Dr. Linda Pai’s colon cancer column (Gateway, March 19) provided excellent information regarding colon cancer screenings.
However, people should be aware that the Patient Protection and Affordable Care Act does not ensure that all people who have pre-cancerous polyps found will have no out-of-pocket financial obligation.
If you have never had a colonoscopy and go in for an endoscopic procedure, and it is negative, it’s regarded as “routine preventative” and will be paid by insurance. You are then advised to return in 10 years and have another “routine preventive” screening.
Also, if there are the findings of a polyp(s) on that first screening, there are no out-of-pocket expenses. However, if you have polyp(s) removed at the time of the first colonoscopy, you are advised to return every five years for colonoscopies, and then you fall in the “diagnostic category” for future colon cancer screenings.
Any future colonoscopies are coded on billing as “diagnostic,” and you will incur deductible and coinsurance costs, regardless of whether there are polyps found or not.
The Patient Protection and Affordable Care Act only pertains to a colonoscopy every 10 years, a sigmoidoscopy every five years and a fecal occult exam every year.
I am an advocate of colonoscopies, whether they cost you money or are covered by your insurance, but it is important to be informed about your specific situation.
Also, before you have the procedure done, investigate the “facility charge” where you will have your colonoscopy or any other type of procedure. There will be a physician charge for the colonoscopy, as well as a facility charge.
The facility charge represents a large part of what you are billed, and facility charges vary greatly between medical facilities. They are not necessarily competitively priced.
That can also add to your out-of-pocket expenditures for having procedures done.
Ask questions. Be informed. Don’t rely on your provider to refer you to the most cost-effective facility.