Free Colonoscopy Coverage Means Polyps, Too

A routine colonoscopy was supposed to be free under the new health care law, but then insurers began charging if doctors found and removed a polyp during the procedure.

That's a no-no, announced the Department of Health and Human Services (HHS) last week, in an effort to clear up confusion about this and other medical tests that should be considered free preventive care, the Associated Press reported.

In the notice posted on the HHS website, the agency explained that "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." Including polyp removal as part of a routine colonoscopy also has the backing of several medical associations, the agency noted.

In addition, the government's notice about covered preventive care included genetic testing for breast cancer, which can run as much as $3,000, plus coverage of doctor-prescribed over-the-counter products such as aspirin for heart care and nicotine patches for smoking. According to the Associated Press, the notice does not have the force of law, though patient advocate groups say insurers are expected to follow it.

A colonoscopy can dramatically cut the death rate from colon cancer by catching precancerous polyps early. Adults are urged to have a colonoscopy to screen for any problems when they turn 50, but it's an expensive test that can cost more than $1,000.

When it was first announced that a colonoscopy would be covered for free under the health care law, this got a lot of attention, but then patients began complaining when many insurers started charging if polyps were discovered and removed during the procedure.

"Insurers were reclassifying it from a preventive test to a diagnostic procedure," Stephen Finan, policy director for the American Cancer Society Cancer Action Network, told the Associated Press. "In some cases the cost-sharing was a significant amount of money." His group was among several that complained to the administration.

The HHS notice also said that if a health plan does not have a network doctor who performs a particular preventive service, "then the plan or issuer must cover the item or service when performed by an out-of-network provider," without charging the patient copays or additional charges.

 

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