What You Need to Know About Colonoscopies & Your Insurance

Thursday, 26 August 2021


Perhaps you’ve reached a certain age and your doctor is urging you to start getting that dreaded, but necessary, preventative colonoscopy! But before you schedule your appointment, you may be wondering how the insurance company processes this type of claim. You’ve heard that it’s covered at 100%, but is that the whole truth?

The answer is YES! If you are over the age of 50 and are required to get your preventative colonoscopy, with any major medical plan, this procedure is going to be covered at 100% regardless of your deductible, within limitation (once every 10 years).

But, there are a few things that can happen to cause a surprise out of pocket bill, so here’s what needs to happen for your colonoscopy to be covered at 100%:

  1. You must go to an in-network doctor/facility
  2. The procedure must be coded as preventative
  3. The doctor cannot find anything during the procedure that needs submitted for further testing

With a colonoscopy, if you are having any symptoms or pre-existing conditions prior to the procedure, the doctor may code the procedure as diagnostic. When something is coded as diagnostic, the insurance company will not pay at 100% and will be subject to your deductible.

We know that colonoscopies can be a tricky procedure when it comes to your insurance, so give Clevenger Insurance a call today at 574-267-2181 for any questions you may have!

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