Impatient | Helping make the health care system work for you
Health

#PriceCheck: Some under 50 should get a colonoscopy



Christopher Furlong/Getty Images

The colonoscopy is getting its 15 minutes of fame here on Impatient!

As I shared recently, KPCC - with our friends at KQED and clearhealthcosts.com - has re-launched PriceCheck. Through this project, we're crowdsourcing the costs of certain medical procedures. Right now, we're focusing on colonoscopies.

'Free' colonoscopies?

Screening colonoscopies are considered preventive care under the Affordable Care Act, and therefore should be fully covered by insurance. But as I explained last week, there are several reasons your colonoscopy might not come free of charge.

One reason: You might be on the hook for part of your colonoscopy if you don't meet the age requirements, according to Dr. Jeffrey Rice, founder and CEO of Healthcare Bluebook. The U.S. Preventive Services Task Force generally recommends screening colonoscopies for people age 50 and up.

But people with a family history of colorectal cancer should also be eligible for fully covered screening colonoscopies - even if they're under 50, says Jasmine Greenamyer, chief operating officer of the Colon Cancer Alliance.

Cost 'is discouraging people'

The Centers for Disease Control and Prevention says that for people with a first-degree relative with colorectal cancer, screening procedures including colonoscopies should either begin at age 40, or 10 years before the age the youngest relative was diagnosed with colorectal cancer.

But a CDC study out this month says just 38 percent of people age 40 to 49 with a first-degree relative with colorectal cancer got a colonoscopy in 2010. That's a problem, since rates of colorectal cancer are increasing among people ages 20 to 49, even as they're decreasing for people over 50, Rob Stein reported for NPR last year, based on this report in JAMA Surgery.

Could cost be a deterrent to getting a preventive colonoscopy? Greenamyer says yes.

There's a big difference in cost between free, preventive colonoscopies and procedures that are considered diagnostic. Greenamyer says people worry that a medical facility could improperly classify their procedure as a diagnostic test rather than a screening one, resulting in an unexpectedly large bill.

"There are already fears around a highly invasive test and then you add these layers to it - we definitely know it's discouraging people," Greenamyer says.

And from what she's heard, she says those fears are grounded in some truth.

Even though people with a family history of colorectal cancer should get screening colonoscopies at no cost, she says, "It's really kind of tragic how many people come forward saying they had to really fight their doctor or insurance company to get this covered," Greenaymer says.

Talk with your doctor

Mary Doroshenk, director of the National Colorectal Cancer Roundtable, offers this advice for people under 50 who are considered at-risk for colorectal cancer: Talk with your doctor about your family history of colorectal cancer and the screening guidelines before you undergo a colonoscopy.

"It's very important that they have that talk with their doctor," she says, "because the doctor's going to determine whether or not it's coded as a screening colonoscopy, which should be free of cost-sharing, or a diagnostic colonoscopy, in which the cost-sharing is going to apply."

Have you had a colonoscopy recently? Share your experience with #PriceCheck. If you're under 50 and have undergone a colonoscopy due to your family history of colorectal cancer, share your costs - and shoot me an e-mail about your experience. You can reach me at Impatient@scpr.org.