Will Insurance Cover Screening Procedures for Colon Cancer?

Patients with colon cancer have a higher chance of survival if the disease is detected early. Procedures used in screening and diagnosis for colon cancer include colonoscopy (a procedure that uses a camera to see signs of ulcerations and polyp formations), sigmoidoscopy (a procedure similar to colonoscopy but it only examines the lower intestine), and fecal occult blood testing (it can detect traces of blood in a fecal sample). 

These screening procedures may be very important, but it is still not clear among patients if these procedures are covered by their insurance companies. According to the Affordable Care Act, insurance companies should cover preventive health services, such as procedures for colon cancer screening.

These services and procedures must also be approved and recommended by the U.S. Preventive Services Task Force. One of the recommendations of the task force is for adults, aged 50 and above, to undergo colorectal cancer screening procedures. 

Among the different colorectal screening procedures, colonoscopy is considered to be the most thorough and most accurate in the diagnosis of colon cancer. Polyps are discovered and removed by colonoscopy. The polyps removed are then tested to determine if they are malignant or benign. However, removing the polyps can result in billing problems, according to Katie Keith, a research professor from Georgetown University who co-authored a report about insurance companies covering colonoscopy under the Affordable Care Act.

Based on Keith’s study, insurance companies consider polyp removal through colonoscopy as therapeutic, instead of a screening procedure. Because insurance companies think that it is only therapeutic, they do not cover the procedure, and hospitals bill patients for at least $2,000.

Last February, the Obama administration clarified that removing polyps through colonoscopy is an important part of screening for colon cancer.  Colonoscopy and polyp removal should be totally covered by insurance companies, except for Medicare insurance holders.

Aside from colonoscopy and polyp removal, patients are still not sure about a number of things, like insurance policies regarding follow-up tests. For example, an individual may be positive on the fecal occult blood test and needs a follow-up test, like colonoscopy. It is not clear among insurance plan holders if colonoscopy will still be covered by their insurance.

In several communities, the occult blood test is commonly opted. In cases in which blood is found in the fecal sample, the patient can still decide if they will undergo colonoscopy, and if they have enough money for the said procedure, said Robert Smith, senior director of Cancer Screening at the American Cancer Society.

Furthermore, the Affordable Care Act clarified that high-risk patients, such as patients with a history of polyps and who have a family history of colon cancer, can have more frequent screening tests. Insurance companies should cover their frequent screenings. High-risk patients are advised to have a colonoscopy at least every five years, instead of 10 years for low-risk patients.

However, despite the Affordable Care Act, there are still some insurance companies who never follow the law. Like what happened to Allen Worob, 66, who had polyps. His insurer told him that they cover the colonoscopy, but if polyps are found, Worob had to pay the $ 2,500 hospital bill.