Myth #3 – Colonoscopies are Too Expensive

Do you have concerns about the cost of a colonoscopy? It has been rumored that colonoscopies are expensive, but did you know that most screening colonoscopies are covered under private insurance and Medicare? Read on as we dispel the myth that colonoscopies are too expensive.

comparing colonoscopy costs

How Much is a Screening Colonoscopy?

Under the Affordable Care Act, most screening colonoscopies (including anesthesia) are covered by insurance and, if you qualify, you can even avoid the hassle of a pre-procedure consultation with a GI doctor under a “direct access” or “open access colonoscopy” – saving you time and money.

If you are at average risk for colon cancer, your screening colonoscopy is considered a preventative service and is not subject to cost-sharing. Between the ages of 50 and 75, you are entitled to one screening colonoscopy every ten years, following the recommendations of the United States Preventative Services Task Force.

With an “open access” or “direct access colonoscopy,” healthy, qualified patients can schedule a screening colonoscopy without an initial office visit and co-pay to a gastroenterologist. However, open or direct access colonoscopies are available in participating markets only to patients who qualify. Qualification is based on medical history and current medical status. Ask your doctor for more details.

What if My Doctor Removes a Polyp During the Procedure?

If you have private healthcare insurance and your doctor removes a polyp during a first-time screening colonoscopy, you won’t be responsible for a copay or deductible. According to Centers for Medicare and Medicaid Services (CMS), “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.”

If you are a Medicare beneficiary, however, the screening colonoscopy guidelines differ. If your doctor finds a polyp, the screening colonoscopy is coded as a diagnostic colonoscopy and you will be responsible for a copayment.

Are There Other Costs Associated With a Colonoscopy?

Even though insurance typically covers screening colonoscopies, you may be responsible for paying for your bowel prep kit and other services. To get accurate pricing and avoid unexpected costs, obtain the current procedural terminology (CPT) code for your colonoscopy from your doctor. Call your insurance provider and ask:

  1. What out-of-pocket costs, if any, should I expect to pay for CPT code ____?
  2. What in-network gastroenterologists are near me?
  3. Can you verify whether the anesthesiologist for my colonoscopy is in your network?
  4. What in-network facilities are near me?
  5. Can I save money by scheduling my procedure at an ambulatory surgery center (ASC) versus a hospital outpatient department (HOPD)?
  6. If my doctor finds a polyp during my screening colonoscopy, will I have any financial responsibility?

Medicare patients can access the Procedure Price Lookup Tool to compare payments and copayments for colonoscopies and other medical procedures performed in ASCs and HOPDs.

How Much is a Colonoscopy Without Insurance Coverage?

Colon cancer screenings are an essential part of your preventative healthcare. If you don’t have health insurance, you still have affordable options to help you get access to this life-saving procedure:

These suggestions also apply to patients who want to be screened earlier than their insurance provider’s recommended age. The American Cancer Society recommends all adults who are at average risk for colon cancer begin screening at age 45, but Medicare and most commercial insurers will not cover colon screenings until age 50.

Call a Gastroenterologist

A colonoscopy is an essential component of digestive wellness and can help prevent colon cancer when scheduled at recommended intervals. By asking the right questions, you can get an affordable colonoscopy with or without insurance. Call your gastroenterologist and ask to schedule your colonoscopy at an outpatient endoscopy center for a high-quality procedure at a lower cost.