Patients should no longer be slapped with surprise co-pays when polyps are discovered during supposedly free screening colonoscopies, according to administrative guidance issued last week by the U.S. Department of Health and Human Services.
The 2010 Affordable Care Act, which waived annual deductibles and co-pays for Medicare beneficiaries undergoing colonoscopies, required most private insurers to cover preventive care at no additional cost to patients. However, an unintended loophole emerged that let insurers charge patients with significant co-pays when physicians discovered polyps during exams, which essentially reclassified supposedly covered preventive screenings into uncovered therapeutic procedures.
"Polyp removal is an integral part of a colonoscopy," notes the HHS, which now says insurance plans or insurers "may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure."
Evidence shows that even limited cost-sharing can deter patients from getting the test, says Christopher Hansen, president of the American Cancer Society Action Network. He points out that polyps left untreated can result in advanced stage colorectal cancer that is much more expensive to treat and difficult to survive.
The loophole won't be completely closed until legislation is enacted that ensures screenings are free to all patients - even if polyps are discovered. U.S. Rep. Charles W. Dent (R-Pennsylvania) introduced the Removing Barriers to Colorectal Cancer Screening Act of 2012 last March. The legislation died during a subcommittee's review, but he plans on reintroducing the act this year, according to Mr. Hansen.
As previously reported, Medicare's screening oversight doesn't affect surgical facilities from a revenue standpoint, but it's in a facility's best interest to stand up for its patients, says Andrew S. Weiss, CASC, administrator of the Endo Center at Voorhees in New Jersey. He says the cost-sharing loophole is still an issue for patients, and urges support of Rep. Dent's legislation.
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