Over the past few years, we have seen a rise in the availability of at-home screening tests for colorectal cancer. These tests are convenient because they are non-invasive, require no special preparation, and can be performed in the privacy of your own home. You send the test back to a lab for analysis and receive a report once the results are determined.
If you receive a positive result from a home test, your doctor will likely schedule a colonoscopy as a follow-up procedure. Because the home test showed an abnormality, the subsequent colonoscopy performed is considered diagnostic. And this is where the confusion begins… aren’t colonoscopies covered by insurance under the Affordable Care Act (ACA)? The answer is complicated. The ACA covers certain preventive services because they are used as a screening tool to catch potential health issues early. A screening colonoscopy is covered under the ACA but a diagnostic colonoscopy is not. The American Cancer Society has a great resource about insurance coverage for colorectal cancer screening on their website, here.
I’ve worked with employees who receive a positive result from an at-home colon test, have a diagnostic colonoscopy as a follow-up, and are upset when they receive a very large bill for the procedure because it is not covered by their insurance. Because the procedure was coded as diagnostic, the employee is responsible for the full cost of the colonoscopy, including the usual deductible and co-pay, which can range from $5,000-$7,000.
How you want to screen for colon cancer is a personal choice, but it is important to be aware of any out-of-pocket costs that may occur if you opt for an at-home test. We recommend consulting with your healthcare provider to determine the optimal screening schedule and testing method(s) based on your family history, age, and health history.
If you ever have any questions about your insurance and which procedures will or will not be covered by your plan, please feel free to contact me. I am always happy to help! You can also visit the Employee Advocate page on our website for additional resources, here.