How Much Does a Colonoscopy Cost? Colonoscopy costs vary depending on a number of factors. Colonoscopies can cost anywhere from $2000 to $10000 for patients without health insurance. On the other hand those getting screened with health insurance typically have $1000 deductible on average. Why Do Colonoscopy Costs Vary? The final cost of a colonoscopy can depend on different variables. Prices vary because of the following factors: Cost by state: Colonoscopies performed in top cosmopolitan states may cost more than those done in smaller cities. Additionally local health laws may vary from one state to another and could affect the final cost of screening. Risk factor: Patients who have a higher risk of developing colon cancer may be charged more than patients at an average risk. Certain pre-existing medical conditions may also affect colonoscopy cost. Those with hereditary syndromes such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer may be charged more. Physician and facility: Where the colonoscopy is performed dictates the final price of this procedure. This exam is cheapest at a doctors office and highest when performed in a hospital. Similarly it may be cheaper to get tested at an independent surgical center than a hospital outpatient. Extra charges: Other necessary costs are sometimes not reflected on the colonoscopy quote. This includes anesthesia and colonoscopy preparation kits. Additional charges may be added when there is polyp removal involved during the examination. Breaking Down the Colonoscopy Bill A colonoscopy procedure involves a couple things including the test itself. Other charges will be reflected on your final cost which includes the following: Anesthesia: Anesthesia is free for preventive colonoscopies. Those who are undergoing a colonoscopy for medical and diagnostic purposes will have to make partial out of pocket payments. Physician and Facility Fees: An extra cost may be charged depending on the location of the exam. An extra physicians fee may be charged on top of the test cost itself. Colonoscopy Preparation: Bowel preparation kits are not 100% covered by medical insurance. You have to pay a percentage of the price under your policy or in full if you are not under any health insurance. Insurance Coverage for Colonoscopies: Private and Medicare Colonoscopies are the most expensive screening tests afforded by Americans. Data suggests more than 10 million people get screened for colon cancer annually which adds up to $10 billion in yearly costs for colonoscopies alone. In an effort to lower the colon cancer mortality rate the United States Preventive Services Task Force (USPSTF) strongly recommends proactive colonoscopy screening to all Americans. To incentivize more individuals to get screened for colorectal cancer a federal law has been passed to reduce out of pocket costs for colonoscopy. The Affordable Care Act and Colonoscopy Coverage As previously mentioned the Affordable Care Act (ACA) mandates Medicare as well as private insurers to cover all costs for preventative colonoscopy screening. However this doesnt mean that all colonoscopies are completely free of charge. Discussed below are some nuances of colonoscopy coverage: It is important to note that this only applies to health plans created from 2010 onwards. Pre-existing health plans that havent been renewed since 2010 may not be covered by the ACA. The ACA mandates free preventative colonoscopy screening. This means that colonoscopies classified as diagnostic are not covered by the policy Specific policies may not cover other costs involved in a colonoscopy screening. These include anesthesia and facility fees among others that may come as an out of pocket cost for certain plan holders How Can I Get a Free Colonoscopy? The Affordable Care Act (ACA) makes it possible for patients to get a free colonoscopy under certain conditions. Recent studies showing the rising incidence of colon cancer in young adults as young as 35 has pushed the American Cancer Society (ACS) to make amendments in their recommended screening age. With this the ACS has changed the recommended screening age from 50 to 45. This means that individuals with a familial history of colon cancer alongside those who are at an individual risk due to the presence of other gastrointestinal syndromes and general medical conditions may qualify for a free colon cancer screening at an earlier age. Online tools can help patients understand if they are eligible for free colon cancer screening. This website offers a free quiz to help identify if you are eligible or not. Note that these materials dont guarantee a free colonoscopy. We recommend that you get in touch with your insurance provider and facility of choice to get an accurate colonoscopy cost. Frequently Asked Questions 1. Does My Insurance Cover Colonoscopy? Patients undergoing a colonoscopy for the first time are likely to be eligible for a free test. Patients who are not exhibiting common colon cancer symptoms are considered healthy and as such the colonoscopy will be defined as a preventative measure against cancer. For patients who are exhibiting symptoms or are at high risk of colon cancer there is no definitive way of telling if you are eligible for a free colonoscopy. We recommend that you ask your insurance provider about the specific cost of your test and whether it will be fully or partially covered by your current plan. For Medicare holders colonoscopies are fully covered once every 10 years for average-risk individuals and every 2 years for high-risk patients regardless of age. 2. Getting A Colonoscopy Before 50 90% of colon cancer cases are detected in individuals age 50 years and older. However recent cases of colon cancer in younger adults have paved the way for more lenient screening rules leading to more inclusive policies for younger plan holders. Even then different health plans offer varying benefits. Some providers may allow full or partial insurance coverage for individuals within the 45-49 range while others may choose to keep their colonoscopy cost-free exclusively for patients 50 years and older. 3. At What Age Does Medicare Stop Covering Colonoscopy? Medicare holders are reimbursed for colonoscopy regardless of age. A study published in the Annals of Internal Medicine suggest that colonoscopies may not even be necessary for adults over the age of 75 since the risk of developing colon cancer is reduced in patients aged 70 to 79. Although the overall lifetime risk is reduced individual health also plays a factor in the risk of developing colon cancer. Patients with type 2 diabetes for example may still develop colon cancer later in their lives. 