[seanmcdirmid]

American health insurance really screws the pooch here. If you go for a colonoscopy without a previous fecal testing, it is a diagnostic procedure that is fully covered by your insurance without triggering deductible and copay. However, if you go for fecal testing first and then they find something suspicious that warrants a colonoscopy, it is no linger considered diagnostic (you have a legitimate problem now) and deductible/copays apply.

So in practice, doctors will tell you to just get the colonoscopy to save (your own) money.

[astura]

You're not really wrong, but you're using the wrong terms which is extremely confusing.

https://www.cancer.org/cancer/colon-rectal-cancer/detection-...

For asymptomatic people without abnormal stool, colon cancer tests are called "screening," never "diagnostic." "Screening" is covered without cost sharing. Colonoscopy, fecal tests, etc.

>But if you have a screening test other than colonoscopy and the result is positive (abnormal), you will need to have a colonoscopy. Some insurers consider this to be a diagnostic (not screening) colonoscopy, so you may have to pay the usual deductible and co-pay.

[seanmcdirmid]

Thanks for the clarification. I didn’t really know the difference in the terms being thrown around, just the oddness in the billing.

[gregw2]

You are complaining about the rare situation where someone gets fecal scanning first (and I agree this leads to perverse incentives)... But here's what the real racket is... American healthcare considers the colonoscopy preventative so the exam is covered... but if they see even a single polyp and decide to cut it off to get checked whether it is benign or not, that is not preventative but is diagnostic and thus is not covered and costs you $$$ in copays.

[astura]

They aren't supposed to do this - See the link I posted on a sibling comment

https://www.cancer.org/cancer/colon-rectal-cancer/detection-...

>Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a ‘screening’ test if a polyp was removed during the procedure. It would then be a ‘diagnostic’ test, and would therefore be subject to co-pays and deductibles. However, the US Department of Health and Human Services has clarified that removal of a polyp is an integral part of a screening colonoscopy, and therefore patients with private insurance should not have to pay out-of-pocket for it (although this does not apply to Medicare, as discussed below).

[cmurf]

That's what my provider told me too. However:

https://www.npr.org/sections/health-shots/2022/05/31/1101861...

[seanmcdirmid]

Huh. I didn’t see that in my exam. They did a biopsy on one polyp, but I wasn’t charged for it.

[hef19898]

Hope results were of the non-worrisome kind!

[seanmcdirmid]

Nah, it all sounded really standard. I think 45 is a bit too young for the test, but it wasn't a bad experience at all besides getting completely hammered by the laxative. Next time I'll ask for anti-nausea medication.