Thousand Oaks Proctology

Thousand Oaks Proctology

Dr. David B. Rosenfeld, M.D.

Hemorrhoids | Colonoscopy | Proctology

341 S Moorpark Rd, Thousand Oaks, CA 91361

Decoding the Price Tag: What You Need to Know About Colonoscopy Costs

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Colonoscopies are an important part of routine health care, as it is a lifesaving procedure by detecting and removing polyps that may be precancerous. However, due to insurance companies’ insane practice of keeping pricing non-transparent, colonoscopy costs remain a mystery, making some patients wary of having them, instead putting them off until it’s too late.

Colonoscopy costs can vary widely and depend on numerous factors including state, city, insurance, age, and more. The average cost of a colonoscopy in America is currently $2,750.

What Is a Colonoscopy?

What Is a Colonoscopy Costs

A colonoscopy is a procedure that is one of the most effective screening methods to prevent and diagnose colon cancer along with diagnosing other conditions.

During a colonoscopy, a slender and flexible tube equipped with a camera and lights is gently inserted through the rectum, examining the entire length of the colon. Real-time imaging allows the proctologist to scrutinize the colon’s lining for tumors, polyps, inflammation, diverticulosis, or bleeding.  Patients are asleep during the procedure so they don’t feel anything.

Despite common fears about discomfort, bowel preparation, and potential risks, the procedure is generally very safe, with minimal risks and pain. The key advantage of a colonoscopy lies in its ability to remove polyps, conduct biopsies of lesions, and identify inflammation.

Before undergoing a colonoscopy, patients must undergo bowel prep, involving a specific diet and laxatives to cleanse the colon for a clear examination. Although bowel preparation can be challenging, it is crucial for obtaining an unobstructed view of the colon during the procedure. The bowel preparation is very tolerable. Check out the Bowel Prep Shuffle!

What is the Average Cost of a Colonoscopy?

Calculating the average cost of a colonoscopy can be tricky; there are several factors at play. If you have insurance most charges are covered. Insurance companies usually do not cover anesthesia. If paying cash all the factors below come into play when paying for a colonoscopy.

Below is a list of charges to expect when paying cash and to expect on the explanation of benefits by the insurance company.

  • Colonoscopy Charge  – The colonoscopy itself has a cost and when an invasive procedure such as biopsy, snare, clip application or injection is performed this adds to the cost. The procedure charges are received after the colonoscopy is performed as the doctor won’t know if anything needs to be done until the procedure is being performed. In my practice the biller gives the pricing for biopsy or polyp removal at the time of the visit. 
  • Anesthesiologist fee – may not be covered by insurance
  • Pathologist fee – If specimens are collected, they are sent to a pathologist who will charge a fee.
  • Surgery center fee – The facility where the colonoscopy is performed charges a fee.

Currently, the average cost of a colonoscopy is between $1,250 to $4,800 or more. Many insurance plans will cover the cost of a colonoscopy, mainly if the procedure is for preventive care.

Medicaid, Medicare, and insurance plans, even if it’s not preventive but diagnostic, will also negotiate for lower costs, so while the average may seem higher, many people will end up paying much less.

Navigating Colonoscopy Costs and Out-of-Pocket Expenses

Colonoscopy Costs

Are You Over 45 Years of Age?

Individuals aged 45 and above are recommended to commence routine colorectal cancer screenings. Those at a heightened risk for developing the disease may require screenings at an earlier age.

These screenings are generally covered by insurance, Medicare, and Medicaid and will not cost a patient anything except maybe an initial copay. It’s important to call your insurance to check with them to make sure you are covered for a screening and that you won’t pay out of pocket for it. If you are having a diagnostic exam which is used for gastrointestinal-related symptoms like abdominal pain or diarrhea, your insurance may cover part of it, but not all of it.

