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How Much Does a Colonoscopy Cost?

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    Average Cost $3000

    Before you go in for your colonoscopy, you most likely are concerned about how to prepare for the procedure and what to expect. Along with these concerns, you may also wonder how much a colonoscopy will cost. The average cost of a colonoscopy is $3,000 but can range between $1,750 to $4,800+. Federal law requires that health insurance covers the procedure for colorectal cancer screening. However, you may be charged out-of-pocket costs depending on your deductible and copays among other factors. A colonoscopy can also range in price depending on where you have the colonoscopy, which region you live in, and your insurance policy. Lastly, if there is an abnormality found the cost can increase substantially due to biopsy and surgical removal fees

    Is a Colonoscopy Typically Covered by Insurance?

    The Affordable Care Act requires that private insurers and Medicare cover the costs of colorectal cancer screening tests, including colonoscopies. This means that your insurance will pay 100% of the charges associated with the test. However, there may be other costs not related to the test itself. Some insurance providers will cover these added costs (like pathology services and sedation). Talk with your insurance provider and ask what will be covered and what you will be responsible for paying before your procedure.

    The amount you pay also depends upon the contract that is between your insurance carrier and your medical provider. Choose in-network providers to take advantage of lower co-pays and deductibles. Remember that if you choose an out-of-network provider you will incur more fees, including a higher patient deductible and out-of-pocket expenses.  Again, contact your insurance provider and they will be able to walk you through what fees to expect and help you find an in-network provider.

    How Much Does a Colonoscopy Cost Out of Pocket?

    If you do not have insurance, you will pay for the procedure out-of-pocket. If this is the case, take your time to shop around for the best price. The total cost can range between $1000 to $3,750. The procedure is the same regardless of where it takes place. Different factors that determine how much you will be charged for a procedure include:

    ·         Facility used to perform the colonoscopy

    ·         General health of the patient

    ·         Geographic location

    ·         Insurance provider

    If there is an abnormality found during the colonoscopy, such as a polyp, you probably will incur more costs. A biopsy and removal of the polyp can add $2000 or more to the total amount you are billed.

     Are There Alternatives to a Colonoscopy?

    The fourth leading cause of death worldwide is colorectal cancer (CRC). Early screening tests, like colonoscopies, can detect colon cancer early and save lives. However, less than 60% of people choose to get these screening tests due to the unpleasant and uncomfortable pre-colonoscopy bowel cleaning. There are other options to a colonoscopy for CRC screening that can be done in the comfort of your home.  For the tests, you are prescribed a kit by your doctor used to collect a stool sample to be mailed to a lab for analysis. These are known as fecal blood tests and include:

    • Fecal immunochemical test (FIT or iFOBT):  Detects hidden blood in stool
    • Guaiac FOBT (gFOBT): Detects hemoglobin (red blood cell protein) shed by polyps or colorectal cancer in stool
    • Multitarget stool DNA test (FIT-DNA). Detects blood and DNA shed from cancer cells in stool

    The tests do not require the bowel-cleaning preparation before stool collection and typically cost only a few hundred dollars. Remember that a colonoscopy is the gold standard and you will still need to get one if there is an abnormal result from a fecal blood test.

    How Much is a Home Cancer Screening Test?

    Home cancer screening tests vary in cost depending on the type and where you send the test. The at-home tests that can be purchased at your local drug store or online are very inexpensive. Other at-home tests prescribed will be more expensive and more dependable in terms of lab results. Cost ranges of at-home fecal blood screening tests are as follows:

    • FIT – $3.00 –  $20.00
    • FOBT – $48.00 – $149.00
    • FIT-DNA – $400.00 – $800.00

    How much do other related procedures cost?

    Virtual colonoscopy (CT or MRI). Average cost $500.00.

    A virtual colonoscopy takes a three-dimensional image of your large intestine. Virtual colonoscopies generally cost less than a traditional colonoscopy. Keep in mind they are not considered a valid screening test for colon cancer, so you will have to cover the cost depending on the insurance carrier.

    Flexible sigmoidoscopy (SIG). Average cost $500.00 – $750.00.

