Big surprise bills for any colonoscopy done after a positive result from a stool-based screening test will be prevented under new federal rules, a group of U.S. medical organizations say.
On Jan. 10, the Biden administration issued guidance requiring private insurers to cover such colonoscopies.
The guidance expands on the requirement that plans provide the screening benefit to patients 45 and older for plan or policy years beginning on or after May 31, 2022. Patients with health insurance plans that have already been implemented need to check with their insurer because they may not include this coverage until next year.
Four groups pushed for the coverage, including the American Gastroenterological Association (AGA), American Cancer Society, American Cancer Society Action Network and Fight Colorectal Cancer.
“Now patients can choose the best colorectal cancer screening test for them without fear of a surprise bill,” said AGA President Dr. John Inadomi.
“Patients have full coverage of the full screening continuum — from an initial stool or endoscopic test to a follow-up colonoscopy,” Inadomi said in an association news release. “Now that the financial barriers have been eliminated, we can focus on increasing screening so we can prevent cancer deaths.”
Despite the availability of preventive screening, colon cancer is the second leading cause of cancer death in the United States. In 2018, 68.8% of those eligible were screened for colon cancer.
“Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network.
She noted that the American Cancer Society estimates that more than 150,000 individuals will be diagnosed with colon cancer this year, and it will claim more than 52,000 lives.
The disease is preventable when pre-cancerous polyps are found and removed through a colonoscopy, Lacasse said in the release.
The No Surprises Act, which will eliminate surprise bills after an emergency from a medical provider that patients did not choose and is not in their insurance network, went into effect Jan. 1.
For more on colon cancer screening, visit the U.S. National Cancer Institute.
SOURCE: American Gastroenterological Association, news release, Jan. 13, 2022