4. Is Colonoscopy Preparation Covered By Insurance? The actual colonoscopy is only a part of the screening. Prior to the actual examination patients will be asked to go through a colon prep. This involves the ingestion of a substance designed to clean the colon to ensure accurate test results. In some cases patients may also undergo a pre-test consultation and is not necessarily covered in the policy. This means that bowel preparation kits costing anywhere from $9 $120 depending on your prefered kit and coverage plan are not fully covered by insurance companies. Top Bowel Preparation Kits and Cost Brand Generic Name Type Prescription/OTC Cost MiraLax polyethylene glycol 3350 systemic Oral laxative Both $14/119 gram pack Dulcolax Bisacodyl systemic Oral laxative suppository rectal liquid Both $9 $30 depending on type and amount Suprep Sodium sulfate systemic / magnesium sulfate Oral laxative Prescription only $110 average retail price cost may vary depending on pharmacy and insurance coverage MoviPrep polyethylene glycol 3350 systemic electrolytes Oral laxative Prescription only $110 average retail price cost may vary depending on pharmacy and insurance coverage 5. What Counts As Routine/Preventative Colonoscopy? Colonoscopies are only free when classified as preventative. Its safe to say that anyone undergoing a colonoscopy for the first time is eligible for a free test. On the other hand colonoscopies may be considered diagnostic or medical in nature under the following conditions: If the patient has no personal history of colon cancer but is exhibiting colon cancer symptoms If the colonoscopy is being used to study existing conditions such as anemia or constipation If the colonoscopy is being used to reach a definitive diagnosis usually after another screening method comes back positive If the colonoscopy is being used to remove polyps If the patient has had a polyp removed previously 6. Im Scheduled To Have Another Colonoscopy. Is It For Free? Patients who have received full coverage for their previous colonoscopy but have undergone polyp removal are no longer eligible for a free colonoscopy. At this point the test will be classified as surveillance screening rather than diagnostic in nature due to the previous discovery of polyps in the colon. Deductibles and copayments depend on your provider. Learn more about your plan in order to understand its full benefits. 7. Is Anesthesia Covered For Colonoscopy? The U.S. Department of Health and Human Services (HHS) issued a notice in 2015 clarifying anesthesia coverage for colonoscopies. This states that insurance providers both private and government-provided may not impose extra costs for anesthetic services as long as they are done for preventive colonoscopies. Copayments and deductibles are usually applied to patients undergoing colonoscopies after a polyp has been detected. This also applies for colonoscopies done to prevent the recurrence of colon polyps. Getting the Most Out of Your Provider For Patients with a Family History of Colon Cancer In some cases insurance providers may cover free testing for individuals with a proven family history of colon cancer. We recommend doing the following in order to increase your chances of qualifying for a free colonoscopy: 1. Find out if you have a first-degree relative who was diagnosed with either colon cancer or polyps before the age of 50. 2. Make a record with your primary physician. This declaration will show up in your medical records noting that you have a family history of colon cancer. This will include the relatives name and his or her age during the diagnosis. 3. Ask about screening benefits from your insurance provider. Use your medical record as proof for being at an above average risk for colon cancer. Note that this should be done before you schedule a colonoscopy since benefits are not guaranteed and vary depending on your plan. Questions to Ask Your Insurance Provider Healthcare policies are rarely straightforward making it difficult for the average patient to really understand the full extent of his or her benefits. Asking your provider beforehand allows you to prepare financially before the colonoscopy bill rolls in. Here are some questions you should ask in preparation for a colonoscopy: Are preparation kits included in my plan? Are there specific brands covered by my plan? If not what kind of discount do I get under my policy? I have exceeded the once every 10 years / 2 years screening policy recommended by the American Cancer Society. I am planning to get another preventative colonoscopy within the time frame is it still fully covered by my insurance? Would the presence of a polyp during my first screening affect the coverage? Will I be required to pay out of pocket for a pathology? At what age do I become eligible for screening benefits? Do you consider coverage for individuals who require earlier screening than others? Do you have an age limit for preventative colonoscopy screening? Are you partnered with any establishments where I can get further discounts on my colonoscopy? Out Of Pocket Colonoscopy Cost $2000 and above is the common out of pocket cost for uninsured patients in the U.S. However there are various options available online and locally that could help mitigate colonoscopy costs. Check For Local Programs In Your Area Sites like Colonoscopy Assist help patients all over the U.S. find cheaper colonoscopies in their areas. With various programs available in over 25 states uninsured patients can pay as low as $1075 for an all-inclusive screening. You can also ask around public health organizations for ongoing programs that help uninsured patients get lower costs for their colon cancer test. Get a Colonoscopy Loan Personal loans can be used to fund a colonoscopy. The same rules for taking out a personal loan apply when being used for medical reasons. Get in touch with your bank or private lender to learn the specifics of their lending policy. Are Colonoscopies Worth It? A colonoscopy may be expensive but its nothing compared to actual cancer treatment. In 2014 the American Cancer Society published the out pocket costs of cancer patients: a staggering $4 billion. Through the years colonoscopy has remained to be the golden standard in colon cancer screening and for good reason. At the end of the day the minor financial and logistical inconveniences posed by colonoscopy are actually privileges when compared to the relentless costs and stress from late stage colon cancer. When it comes to colon cancer time is money. Book a colonoscopy today. The post The Cost of Colonoscopy: Insurance Anesthesia And More appeared first on Gastro Center NJ. via Gastro Center NJ https://gastrocenternj.com/colonoscopy-cost/