As per the provision, new insurance policies are compelled to cover colonoscopies, mammograms, blood pressure screenings, HIV tests etc aimed at early detection of health problems, with no co-pays or deductibles. Doctors say that this provision which makes it easier to get care, may lead to a roadblock because some patients are billed when certain preventive procedures reveal growths that could become cancer.
Since September 2010, the procedure has been covered by federal health care reform for men and women aged 50 years and above, although many older insurance policies are exempt from the new provision.
When a polyp is removed during a colonoscopy, the procedure is often defined as diagnostic and not preventive. That means Medicare and many private insurers charge patients for fees which range from a nominal fee to $3,000, depending on policy terms and facility fees for surgery centers.
If patients show symptoms of cancer or are going through a colonoscopy as a follow-up to an earlier diagnosis, insurance companies may charge for screenings. But colonoscopies are considered to be preventive care by many insurers and are covered regardless of whether polyps are present.