Will I Be Charged For My Colonoscopy?

At Gastroenterology of the Rockies, our mission is to put the patient first in everything that we do and provide the highest quality digestive health care. As colonoscopies are the most common procedure we perform, we have noticed that the billing process can be confusing and sometimes frustrating.

To better educate our patients with the government regulations and the implications on their individual health insurance plans, we summarized the billing process by answering the simple question “Will I be charged for my colonoscopy?”

Although the question appears to be simple, the answer can often times be a lot more complex. This is because the billing process depends upon the patients age, if they have existing symptoms, if they had a prior colonoscopy, a positive result from an at-home colon cancer screening test, or if they have personal or family history with colon polyps or cancer.

As there are a lot of things to consider regarding your colonoscopy we put together the summary below to help clarify the process. And, as with all healthcare needs, please make sure to consult your individual health plan to understand your specific benefits and potential out-of-pocket costs.

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:

The cost of a preventative or screening colonoscopy is generally covered by your insurance under the Affordable Care Act.

However, the cost of a diagnostic colonoscopy is generally NOT fully covered by your insurance, and you may have to pay the required 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:

Are 45 years of age or older (50 years of age for some insurances)

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

Have not had a colonoscopy within 10 years

Do not have a personal or family history of colon polyps or colon cancer (coverage is plan-specific and screening colonoscopies 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. Please 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 gastrointestinal symptoms (i.e., abdominal pain, diarrhea, rectal bleeding) or abnormal imaging of colon (i.e., CT scan, MRI).
2. Have a personal history of polyps or have a gastrointestinal disease
3. Have a positive Cologuard or FIT test – you must then get a follow-up diagnostic colonoscopy!

*Please contact your insurance company to determine your individual benefits and possible out-of-pocket costs for your colonoscopy.