Will Insurance Pay?

Will Insurance Pay For Your Colonoscopy?

Colonoscopy is the best method for preventing and detecting colon cancer. This type of cancer is the second leading cause of cancer death in the US. IT is important that you have this test because it could save your life.

Patients are often concerned about the cost of this procedure, so we suggest that you contact your insurance carrier prior to the procedure to discuss your benefits. This does not apply if your primary insurance coverage is Medicare. When discussing your benefits with your insurance company, it is imperative that you notify them of which type of colonoscopy you are having based on the criteria below. Your insurance carrier can help you determine what portion you may have to pay.

Most Insurance companies offer wellness and screening benefits to their members. This means a service performed for screening purposes alone may be covered 100%.

Screening Colonoscopies are indicated for the following criteria:

  • Starting at age 50 or older in patients with no symptoms
  • No personal or family history of colon cancer
  • No history of colon polyps from previous colonoscopies
  • Repeat screening 10 years after a normal colonoscopy

These procedures are often covered by insurance companies but patients may be required o pay co-payment or deductible. Diagnostic procedures are usually NOT covered under a wellness benefit.

Diagnostic Colonoscopies are indicated for the following reasons:

  • Previous Colonoscopy with adenomatous polyps removed
  • Symptoms such as rectal bleeding, abdominal pain, change in bowel habits, etc.
  • Inflammatory bowel disease/diverticulosis
  • Personal/Family history of colon cancer