Feds Say That In Screening Colonoscopies, Anesthesia Comes With No Charge
Earlier this week the federal government clarified that administered during a free colonoscopy to screen for colorectal cancer. That鈥檚 good news for consumers, some of whom have been charged hundreds of dollars for anesthesia after undergoing what they thought would be a free test. But聽the government guidance leaves important questions unanswered.
Under the health law, most health plans have to provide聽care that鈥檚 recommended by the U.S. Preventive Services Task Force without charging members anything out of pocket. The only exception is for plans that have grandfathered status under the law.
That task force,聽a nonpartisan group of medical experts, people periodically receive either a colonoscopy, sigmoidoscopy or fecal occult blood test to screen for colorectal cancer.
Most people are anesthetized during a colonoscopy, in which a flexible tube with a camera at the end is inserted into the rectum and snaked through the large intestine to look for polyps and other abnormalities.
Although the health law made it clear that the colonoscopy itself must be free for patients, it didn鈥檛 spell out how anesthesia or other charges should be handled.
That lack of clarity allowed insurers to argue聽at first that if polyps were identified and removed during the colonoscopy, the procedure was no longer a screening聽test and patients could be billed. that聽patients couldn鈥檛 be charged for polyps removed during a screening colonoscopy because it was an integral part of the procedure.
With this week鈥檚 guidance, the government has made it clear that consumers don鈥檛 have to pick up the tab for anesthesia during a colonoscopy either.
But other questions remain. related to a screening colonoscopy, according to an email from Anna Howard, a policy principal at the American Cancer Society Cancer Action Network, and Mary Doroshenk, director of the National Colorectal Cancer Roundtable.
In addition, cost sharing rules are聽unclear for consumers who get a positive result on a blood stool test and need to follow up with a colonoscopy. The federal government hasn鈥檛 clarified whether that procedure is considered part of the free screening process or whether insurers can charge for it as a diagnostic procedure, Howard and Doroshenk say.
In a , researchers found that four insurers imposed patient cost sharing for colonoscopies after a positive blood stool test and three did not.
As for consumers who paid for anesthesia and now learn that they shouldn鈥檛 have been charged, it鈥檚 unclear if they can get their money back.
鈥淥ur expectation is that those who have received a bill for anesthesia this plan year may be able to appeal, but not for previous years,鈥 Howard and Doroshenk said.
The Department of Health and Human Services didn鈥檛 respond to a request for clarification.
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