Screening colonoscopy saves lives!
Colon cancer is the third most commonly diagnosed cancer. Currently in the U.S. it is the second leading cause of cancer related deaths in men and women combined. On average your risk of having colon cancer is 1 in 20, with 90% of the new cases occurring in people aged 50 and older. With regular screening colon cancer can be found in the early stages when treatment is most effective thus having a 90% 5 year survival rate. Get your screening early to increase your probability of survival.
Important news about insurance coverage of screening colonoscopies for 2014.
The government recently clarified its policy related to cost sharing for colonoscopy for privately insured patients, specifically on the implementation of preventive screening benefits. The Patient Protection and Affordable Care Act now states if a screening colonoscopy is performed and a polyp is found and removed during the screening, an insurer cannot impose cost-sharing since it is an integral part of a colonoscopy.
Beginning January 1, 2014 the screening portion of a colonoscopy is now covered automati- cally by the patient’s insurance carrier. The insurance company can no longer apply the cost of the screening to the patient’s deductible if a polyp is removed.
Here is the exact language provided by the government in their guidance document:
FAQ: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?
No. Based on clinical practice and comments received from the American College of Gastroenterology, Amer- ican Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure.
It is important to note this new ruling does not apply to Medicare patients. The American Gastroenterology Association is continuing to work with their sister societies and patient advocacy groups to advocate legislators correct the colonoscopy cost sharing issue for Medicare patients as well.
This ruling is great news for you and your commercially insured patients. Cost of this procedure should no lon- ger be a barrier for screenings. Please do not hesitate to call our office if you have any questions or
concerns about this ruling. As always, we appreciate your business and are honored to partner with you in the care of your patients.