    In this procedure, physicians look at the end of the large intestine (sigmoid colon and rectum) with a sigmoidoscope, a thin flexible tube with a camera on the end. A sigmoidoscopy is less invasive than a colonoscopy. SIG requires less bowel preparation and is usually performed without sedation.

    If there are complications, are those covered? 

    Some complications can occur after a colonoscopy, these include:

    • Intestinal perforation
    • Bleeding
    • Post-polypectomy electrocoagulation syndrome (caused by a burning injury to the bowel)
    • Negative reaction to anesthesia
    • Infection (causes fever, chills, and abdominal pain)
    • Rapid heart rate

    If a problem is found during the screening or colonoscopy and resolved then you should not have to pay for this cost. An example of this would be if a polyp is found, subsequently removed, and bleeding occurs. The hospital will treat the complication and If you have insurance that has a deductible and you have not reached the deductible, you may have to pay out-of-pocket costs. If you are concerned about complications after your procedure and if your insurance will cover these costs, again, talk to your insurance provider to see what charges you may incur.

    Other related costs if any?

    Unfortunately, while the colonoscopy is covered by insurance, there are several costs that you are considered out-of-network. These out-of-network charges typically average $1000 and usually include anesthesiologist and pathologist fees. If you are concerned about these costs, contact your health insurance provider and ask if any of the following costs will be covered by insurance. Added costs not related to the screening exam itself include:

    • Consultation fee
    • Anesthesia: Different sedations can significantly affect the overall cost
    • Colon prep kit: May be provided by healthcare center or bought by the patient
    • Pathology costs:  For instance, a lab fee for abnormal tissue examination
    • Facility fee: Some facilities charge for using exam space
    • Different fees for diagnosis: For example, a colonoscopy with or without removal of a polyp

    How Many Bills Will I Likely Receive (Hospital vs. Doctor vs. Pharmacy vs. Specialist)?

    You will receive at least two different bills, or charges, for your colonoscopy – one from your doctor and the from the facility where you had your procedure. The different healthcare providers that may bill you include:

    • Physician
    • Facility
    • Anesthesiologist
    • Pathology Lab

    If you are confused about how you will be billed and the costs you are expected to pay for call your insurance provider and ask the following questions:

    • Do I have colonoscopy screening benefits?
    •  Can you help me find a doctor that is in-network?
    •  Can you help me find a facility that is in-network?
    • Do I have a deductible for this procedure?
    • What percentage of the procedure am I responsible for?
    • If my doctor finds a polyp during the test, how does that affect my cost-sharing responsibility?
    • Is there a place on your website that breaks down any charges I am responsible for?

     References

    Ebell, M. H. (2014, September 01). Accuracy of fecal DNA and fecal immunochemical test for colorectal cancer detection. American Family Physician, 90(5), 326-327. Retrieved from AAFP: https://www.aafp.org/afp/2014/0901/afp20140901p326a.pdf

    Kim, S. Y., Kim, H.-S., and Park, H. J. (2019, January 14). Adverse events related to colonoscopy: Global trends and future challenges. World Journal of Gastroenterology, 25(2), 190-204. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337013/

    Norton, A. (2020, October 16). Insured patients are getting surprise bills after colonoscopies. HealthDay News. Retrieved from WebMD: https://www.webmd.com/colorectal-cancer/news/20201016/insured-patients-are-getting-surprise-bills-after-colonoscopies

    Richter, J. (2019, March 12). Just do . . .yourself: At-home colorectal cancer screening. Retrieved from Harvard Health Publishing: https://www.health.harvard.edu/blog/just-do-it-yourself-at-home-colorectal-cancer-screening-2019031216183

    Subramanian, S., et. al. (2019, April 25). Comparison of program resources required for colonoscopy and fecal screening: Findings from 5 years of the colorectal cancer control program. Preventing Chronic Disease, 16. Retrieved from CDC: https://www.cdc.gov/pcd/issues/2019/18_0338.htm

    Tangka, F. K. L., et., al. (2016, January 28). Clinical costs of colorectal cancer screening in 5 federally funded demonstration programs. Cancer, 119 () 15), 2863-2869. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731092/

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