If You Are Under 45 Years of Age

Those under 45 years of age will not automatically be covered for a colonoscopy screening. However, some colonoscopy costs may be covered based on medical history and risk factors. For example, if you have the following risk factors your insurance may cover a colon cancer screening, although they may not cover a diagnostic colonoscopy.

  • Family history of colon cancer or polyps
  • A personal history of colon cancer or polyps
  • Rectal bleeding or a stool test showing blood
  • A personal history of inflammatory bowel disease
  • A personal history of radiation to the abdomen or pelvic area to treat cancer

Hidden Fees for Colonoscopy Costs

If your insurance doesn’t cover your colonoscopy costs or you have to pay out-of-pocket for the procedure, it’s important to factor in some “hidden fees.” Be sure that your doctor is in your network if you are paying with insurance; an out-of-network doctor may cost more than an in-network one. If the proctologist or gastroenterologist is out of network as for their cost up front as the patient usually pays for the doctors portion up front. Ask if the facility is “in network,” if they are not then the cost can be much more.

And it’s not just the gastroenterologist or proctologist, but the anesthesia care team and the pathology lab that need to be in-between too. If there’s not an in-network doctor near you, it might be worth traveling to get a lower rate.

As you calculate your colonoscopy costs, don’t forget to include the bowel prep kit. This should be included if you are having a screening but ask your healthcare provider for the CPT code to get accurate pricing for it.

Finally, ask your insurance and healthcare provider about what happens if they do find something during the colonoscopy. Coverage approval for a colonoscopy by an insurer may initially be granted, only to be reversed if precancerous polyps are detected during screening. Policies on this matter can vary among different insurers.

The Centers for Medicare & Medicaid Services (CMS) assert that the removal of polyps is an integral part of the colonoscopy process and should not result in shared costs. However, for Medicare beneficiaries, screening colonoscopy guidelines differ, transitioning it into a diagnostic colonoscopy. In such cases, if a polyp is found, the individual is responsible for the copay.

Financial Assistance and Options for Colonoscopies

Financial Assistance and Options for Colonoscopies

Colonoscopies are crucial for detecting and preventing colorectal cancer, but the associated costs can be a concern for many individuals. Fortunately, there are financial assistance programs and options available to help navigate these expenses.

  • Government Programs
  • Insurance Coverage
  • Patient Assistance Programs
  • Nonprofit Organizations
  • Hospital Financial Assistance Programs
  • Community Health Centers
  • Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs)
  • Negotiation and Payment Plans

Ask about a cash plan as there are more plans on the market such as MD Save which is a one stop shopping experience for colonoscopies and surgeries. Find what you are having done and compare cash prices to include everything from the facility, anesthesia, pathology, and the doctor performing the procedure.

Be sure to research each of these options in advance of scheduling a colonoscopy. While you may be in some pain depending on your condition, it’s important to do as much as you can to make sure you aren’t being overcharged for a procedure.

The Importance of Preventive Care: Weighing Colonoscopy Costs Against Long-Term Health Benefits

Prioritizing preventive care, particularly through routine colonoscopies, is a vital aspect of maintaining long-term health. While the costs associated with a colonoscopy may raise concerns, it is crucial to consider the significant health benefits that come with early detection and prevention of colorectal issues. Colonoscopies play an important role in identifying precancerous polyps and tumors, allowing for their removal before they develop into more serious conditions.

By weighing the upfront expenses against the potential long-term health benefits, you can make an informed decision. Investing in preventive care not only safeguards against the risk of colorectal cancer but also promotes a healthier and more sustainable future. A colonoscopy, when normal, usually needs to be done again in 10 years. If polyps are found it could be 3 or 5 years. The procedure is life saving. If the cost is around $2,500 to $4,000 for everything, divide this by 36 months, 60 months or 120 months and the cost is much less than it seems. More importantly, you are worth your health and if colon cancer develops due to a lack of a colonoscopy, the cost to remove a colon cancer along with the possible need for chemotherapy and the severe negative effects on your life is much more than the cost of a colonoscopy.