Colonoscopies can be classified as for screening or for diagnosis. How they are classified makes all the difference for patients’ out-of-pocket costs.
The Centers for Medicare & Medicaid Services hasthat under the preventive services provisions of the ACA, removal of a polyp during a screening colonoscopy is considered an integral part of the procedure and should not change patients’ cost-sharing obligations.
In addition, getting a screening colonoscopy sooner than the recommended 10-year interval, as Melville did, could open someone up to cost-sharing charges, Howard said. Dartmouth Health declined to discuss Melville’s case with Kaiser Health News even though she gave her permission for it to do so.on behalf of Dartmouth Health. Compton said the diagnosis codes had inadvertently been dropped from the system and that Melville’s claim was being reprocessed, Melville said.
“Contact the insurer prior to the colonoscopy and say, ‘Hey, I just want to understand what the coverage limitations are and what my out-of-pocket costs might be,’” Howard said. Billing from an anesthesiologist — who merely delivers a dose of sedative — can also become an issue in screening colonoscopies. Ask whether the anesthesiologist is in-network.
Melville said that a health system billing representative told her that among the papers she signed at the hospital on the day of her procedure was one saying that if a polyp were discovered, the procedure would become diagnostic.