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Home >  News >  May, 2013

Colonoscopy Co-Pays are Covered, With a Catch

Lawmakers seeking to close Medicare loophole.

Published: May 10, 2013

Colonoscopy patients covered by commercial insurance shouldn't be charged co-pays for the screenings, even if therapeutic action is required mid-procedure, according to the federal government. Medicare patients, however, are still awaiting a fix to an inadvertent loophole in the healthcare reform law.

In the interest of making preventive care more widely available, 2010's Affordable Care Act waived colonoscopy co-pays for Medicare beneficiaries and required most commercial insurers to do the same for their customers.

But when a screening colonoscopy discovers a polyp and the endoscopist removes it, the diagnostic procedure is reclassified as therapeutic and the patient might be saddled with the co-pay after all.

Earlier this year, a collaboration of federal agencies clarified that "polyp removal is an integral part of a colonoscopy" (see Question #5) and that commercial payors shouldn't hold patients responsible for co-pays incurred during reclassified cases.

Medicare patients, however, were still on the hook. Congressional efforts to close the loophole failed last year, but a pair of bills were introduced in March to make another attempt.

A recent analysis published online by Gastroenterology & Endoscopy News examines the barriers that co-pays can present to patients' motivations to undergo colonoscopies.

David Bernard

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