By Michael Kirsch, MD, Center for Digestive Health and Endoscopy Center
Many patients are confused by the difference between a screening and a diagnostic colonoscopy.
In general, most insurance companies will cover screening colonoscopies, but most diagnostic colonoscopies will be subject to deductibles and co-insurance.
While each of these procedures is performed in the exact same manner technically, the difference is why the colonoscopy is being done. This may appear to be a trivial issue to you, but it may matter a great deal to your insurance company.
A screening exam means that you have no symptoms or relevant laboratory or x-ray abnormalities that are being investigated with a colonoscopy. Think of a screening exam as a check-up for the colon. If, however, you have bowel symptoms, weight loss, blood in the stool, a personal history of colon polyps or a CAT scan that shows an abnormality in the large intestine, then your colonoscopy will be considered diagnostic, not screening.
Before you have your colonoscopy, it is important to contact your insurance company about your benefits so you understand your coverage prior to undergoing the procedure. I always advise that you write down the name of the insurance company representative and make some notes of the conversation, just in case. Patients become frustrated (or more) when they receive a bill for a service that they thought would be fully covered.
To review, screening means you are checking a healthy patient for a condition and diagnostic means you are investigating an existing or prior abnormality. Now brace yourself for my next sentence. If a polyp is found on a screening colonoscopy, then the procedure will be changed to a diagnostic colonoscopy because the gastroenterologist will be removing a lesion. Don’t try to figure this one out – we find it confusing also. What this means is that a patient may believe that he will be fully covered for his screening procedure only to discover later that he will bear some of the cost of his diagnostic procedure. Yes, of course this is silly.
None of this should discourage anyone from proceeding with screening colonoscopies when advised by your doctor. The mission to prevent colon cancer is much more important than the absurdities of insurance company policies. But, it’s best to understand your coverage before you have been sedated rather than after you wake up.
Get your colonoscopy at The Center for Digestive Health Endoscopy Center!
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• State of the art endoscopy center
• Caring nurses dedicated to you
• Easy and convenient parking
• No hospital admissions or check-in
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Special Medical Interest(s):
• Abdominal Pain
• Colon Cancer Prevention
• Constipation/Diarrhea Disorders
• Crohn’s Disease & Ulcerative Colitis
• GERD/Heartburn/Acid Reflux
• Irritable Bowel Disease
• Liver Disease & Hepatitis
