Private insurers will no longer be allowed to charge patients copayments or coinsurance when they have polyps removed during a colonoscopy.
Under the Affordable Care Act, most insurers are prohibited from imposing cost-sharing on patients for several recommended preventive screening procedures, including colonoscopy.
However, some health plans had been charging copayments or coinsurance when polyps were removed during the procedure. In February, the Department of Labor clarified that polyp removal is "an integral part of colonoscopy" and plans cannot charge patients for that part of the procedure.
The move was praised by the American Gastroenterological Association (AGA), which along with other physician groups, had been pushing the government to make that policy clear.
However, the groups remain concerned because the policy does not apply to Medicare. The current Medicare policy covers screening colonoscopy with no coinsurance or deductible. But if polyps are removed, the screening is reclassified as therapeutic and patients are responsible for coinsurance equal to 20% of the Medicare-approved charge.
This "colonoscopy loophole" creates a financial barrier that could discourage patients from undergoing colonoscopy, according to the AGA. Currently, nearly 38% of U.S. adults age 50 years and older have never been screened for colorectal cancer.
Changing the Medicare policy requires action by Congress and would cost the government about $200 million in lost revenue over 10 years, according to the AGA.
