Diagnostic Services
Learn about...Colonoscopy at GCMC
The Purpose of the Procedure
Insurance Coverage
Preparation for the Procedure
The Day of the Procedure
The Colonoscope
The Procedure
What the Physician Sees
After the Procedure
Home Again and Discussion of Test Results
Summary
Insurance Coverage
Prior to scheduling a colonoscopy, patients should check with their medical insurance provider to determine if the plan covers the procedure for the reason specified by your physician. This can be especially important if you are having a screening colonoscopy, as many insurance companies do not cover preventive care.
Guidelines for Medicare and Medicaid are as follows.
Please be aware that Medicare and Medicaid plans are subject to change, and you need to verify the information with Medicare. The information below was last updated January 7, 2005.
Medicare: http://www.medicare.gov
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High Risk Individuals - If you are at high risk for colorectal cancer, Medicare covers a colonoscopy every 2 years. Your risk for colorectal cancer may be higher than average if you or a close relative have had colorectal polyps or cancer, or if you have inflammatory bowel disease. Medicare requires that you pay 20 percent of the Medicare approved amount after the yearly Part B deductible.
Average Risk Individuals - If you are at average risk (i.e., not at high risk) for colorectal cancer, Medicare will cover a colonoscopy every 10 years. You pay 20 percent of the Medicare approved amount after the yearly Part B deductible. However, if you are at average risk and have had a covered flexible sigmoidoscopy, you must wait 4 years to be eligible for Medicare coverage of a colonoscopy.
Medicaid covers colonoscopies if medically necessary, but not as a preventive measure.