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My insurance plan covers Colonoscopy Screening, why did I receive a bill?

If your physician finds a polyp during a colonoscopy screening, it is very important that it is removed at the time of the procedure. Removing polyps helps to prevent colon cancer.

However, in doing so, the examination no longer meets the definition of a “screening” and we must accurately code the bill to represent the services that were performed. It must now be coded as “diagnostic”.

Often insurance companies will not pay for the colonoscopy as a screening and you have a larger copay or deductible than you anticipated. When you call the insurance company to determine why, they will often tell you that your doctor “coded it wrong”. This is not correct, since it is illegal for us to code a claim only for the purpose of getting an insurance payment.

Your insurance company should cover your exam when you come in for a screening, whether it is a negative screening or a polyp is found.

The purpose of the examination is early detection, and when the exam accomplishes what it was intended to do, it is inappropriate for the insurance company to then deny the proper payment.

Had the doctor not removed the polyp, only then could we have called it a screening, and billed/coded it that way. However, that would defeat the purpose of the exam.

Coverage is based on a member’s individual health benefits and may vary from payer to payer. We advise you to call your insurance company to confirm your benefits for prior to your appointment.


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