Colonoscopy: The Gold Standard

A colonoscopy is the only test that can detect and prevent colorectal cancer by finding and removing polyps during a single procedure. A colonoscopy can be both a screening test - that finds undiagnosed symptoms, and a diagnostic procedure - that finds and treats the cause of potential symptoms.

 

If you choose a screening test other than a colonoscopy, like a FIT test (fecal immunochemical test), and the result is positive (abnormal), you will need to have a follow up colonoscopy. Some insurers consider this to be a diagnostic colonoscopy (not a screening), and you may be charged for this additional procedure.

Colonoscopies also have an exceptionally high detection rate which contributes to higher survival rates as this allows patients to catch colorectal cancer in the early stages. Because of these compelling statistics, a colonoscopy is still considered the gold standard for detecting and preventing colorectal cancer.

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Colonoscopy Costs

General guidelines for colonoscopy costs, please contact your insurance for exact benefits and costs.

Colonoscopy Billing FAQs

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  (50 years of age for some insurances)

2. Do not have any gastrointestinal symptoms  (e.g., abdominal pain, diarrhea, rectal bleeding)

3. Have not had a colon cancer screening test  (e.g., colonoscopy, Cologuard, Fit test) within 10 years.

4. Do not have a personal or family history of colon polyps or colon cancer  (plan-specific, screenings may include family history)

*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.  Have a personal history of polyps or have a gastrointestinal disease. In other words, if you had colon polyps in the past, your colonoscopy is a diagnostic, not a preventative colonoscopy, because the time intervals between future colonoscopies would be shortened.

2. Have gastrointestinal symptoms  (e.g., abdominal pain, diarrhea, rectal bleeding) or abnormal imaging of colon (i.e., CT scan, MRI).

3. Have a positive Cologuard or FIT test – you must then get a follow-up diagnostic colonoscopy!

 

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.