Costs for colonoscopy screening

When I had a screening colonoscopy in 2015, the doctor removed a polyp and told me to come back for another colonoscopy in three years. I paid nothing for the 2015 test because it was a preventive screening. When I scheduled my appointment for this year, the provider said the procedure was diagnostic because of that earlier polyp removal. Doesn’t the law protect people in these situations from being charged for more frequent but necessary screenings?

Not necessarily. The Affordable Care Act greatly expanded coverage of preventive services, including requiring commercial insurers to cover screenings for colorectal cancer without charging patients anything out-of-pocket if they’re between ages 50 and 75.

In general, screening colonoscopies for people at average risk are recommended every 10 years by the U.S. Preventive Services Task Force. (Under the law, preventive services are covered at no cost by insurers if they meet the task force’s recommendations.) There’s no charge to the patient for the test, even if a benign growth called a polyp is found and removed.

Doctors may recommend more frequent “surveillance” testing, as they did in your case, if during screen- ing they find any polyps, which may put you at higher risk for colon cancer. Since the task force doesn’t have a recommendation for high-risk colorectal cancer screening, insurers aren’t required to cover it without cost sharing.