The Latest on Colon Cancer Screening: What You Need to Know

Even though no one likes to talk about having a colonoscopy, a colonoscopy can you’re your life!  Colon cancer is the second leading cause of cancer deaths in the United States, but colon cancer can actually be prevented through screening tests.  When a colonoscopy is performed, and a polyp is found, it can be removed, before it becomes cancer.  That’s why it is imperative that people learn about the different types of screening tests offered.

Last week, the U.S. Preventative Service Task Force (USPSTF) – an independent panel of medical experts – said the benefits of being screened between the ages of 50-75 (the Triage Cancer Blog USPSTFyears of average risk of colon cancer) are “substantial.” Previously, the colon cancer screening tests that were available included the colonoscopy, the sigmoidoscopy, and two types of home stool tests, the gFOBT and the FIT.

Recently, the USPSTF added two new, less-invasive, ways of testing to the list of colon cancer screenings that may qualify for free preventative screening:

  • A virtual colonoscopy that uses unique X-ray machines to examine the colon.
  • An at home test called the Cologuard, which checks stool samples for elevated levels of altered DNA that could be a sign of cancer. This test typically costs $650.

The USPSTF does not have a favorite test; each one has been found to be equally beneficial to the patient. Because of the USPSTF’s “A” rating of these tests, they must be offered to most privately insured patients without a copayment, cost-share, or applying it to their deductible under the rules of the Affordable Care Act.

Unfortunately, insurance coverage of these tests isn’t always straightforward.  Medicare already covers Cologuard as a preventive screening tool; however, many private insurers have not been covering it for free. There is some ambiguity with the wording of the new rules and advocates in the healthcare community are seeking guidance from the Obama Administration.

Although preventative screening is covered at 100%, without copayments or deductibles, some patients may still end up with a bill. For example, while most private insurers cannot charge patients for polyp removal under the ACA, Medicare will impose a 20% copayment if a polyp is found during a screening colonoscopy and removed. Another way patients can be hit with unexpected bills is if a stool test, sigmoidoscopy, or other exam indicates cancer might exist and then a colonoscopy is performed.  Many insurers would then consider the colonoscopy a diagnostic exam, rather than a preventive screening, and charge the patient.

Stay tuned for more developments on insurance coverage for these news tests and other ACA updates!

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