Health Reform, Preventive Screenings, Insurance and my Colonoscopy

Well this year I hit that milestone, 50, and with it came a full list of screenings and preventive services I needed to complete.  The Prevention Plan provided me with a comprehensive list of  preventive services and screenings as recommended by the various US agencies including the U.S. Preventive Services Task Force based upon my age, gender and risk factors. During the last 8 months I’ve been working through the list . Of course at 50 comes the dreaded colonoscopy to check for colon cancer, a very good but underutilized screening. It took me some time and I finally got around to scheduling my test, but before I scheduled it, my wife asked me to verify and determine what my insurer would cover.  What I found was most interesting.

The customer service rep looked up my coverage and explained that the Preventive screening for a colonoscopy is covered at 100%, but and this is a big one, if the doctor decides to do a biopsy or has to remove a polyp or anything else, the coverage reverts to an outpatient procedure subject to a $1,500 deductible and 20% co-pay. Now that makes about as much sense as, well let’s not go there.  Anyway, how about a comparison to my car, I have often had work done on an older car and they say, “while we have the engine opened up, let’s change the timing belt” or some other item as it won’t cost you as much to get that done, since we are already in there.  So how come the insurer doesn’t look at this procedure that way.  Wouldn’t it be better for all if we were incented to get the results of something suspicious?

Of course after explaining this to my wife, who is a registered nurse by the way, she said “make sure you talk with the doctor before the procedure so he just doesn’t willy nilly decide to biopsy something that’s not clear.”  Well how’s that for Prevention!

Whether you agree or disagree with the overall health reform bill, many of the prevention components are positive, including that insurers cover some preventive screenings like a colonoscopy at 100%.  Hmmm, I see some possible loopholes forming now.

About Fred Goldstein

President and Founder of Accountable Health, LLC. My background includes over 25 years of health care experience in hospital administration, health plan management, disease management and population health.
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4 Responses to Health Reform, Preventive Screenings, Insurance and my Colonoscopy

  1. Rango says:

    This is wonderful blog. I love it.

  2. Minecraft says:

    It’s interesting to see this point of view. I can’t say fore sure if I agree or not, but it is something I will think about now.

  3. Ronnie Barker says:

    Isn’t that the most stupid thing you ever heard of that is the whole point of a colonoscopy is to find something and get rid of it. I have ulcerative colitis and have to get one of these things every two years and of course they usually do a biopsy so now I have to come up with all that money. Who can afford to do this every two years. This is a expensive procedure but what would the insurance company rather pay for the colonoscopy or the chemotherapy someone has to have after they have full blown cancer because they could not afford a colonoscopy.

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