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.

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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How Do I Know If My Bowel Prep Is Working?

One of the most common questions we get at CRS is “how do I know if my bowel prep is working?

colon surgeon richmond va
See Dr. Cary Gentry with CRS explain what to expect and the top 3 reasons some patients take longer than others.

When prepping for a colonoscopy your doctor has probably talked to you about how important the bowel prep process is for accurate results. Residue left behind can make it harder for the doctor to view your colon during the exam – meaning a polyp or other issue might not be seen as clearly or even missed.

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Dispelling the Myths of Colon Cancer

The good news is that caught early, colon cancer survival rates are as high as 92%. The bad news is those desirable statistics may only apply to those who catch their cancer while it’s still in the first-stage.

When colon cancer is caught too late, the story can become all-too-common: Someone who patient did, indeed, have symptoms that raised a red flag, but he or she didn’t think they would have cancer because….

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West End

7605 Forest Avenue, Suite 308
Richmond, VA 23229
(804) 288-7077
(804) 285-8120 fax

Hanover

7425 Lee Davis Road
Mechanicsville, VA 23111
(804) 559-3400
(804) 559-3362 fax

Stony Point

8700 Stony Point Parkway, Suite 270
Richmond, VA 23235
(804) 249-2465
(804) 249-2461 fax