For a colonoscopy, the preventative care coverage under the Affordable Care Act means that the doctor is covered. What about the exam center? Is it covered? What about any anesthesia and anesthesiologist? What about the prescription liquid stuff I have to drink before to cleanse my colon? What about the initial visit to the doctor before my procedure?
For most preventive services, only the screening itself is covered at no charge. The actual services required can be subject to cost sharing, and that is based on what plan you have or in many cases, how the doctor's office bills your insurance.
All ACA-compliant private Major Medical plans (including Marketplace plans) cover the costs for colonoscopy as a screening test, patients may be charged for some services. You may have to pay part of the costs of anesthesia, bowel prep kit, pathology costs, and a facility fee (where the procedure is performed).
Colonoscopies that are done to evaluate specific problems, such as intestinal bleeding or anemia, are usually classified as diagnostic – and not screening – procedures. If that’s the case, you may have to pay any required deductible and copay. The same is true if the colonoscopy was done after a positive stool test (such as the FOBT or FIT) or an abnormal barium enema or colonography. Some insurance plans also consider a colonoscopy diagnostic if something is found (like a polyp) during the procedure that needs to be removed or biopsied.
Before you get a screening colonoscopy, ask your insurance company how much you should expect to pay for the exam. Find out if this amount could change based on findings during the procedure. Learn more at cancer.org.
Rule of Thumb: Preventive care visits are generally covered at no cost if they are evaluating your current health status when you are symptom free. Medical treatment for specific health conditions, on-going care, lab or other tests necessary to manage or treat a medical issue or health condition are considered diagnostic care or treatment, and are NOT considered preventive care.
TIP: In order to get your free annual wellness visit, you have to make sure your doctor codes it correctly. You can generally ask your doctor and insurer what each service will be coded as. This allows you to find out if a service will be billed as preventive care or not.