t receive a financial surprise.