Colonoscopies are crucial for detecting colorectal cancer early and improving survival rates. However, the costs associated with this procedure can often be a major concern. In this article, we will explore various options to make colonoscopies more affordable, regardless of whether you have insurance or not.
Understanding the Cost Factors
The cost of a colonoscopy can vary significantly based on several factors. These factors include your insurance coverage, whether you have commercial insurance or Medicare, the specific plan you have, and where the procedure is performed (hospital outpatient department, surgery center, or physician’s office).
Insurance Coverage for Colonoscopy
Many insurance plans, such as Anthem, United Health Care, and Optima in the Tidewater area, cover colonoscopies as part of a “wellness” screening at 100 percent, with no deductible or copay. However, other insurance companies may require a deductible, which can range from zero to over $1,000.
Affordable Options in the Tidewater Area
For those in the Tidewater area, there is an option that offers a significantly lower cost for a colonoscopy. The total cost for a colonoscopy, including the nurse anesthetist, is $850. This price is considerably lower than other gastroenterology practices in the area and much below what you would pay in a hospital outpatient department, which can be as high as $5,500. However, if you choose this lower-cost option, you would need to sign an agreement stating that you won’t bill through your insurance.
Determining Your Cost
The cost of a colonoscopy depends on various factors. If the exam is considered “preventative,” meaning the patient is asymptomatic, with normal results, there may be no cost. However, if symptoms are present or a polyp or other pathology is found during the exam, the procedure may no longer be covered under preventative care, and patients may incur some financial responsibility.
Medicare Coverage
Medicare beneficiaries with supplemental insurance, such as AARP, United, or Anthem, usually pay no copay or deductible if the colonoscopy is performed in a physician’s office. However, some physician practices may only perform Medicare colonoscopies at hospital outpatient departments, which could increase the cost but may still be covered by medical insurance. The Centers for Medicare & Medicaid Services (CMS) state that polyp removal during a colonoscopy performed as a screening procedure should not impose cost-sharing.
Outpatient Setting Costs
For patients without health insurance in the outpatient setting, the typical cost ranges from $2,100 to $3,764, according to CostHelper.com. The average nationwide cost of a colonoscopy is $3,081 without Medicare or other insurance. However, there have been cases where hospitals bill patients over $10,000 for the same procedure that can be done in an office at a significantly reduced cost. Some hospitals include undisclosed “surprise” charges in their fees.
Discounted Options for the Uninsured or Underinsured
Physician-owned office-based colonoscopy centers often offer discounts for patients without health insurance or those with high deductibles. These practices strive to keep costs low and make screening more accessible. They provide heavily discounted procedure rates, and there are no surprise charges. The only exception may be a separate bill for a polyp or tissue biopsy sent to a pathologist for testing, typically costing under $100.00.
Factors to Consider Before the Procedure
Before undergoing a colonoscopy, it is important to consider the potential costs. Here are some factors to keep in mind:
Check with Your Insurance: If you are having the procedure in a physician’s office, your insurance company or the office should be able to determine if there will be any copay or deductible you will be responsible for. If the cost cannot be determined, consider seeking another facility.
Self-Pay Price: If you are uninsured or your insurance will not cover all or part of the colonoscopy costs, ask the physician’s office for their “self-pay” price. This price is often substantially lower than the insurance price or charge.
Explore Alternative Providers: If you are told that your procedure must be done at a hospital facility, consider finding another physician who can perform the procedure in their office. The costs are usually significantly lower, and there are no surprise charges. With modern anesthesia techniques and technology, many patients can have the procedure done outside the more costly hospital setting.
Read Reviews: Before choosing a facility, it can be helpful to read online reviews to get an idea of how patients are treated. Honest reviews can provide valuable insights.
Choose an Affordable and Accessible Option
Prioritizing your health by undergoing a colonoscopy is essential, regardless of the potential costs. Early detection through screenings like colonoscopies significantly improves the chances of successful treatment and survival. Consider the options available to make the procedure more affordable, such as utilizing insurance coverage, seeking discounted rates for the uninsured or underinsured, and choosing the right facility. Taking these steps will help you prioritize your health without burdening your finances.
