Will Insurance Cover My Colonoscopy?

The Affordable Care Act requires recommended preventative services, such as colonoscopies, be covered at no cost to the patient. However, strict guidelines are used by insurance companies to determine whether a colonoscopy is categorized as preventative or diagnostic, which can impact your potential out of pocket cost.

Before your colonoscopy we want to help you plan for the potential costs. Much of this starts with understanding the reason for your colonoscopy. Is it preventive, such as a routine colonoscopy, or it diagnostic for evaluation reasons or treat existing condition?

Is My Colonoscopy Preventative or Diagnostic: What You Need to Know

Preventative Colonoscopy Screening: Patient is asymptomatic (no present gastrointestinal ssymptoms), is age 50 or older, and has no personal history of gastrointestinal disease, colon polyps and/or cancer. A colonoscopy has not been performed within the past ten years. This is usually a routine screening colonoscopy and covered by most insurance plans

Surveillance / High-Risk Colonoscopy: Patient is asymptomatic (no present gastrointestinal symptoms) but has a personal history of gastrointestinal disease (such as diverticulitis, Crohn’s disease or ulcerative colitis), colon polyps and/or cancer. Shorter intervals between colonoscopies are recommended for these patients (usually every 2-5 years). Some insurance carriers consider surveillance / high-risk colonoscopies to be preventative, while others consider them to be diagnostic. This is an important note and something to ask your insurance provider.

Diagnostic / Therapeutic Colonoscopy: A colonoscopy is performed to evaluate or treat gastrointestinal symptoms, colon polyps or gastrointestinal disease.

Before your procedure you should know your colonoscopy category. You should obtain the pre-procedure diagnosis code (meaning the reason for the procedure) from the scheduler or medical assistant. With this information you can contact your insurance carrier to determine:

Is a colonoscopy procedure with this diagnosis (provided by scheduler or medical assistant) covered under my policy?

If so, will the diagnosis be processed as preventative or diagnostic? If my procedure will be diagnostic, will the allowable amount be allocated to my deductible? Once the deductible is met, will any additional amounts be allocated to coinsurance? Please note: If your procedure will be performed at one of our endoscopy center locations be sure to tell your insurance carrier that the procedure will NOT be performed in an outpatient setting.

If the procedure will be considered as diagnostic and the allowable amount will be allocated to your deductible, please contact the CRS Business Office at (804) 249-2465 for an estimate of what you can expect to pay.

The physicians at CRS cannot change the primary diagnosis for the sole purpose of coverage determination. The diagnosis must be an accurate reflection of your medical history and the information you provide during our pre-procedure assessment. This is a regulatory requirement imposed by both government agencies and insurance companies with whom we are under contract.

Get in touch to ask a question or click here to schedule your colonoscopy in any of our 3 Richmond area locations.

Walk With A Doc To Fight Colon Cancer

colonoscopy appointments richmond va

Get moving and join Paul Charron from CRS for a Walk With A Doc event.

Scheduled for Wednesday March 13th this event is designed to raise awareness about colon cancer and help you learn more about colonoscopy screenings, all while getting in your daily exercise.

Dr. Charron is committed to educating and preventing colon cancer through his work as a CRS physician, and throughout his volunteer work in the Midlothian and Richmond communities.

This is a great opportunity to connect with Dr. Charron and other doctors specializing in colon health in a casual setting. During this time you can ask questions to learn more about what to expect from a routine colonoscopy screening appointment, how to stop colon cancer before it starts or simply connect with your neighbors.

There is no cost for this event, and you don’t need to be a member of AMFAM or even RSVP for this event, just show up with your questions and walking shoes.

Where: American Family Fitness, 12900 Amfit Way, Midlothian VA 23114

When: Wednesday, March 13th, 6pm – 7pm

Colonoscopy Prep Guide

The key to preparing for your colonoscopy with as much grace – and as little discomfort – as possible is to carefully follow the instructions provided by your physician.
People who’ve never had a colonoscopy before dread the procedure; those who have had a colonoscopy know the hardest part is the preparation for the procedure.
Ultimately, the steps to prepare for a colonoscopy are designed to cleanse your colon, so it is free from any waste or debris that prohibit the doctor from getting a good view, or that could lead to false results.

Follow Our Colonoscopy Prep Guide & You’ll Do Great

Cleansing the colon takes place in three phases:

  1. Using dietary restrictions to minimize the amount of waste that enters the colon, starting the few days before your procedure. The day before your procedure, your diet will consist of clear liquids only.
  2. Drinking and/or taking the supplements that encourage the complete release of the contents in your bowels.
  3. Finalizing the colon cleanse using fleet enemas (provided by the physician) if necessary. Many people never move through this phase since Phases 1 and 2 are usually sufficient.
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American Cancer Society Updates Colorectal Screening Guidelines

colonoscopy richmond vaThe American Cancer Society recently announced new colorectal cancer screening guidelines.

One of the most notable change is lowering the age most people should  begin screenings to 45 and even earlier for those with an above average or high risk of developing colon cancer.

Click the link to read the full list of colon cancer screening guidelines.

If it is time to schedule your first colonoscopy, or a follow up get in touch to schedule your appointment online with the providers at Colon & Rectal specialists.

Are Anoscopy Examinations Painful?

colon and rectal specialist richmond va
The news that you need an anoscopy exam can be alarming, particularly if you’ve never had a rectal exam or colonoscopy in the past. Most patients worry the exam is painful, particularly if the issue in question already causes a level of discomfort.

The good news is that an anoscopy exam is not typically painful, however it may feel slightly uncomfortable and you could experience a small “pinching” sensation if biopsy is necessary.

That being said, any discomfort you experience will be relatively minimal, and you can return to your normally scheduled activities immediately afterwards.

Knowing what’s going to happen, is key to feeling more comfortable and knowledgeable about the procedure, which helps patients to relax. Being relaxed is the single most important thing you can do to minimize any type of discomfort during the exam.

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