COLONOSCOPY BILLING FAQS

Colonoscopy billing:

You will receive three separate bills for your procedure, these bills include: your physician/anesthesia, the facility, and you may also receive a pathology or laboratory bill. Gastroenterology of the Rockies will contact your insurance company about your benefits, however, we also recommend you contact your insurance company directly to verify your specific benefits.

Will I be charged for my colonoscopy?

To answer this question, we need to address the difference between a preventative, or screening colonoscopy, and a diagnostic colonoscopy:

1. The cost of a preventative, or screening colonoscopy, is generally covered by your insurance under the Affordable Care Act.
2. The cost of a diagnostic colonoscopy is generally NOT fully covered by your insurance, you may have to pay the deductible and copay.

What is a preventative, or screening colonoscopy? Do I qualify?

A preventative, or screening colonoscopy is performed on an asymptomatic patient to test for the presence of colorectal polyps or cancer. Preventative, or screening colonoscopies are performed on patients who:

1. Are 45 years of age or older
2. NO gastrointestinal symptoms (e.g., abdominal pain, diarrhea, rectal bleeding)
3. NO screening colonoscopy within the last 10 years
4. NO personal history of colon polyps or gastrointestinal disease

*You may also be charged for some additional colonoscopy services according to the cost sharing provisions in your individual health plan. Contact your insurance company to determine your individual benefits and possible out-of-pocket costs for your colonoscopy.

What is a diagnostic colonoscopy?

A diagnostic colonoscopy is performed on a patient to evaluate abnormal findings or symptoms. Diagnostic colonoscopies are performed on patients who:

1. Had colon polyps in the past
2. Have a gastrointestinal disease
3. Have gastrointestinal symptoms (e.g., abdominal pain, diarrhea, rectal bleeding, or abnormal imaging of colon (i.e., CT scan, MRI).

Contact your insurance!

Contact your insurance to determine your specific benefits and possible out of pocket costs (deductible, coinsurance, facility copay) for the procedure. It is important to inquire about both the physician and facility costs, discuss any symptoms and/or personal history (including prior colonoscopy dates and findings), and family history related to your procedure. Each insurance plan may provide different benefits and handle claims differently. Ask how your specific plan will pay for a screening colonoscopy as well as a colonoscopy with polyp removal. Due to individual variabilities, our staff cannot predict the final cost of your procedure.

You may receive statements from multiple entities for balances after your insurance is processed. There will be charges from the physician, the facility where your procedure is performed, and the anesthesia provider if applicable. If there is a need for biopsy or polypectomy, you will also receive a bill from the pathology provider.