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News about Colonoscopies and Insurance Co-Pays

We received some great news regarding colonoscopy screening from the National Colorectal Cancer Round Table (NCCRT) today.

medical-symbolFrom NCCRT:

Health and Human Services has released final guidance today on essential health benefits including an FAQ.

In the FAQ, it states that insurers may not charge a co-pay if there is a polyp removal during a screening colonoscopy.

This is excellent news for all of us who have been working on the colonoscopy copay issue, as it applies to the private insurance market. The only negative is that the last sentence could be interpreted to mean that the removal of cost-sharing does not apply to colonoscopies that follow an FOBT screening. We can try and clarify this issue. Still, overall, very good news.

The specific passage is below.

Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?

No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.

The complete FAQ can be found here.

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